Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
Pediatr Infect Dis J. 2011 Sep;30(9):740-4. doi: 10.1097/INF.0b013e31821b10c3.
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.
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.
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.
Serotype 19A was strongly associated with BPF. Vaccines containing this serotype will be important for prevention.
严重的肺炎链球菌坏死性肺炎可能发展为支气管胸膜瘘（BPF）。本研究的目的是描述儿童肺炎链球菌肺炎发展为支气管胸膜瘘的临床过程，并确定其发生的危险因素。分析因 BPF 而行肺切除术患儿的组织病理学特征，以探讨肺炎链球菌引起破坏性肺部疾病的发病机制。
回顾性分析 2001 年 1 月至 2010 年 3 月期间长庚儿童医院确诊的 112 例培养阳性的肺炎链球菌肺炎患儿的病历资料。
18 例（18/112，16.1%）患儿并发 BPF。与无 BPF 的患儿相比，并发 BPF 的患儿入院时的白细胞计数明显较低（P=0.03），发热和住院时间明显较长（P<0.001）。多变量分析显示，急性呼吸衰竭（比值比=8.9；95%置信区间=2.6-30.9；P=0.001）和血清型 19A 感染（比值比=5.0；95%置信区间=1.2-22.1；P=0.03）是发生 BPF 的危险因素。对 12 例行肺切除术的患儿进行了组织病理学分析。12 例中有 11 例可见凝固性坏死伴肺梗死。
血清型 19A 与 BPF 密切相关。含有该血清型的疫苗对于预防该病将非常重要。
