RESUMO
We report a rare case of Fusobacterium nucleatum necrotizing pneumonia following an influenza viral infection. This rare bacterial lung infection can have severe complications such as respiratory failure and septic shock, so early recognition and treatment are necessary.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Fusobacterium/complicações , Fusobacterium nucleatum/efeitos dos fármacos , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Necrosante/etiologia , Feminino , Infecções por Fusobacterium/microbiologia , Infecções por Fusobacterium/fisiopatologia , Humanos , Influenza Humana/fisiopatologia , Pessoa de Meia-Idade , Pneumonia Necrosante/fisiopatologia , Resultado do TratamentoRESUMO
We report a case of disseminated infection by Rhodococcus equi as the inaugural manifestation of idiopathic T-CD4+ lymphopenia. We aim to demonstrate our diagnostic and therapeutic approach and focus on the major dilemmas arising from the lack of scientific evidence regarding best clinical practice of this infection in humans.
Assuntos
Infecções por Actinomycetales/microbiologia , Linfopenia/diagnóstico , Pneumonia Necrosante/diagnóstico , Rhodococcus equi/isolamento & purificação , Infecções por Actinomycetales/complicações , Infecções por Actinomycetales/diagnóstico , Infecções por Actinomycetales/patologia , Administração Intravenosa , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Biópsia por Agulha/métodos , Lavagem Broncoalveolar/métodos , Broncoscopia/métodos , Linfócitos T CD4-Positivos , Tosse/diagnóstico , Tosse/etiologia , Quimioterapia Combinada , Serviço Hospitalar de Emergência , Febre/diagnóstico , Febre/etiologia , Humanos , Levofloxacino/administração & dosagem , Levofloxacino/uso terapêutico , Linfopenia/etiologia , Masculino , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Necrosante/etiologia , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
It may be necessary a consideration about the best approach to the acute concomitant problems that critical COVID-19 patients can develop. They require a rapid diagnosis and an early treatment by a multidisciplinary team. As a result, we would like to describe two clinical cases a patient with diagnosis of COVID-19 pneumonia with good respiratory evolution that, after extubation suffered an acalculous cholecystitis and a patient with COVID-19 pneumonia that suffered an overinfection with necrotising pneumonia that presented with haemoptysis and was finally treated with arterial embolisation by the interventional radiologist's team.
Assuntos
COVID-19/complicações , Colecistite/etiologia , Pneumonia Necrosante/etiologia , Idoso , Estado Terminal , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
No disponible
Assuntos
Humanos , Traqueíte/etiologia , Bronquite/etiologia , Pneumonia Necrosante/etiologia , Intubação Intratraqueal/efeitos adversos , Infecções por Coronavirus/complicações , Síndrome Respiratória Aguda Grave/complicações , Obstrução das Vias Respiratórias/epidemiologia , Traqueíte/epidemiologia , Bronquite/epidemiologia , Pneumonia Necrosante/epidemiologia , Fatores de Risco , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/patogenicidade , Infecções por Coronavirus/transmissão , Respiração Artificial/efeitos adversosRESUMO
BACKGROUND: The incidence of necrotizing pneumonia (NP) caused by Mycoplasma pneumoniae (MP) is increasing. We analyzed the clinical characteristics and the risk factors for NP caused by MP. METHODS: A retrospective observational study was conducted in 37 patients with NP caused by MP (NP group) and 74 patients diagnosed with lobar M. pneumoniae pneumonia with no necrosis (control group) who were admitted to our hospital between January 2013 and December 2017. The clinical manifestations, laboratory data, imaging findings, treatments and outcomes were analyzed. RESULTS: The proportion of females, the incidence of pleural effusion, fever duration, hospitalization days, white blood cell count, neutrophil ratio, D-dimer level and use of other types of antibiotics were higher in the NP group than in the control group (P < 0.05). The control group exhibited a greater use of low molecular weight heparin (LMWH) than the NP group (P < 0.05). According to the multivariate logistic regression analysis, a white blood cell count > 12.3 × 109/L (Odds ratio, OR = 6.412), a neutrophil ratio > 73.9% (OR = 6.081) and D-dimer level > 1367.5 ng/mL (OR = 8.501) were risk factors for pulmonary necrosis caused by MP. Furthermore, the use of LMWH (OR = 0.074) reduced the risk of pulmonary necrosis. CONCLUSIONS: NP is a rare complication of severe Mycoplasma pneumoniae pneumonia (SMPP), and although the clinical course is longer than common MP infection, the necrotic area is absorbed gradually. In patients with SMPP presenting with lobar consolidation, a white blood cell count > 12.3 × 109/L, a neutrophil ratio > 73.9% and D-dimer level > 1367.5 ng/mL are risk factors for pulmonary necrosis, and the use of LMWH reduces the risk of pulmonary necrosis.
Assuntos
Pneumonia por Mycoplasma/complicações , Pneumonia Necrosante/etiologia , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Contagem de Leucócitos , Masculino , Mycoplasma pneumoniae/patogenicidade , Derrame Pleural/tratamento farmacológico , Derrame Pleural/etiologia , Pneumonia por Mycoplasma/etiologia , Pneumonia Necrosante/tratamento farmacológico , Estudos Retrospectivos , Fatores de RiscoRESUMO
An adolescent girl with a history of frequent electronic cigarette use of nicotine was hospitalized with severe necrotizing pneumonia. Blood cultures obtained before the administration of empirical broad-spectrum intravenous antibiotics had positive results for the growth of Fusobacterium necrophorum The pathogen is an uncommon but well-known cause of anaerobic pneumonia with unique features that are collectively referred to as Lemierre syndrome or postanginal sepsis. The syndrome begins as a pharyngeal infection. Untreated, the infection progresses to involve the ipsilateral internal jugular vein, resulting in septic thrombophlebitis with direct spread from the neck to the lungs causing multifocal necrotizing pneumonia. The teenager we present in this report had neither a preceding pharyngeal infection nor Doppler ultrasonographic evidence for the presence of deep neck vein thrombi, leading us to explore alternative mechanisms for her pneumonia. We propose the possibility that her behavior of frequent vaping led to sufficient pharyngeal irritation such that F necrophorum colonizing her oropharynx was inhaled directly into her lungs during electronic cigarette use. Preexisting, but not yet recognized, vaping-related lung injury may have also contributed to her risk of developing the infection. The patient was hospitalized for 10 days. At follow-up one month later, she still became short of breath with minimal exertion.
Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Infecções por Fusobacterium/complicações , Fusobacterium necrophorum/isolamento & purificação , Pneumonia Necrosante/etiologia , Vaping/efeitos adversos , Adolescente , Feminino , Infecções por Fusobacterium/diagnóstico , Humanos , Pneumonia Necrosante/diagnóstico por imagem , Pneumonia Necrosante/microbiologiaRESUMO
Nocardiosis is a rare opportunistic infection caused by the bacteria Nocardia spp. It may present as a localized cutaneous infection or as an invasive infection (pulmonary, central nervous system or disseminated). The authors describe a 65-years-old woman, without a known cause of immunosuppression, admitted with fever, respiratory and constitutional symptoms. After an exhaustive etiological study, it was diagnosed a disseminated nocardiosis (pulmonary and central nervous system), in a probable context of immunosuppression secondary to a previously undiagnosed systemic lupus erythematosus. Nocardiosis is a serious infection with a variable and non-specific presentation making its diagnosis a challenge
No disponible
Assuntos
Humanos , Feminino , Idoso , Nocardiose/etiologia , Lúpus Eritematoso Cutâneo/complicações , Pneumonia Necrosante/etiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/etiologia , Terapia de Imunossupressão/efeitos adversos , Nocardiose/diagnóstico por imagem , Pneumonia Necrosante/diagnóstico , Tomógrafos Computadorizados , Biópsia com Agulha de Grande Calibre , Ultrassonografia , Evolução FatalRESUMO
Necrotising pneumonia or lung gangrene is a challenging problem and it is diagnosed more often today, especially in tertiary hospitals. It is always a challenge to treat these patients as they are usually immunocompromised and are often ill when the diagnosis is made. We report three immunocompromised patients with necrotising pneumonia who were treated surgically. We share the outcomes of these patients and discuss the management of necrotising pneumonia in the immunocompromised.
Assuntos
Hospedeiro Imunocomprometido , Pneumonia Necrosante/cirurgia , Feminino , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pneumonia Necrosante/etiologia , Esplenectomia/efeitos adversos , Adulto JovemRESUMO
We describe the case of a 35-year-old man who presented in respiratory failure after influenza B infection requiring initiation of venovenous extracorporeal membrane oxygenation and eventual pulmonary resection for necrotizing pneumonia. Following a successful wean off venovenous extracorporeal membrane oxygenation, and once hemodynamically stable, he was taken to the operating room for decortication and left pulmonary resection. Recovery was complicated by persistent airleak requiring placement of endobronchial valves, but otherwise he recovered very well. This case demonstrates the benefits of lung resection for necrotizing pneumonia.
Assuntos
Oxigenação por Membrana Extracorpórea , Influenza Humana/complicações , Pulmão/cirurgia , Pneumonia Necrosante/terapia , Insuficiência Respiratória/terapia , Adulto , Humanos , Vírus da Influenza B , Influenza Humana/virologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pneumonectomia , Pneumonia Necrosante/etiologia , Pneumonia Necrosante/cirurgia , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Insuficiência Respiratória/etiologia , Tomografia Computadorizada por Raios XAssuntos
Humanos , Feminino , Lactente , Pneumonia Necrosante/diagnóstico , Pneumonia Necrosante/etiologia , Pneumonia Necrosante/diagnóstico por imagem , Infecção Hospitalar , Diagnóstico Diferencial , Pneumonia Necrosante/tratamento farmacológico , Mycobacterium tuberculosis/isolamento & purificaçãoRESUMO
A 61-year-old male presented with community-onset pneumonia not responding to treatment despite given appropriate antibiotics. Computed tomography scan of the thorax showed large multiloculated pleural effusion with multiple cavitating foci within collapsed segments; lesions which were suggestive of necrotising pneumonia. Drainage of the effusion and culture revealed methicillin-resistant Staphylococcus aureus, which had the same antibiotic profile with the blood isolate and PVL gene positive.