Department of Pediatric Surgery, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan.
Department of Pediatrics, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan.
BMC Pediatr. 2023 Apr 13;23(1):170. doi: 10.1186/s12887-023-03999-y.
Necrotizing pneumonia is rare in children and is one of the most serious complications of a lung infection caused by antibiotic failure. We present a 12-year-old leukopenic child with a long-lasting lung infection, presenting as having a lung hydatid cyst, but diagnosing with necrotizing pneumonia in the right bilobed lung. Failure to medical treatment and ongoing leukopenia justified surgical intervention with positive results.
The patient was referred to our teaching hospital's pediatric surgery department. He had previously been diagnosed with intestinal tuberculosis (TB) and received anti-TB treatment. On referral to our hospital, the patient was suffering from restlessness, frequent coughing, fever, vomiting, and diarrhea. Following the completion of the clinical work-up, a blood test revealed leukopenia (white blood cell count of 2100/microliter), a normal platelet count, and a lesion in the right lung. Computerized tomography scanning (CT-Scan) image reported a lung hydatid cyst. In the pediatrics ward, a broad-spectrum antibiotics regimen with triple-antibiotic therapy (linezolid, vancomycin, and metronidazole) was instituted and continued for a week with no response, but worsening of the condition. In the pediatric surgery ward, our decision for surgical intervention was due to the failure of medical treatment because of a pulmonary lesion. Our team performed right lung upper lobe anterior segment wedge resection due to necrotizing pneumonia and followed the patient 45 days post-operation with a reasonable result.
Living in remote rural areas with low resources and inaccessibility to proper and specialized diagnostic and treatment centers will all contribute to an improper diagnosis and treatment of lung infection. In total, all of these will increase the morbidity and mortality due to lung necrosis in the pediatric population, regardless of their age. In low-resource facilities, high-risk patients can benefit from surgical intervention to control the ongoing infection process.
儿童患坏死性肺炎较为罕见，是抗生素治疗失败导致肺部感染的最严重并发症之一。我们报告了一例 12 岁白细胞减少症患儿，该患儿患有持续性肺部感染，表现为肺包虫囊肿，但在右双叶肺中诊断为坏死性肺炎。由于治疗无效且持续白细胞减少，因此进行了手术干预，结果为阳性。
患者被转至我们教学医院的小儿外科部门。他先前被诊断患有肠结核（TB）并接受了抗 TB 治疗。转至我院时，患者出现烦躁不安、频繁咳嗽、发热、呕吐和腹泻。完成临床检查后，血液检查显示白细胞减少症（白细胞计数 2100/微升）、血小板计数正常，以及右肺病变。计算机断层扫描（CT 扫描）图像报告肺包虫囊肿。在儿科病房，给予广谱抗生素治疗，采用三联抗生素治疗（利奈唑胺、万古霉素和甲硝唑），并持续治疗了一周，但未见好转，病情反而恶化。在小儿外科病房，由于肺部病变，我们决定进行手术干预。由于治疗无效，我们的团队进行了右肺上叶前段楔形切除术，用于治疗坏死性肺炎，并在术后 45 天对患者进行了随访，结果较为理想。
生活在资源匮乏、难以获得适当和专业的诊断和治疗中心的偏远农村地区，都会导致肺部感染的诊断和治疗不当。总的来说，所有这些都会增加儿科人群因肺坏死而导致的发病率和死亡率，而与年龄无关。在资源匮乏的医疗机构中，高危患者可以从手术干预中获益，以控制持续的感染过程。
