Necrotizing pneumococcal pneumonia with bronchopleural fistula among children in Taiwan

Yu Chia Hsieh, Chih Wei Wang, Shen Hao Lai, Jin Yao Lai, Kin Sun Wong, Yhu Chering Huang, Kuang Yi Chang, Cheng Hsun Chiu, Tzou Yien Lin

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Severe necrotizing pneumococcal pneumonia may progress to the development of bronchopleural fistula (BPF). The purpose of this study was to describe the clinical courses and identify risk factors for the development of bronchopleural fistula in children with pneumococcal pneumonia. Histopathologic features of children receiving surgical resections of the lung because of BPF were analyzed to explore the pathogenesis of destructive lung disease caused by Streptococcus pneumoniae. Methods: A total of 112 cases of culture-proven pneumococcal pneumonia were identified between January 2001 and March 2010 at Chang Gung Children's Hospital. The medical charts of all cases of culture-proven pneumococcal pneumonia were reviewed. Results: Pneumococcal pneumonia in 18 children (18/112, 16.1%) was complicated by BPF. As compared with children without BPF, children with BPF had significantly lower white blood cell counts at admission (P = 0.03) and significantly longer durations of fever and hospitalization (P < 0.001). Multivariate analysis revealed that acute respiratory failure (odds ratio = 8.9; 95% confidence interval = 2.6-30.9; P = 0.001) and serotype 19A infection (odds ratio = 5.0; 95% confidence interval = 1.2-22.1; P = 0.03) were risk factors for the development of BPF. Histopathologic analyses were available for 12 children who underwent surgical resections of the lung. Coagulative necrosis with pulmonary infarction was found in 11 of the 12 cases. Conclusions: Serotype 19A was strongly associated with BPF. Vaccines containing this serotype will be important for prevention.

Original languageEnglish
Pages (from-to)740-744
Number of pages5
JournalPediatric Infectious Disease Journal
Volume30
Issue number9
DOIs
Publication statusPublished - Sep 2011
Externally publishedYes

Keywords

  • bronchopleural fistula
  • Pneumococcal pneumonia
  • pulmonary infarction
  • serotype 19A

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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