Etiology and clinical characteristics of necrotizing pneumonia in children

• Evgeniya M. Tolstova
• Marina V. Besedina
• Maria A. Elkina
• Olga V. Zaytseva
• Svetlana B. Yatsyshina
• Nadezhda S. Zaitseva
• Sofia. R. Kuzina
• Dmitry V. Khaspekov
• Ilya V. Turishchev
• Tatiana Yu. Belyaeva

Abstract

Necrotizing pneumonia is a type of the complicated course of out-of-hospital pneumonia characterized by the formation of necrotic cavities in lungs. The incidence of this disease in children remains high, and etiologic diagnosis is often difficult.

The aim of the study was to analyze the clinical and laboratory characteristics and etiology of necrotizing pneumonia in children.

Material and methods. The study included 20 children aged from 1 to 12 years with a confirmed diagnosis of necrotizing pneumonia, complicated by destruction of lung tissue. The study was conducted between November 2021 and March 2023. Bronchoalveolar lavage fluid and pleural cavity contents were analyzed using real-time polymerase chain reaction. Statistical processing of the results included calculation of the extensive indicator, χ² criterion, Fisher’s exact test. Differences were considered statistically significant at p<0.05.

Results. Necrotizing changes were localized in the lower lobe of the left lung in 9 (45%) cases, in the upper lobe of the right lung in 5 (25%) cases, in the lower lobe of the right lung – in 6 (30%) cases. Pleurisy and fibrinothorax were diagnosed in 16 (80%) children. The main pathogens were: Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes. Combined bacterial or bacterial-viral infection was detected in 4 (20%) cases. In 2 (10%) children viral etiology of pneumonia was determined.

Conclusion. The results obtained reflect the etiology of necrotizing pneumonia in the selected cohort of children. The most informative diagnostic method for etiologic verification was the simultaneous study of bronchoalveolar lavage material and pleural fluid using the real-time polymerase chain reaction method.

Keywords:community-acquired pneumonia; pulmonary tissue destruction; necrotizing pneumonia; Streptococcus pneumoniae; Streptococcus pyogenes

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