RESUMO
Necrotizing pneumonia, massive necrosis of lung tissue, is a serious, often fatal, complication of lobar pneumonia. Four children 1.3 to 7.5 yr of age were hospitalized with bacteremic pneumococcal pneumonia. All of them were acutely ill on presentation with arterial desaturation, and they developed anemia and thrombocytosis. Two patients had pleural effusion requiring drainage. A chest CT scan revealed segmental or lobar pulmonary liquification, which led to the diagnosis of necrotizing pneumonia. This finding could be demonstrated early in the course of the disease. Subsequently, all of the patients developed cavitating lesions. With adequate antipneumococcal therapy and/or chest tube drainage, all of the patients recovered completely; however, clinical improvement was prolonged: fever lasted 9 to 20 days, and length of hospitalization was 12 to 26 days. Contrary to that in adults, complete recovery is anticipated in children with bacteremic necrotizing pneumococcal pneumonia, and no invasive investigations are required.
Assuntos
Bacteriemia/complicações , Infecções Pneumocócicas/complicações , Pneumonia Pneumocócica/complicações , Streptococcus pneumoniae , Antibacterianos/uso terapêutico , Bacteriemia/sangue , Bacteriemia/diagnóstico , Bacteriemia/terapia , Tubos Torácicos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Necrose , Infecções Pneumocócicas/sangue , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/terapia , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/patologia , Pneumonia Pneumocócica/terapia , Tomografia Computadorizada por Raios XRESUMO
A study on septicemia in the elderly (mean age 80.3 +/- 9.1 years) was carried out during 1982-85. A total of 184 episodes of bacteremia occurred in 175 patients (incidence rate 7.2%); 61% were attributed to community-acquired sepsis. Gram-negative microorganisms accounted for 64% of all episodes and gram-positive for 30%. The overall mortality was 18.3%. Using univariate analysis, significant factors associated with a high mortality were: hospital-acquired sepsis, respiratory infections as source of the sepsis, severe underlying disease, Klebsiella and Proteus as pathogens, comatose state, hypothermia, thrombocytopenia, and serum sodium abnormalities. Using logistic regression analysis the odds ratio for hospital-acquired septicemia and hypothermia were positive and statistically significant, whereas soft tissue and urinary tract infections as sources were negative and significant. The relative low mortality in our study confirms that age alone is not necessarily a poor prognostic indicator of septicemia in the elderly.
