Hsieh Yu-Chia, Hsiao Cheng-Hsiang, Tsao Po-Nien, Wang Jann-Yuan, Hsueh Po-Ren, Chiang Bor-Luen, Lee Wen-Sen, Huang Li-Min
Section of Infection, Department of Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Pediatr Pulmonol. 2006 Jul;41(7):623-9. doi: 10.1002/ppul.20411.
Little is known about the mechanism of necrotizing pneumonia caused by Streptococcus pneumoniae in children. Pulmonary gangrene secondary to vascular thrombosis was reported in adults with necrotizing pneumococcal pneumonia. We conducted a retrospective study of 15 children with a diagnosis of necrotizing pneumococcal pneumonia at National Taiwan University Hospital to explore its association with pulmonary gangrene, based on evidence from chest computed tomography, serial chest radiographic patterns, and pathologic results. S. pneumoniae serotype 14 was the prevalent pneumococcal serotype. Overall, 63.6% of isolates were not susceptible to penicillin. One child with pneumonia caused by S. pneumoniae serotype 3 complicated by hemolytic uremic syndrome had a rapidly fatal course. An autopsy in this patient documented lung necrosis and pulmonary gangrene. Radiographic follow-up was performed during the clinical course in 9 patients, and showed no evidence of pulmonary gangrene. Four children had no radiographic follow-up. The relationship between pulmonary gangrene and necrotizing pneumonia was unclear in the remaining one. In conclusion, necrotizing pneumococcal pneumonia may be infrequently associated with pulmonary gangrene in children.
关于儿童肺炎链球菌所致坏死性肺炎的发病机制，目前所知甚少。在成人坏死性肺炎球菌肺炎患者中，曾有血管血栓形成继发肺坏疽的报道。我们在台湾大学医院对15例诊断为坏死性肺炎球菌肺炎的儿童进行了一项回顾性研究，根据胸部计算机断层扫描、系列胸部X线片表现及病理结果，探讨其与肺坏疽的相关性。肺炎链球菌14型是主要的肺炎球菌血清型。总体而言，63.6%的分离菌株对青霉素不敏感。1例由肺炎链球菌3型引起的肺炎并发溶血尿毒综合征的患儿病程进展迅速，最终死亡。该患者的尸检显示有肺坏死和肺坏疽。9例患者在临床病程中进行了影像学随访，未发现肺坏疽的证据。4例患儿未进行影像学随访。其余1例患儿中，肺坏疽与坏死性肺炎之间的关系尚不清楚。总之，儿童坏死性肺炎球菌肺炎可能很少与肺坏疽相关。
