Severe staphylococcal pneumonia in children
Severe staphylococcal pneumonia in children
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DOI：
10.1016/s0929-693x(01)80190-1
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发表时间：
2001-09-01
影响因子：
1.8
通讯作者：
Floret, D
中科院分区：
文献类型：
--
作者：
Gillet, Y;Issartel, B;Floret, D
1986~1999年间，8例金黄色葡萄球菌产生Panton和瓦伦丁无色毒素(PVL)的重症肺炎被转至法国葡萄球菌毒素血症参考中心。除了一名儿童外，其余患者都是儿童，为了确定这些肺炎的临床特征，我们在1999年进行了前瞻性监测。金黄色葡萄球菌性肺炎按一般标准定义。对所有病例进行PVL基因检测，以PVL阳性病例为研究组。排除医院获得性肺炎。参考文献52例，PVL阳性16例。这些肺炎发生在以前健康的较年轻患者(中位年龄分别为14.8岁和70.1岁)(对照组中基础疾病的40%)。显著特征是前一天有病毒感染(75%比9%)、休克(81%比53%)、呼吸窘迫(75%比53%)和咯血(38%比3%)。79%的病例出现白细胞减少症。PVL组的死亡率较高(75%比47%)。严重葡萄球菌性肺炎伴有休克、白细胞减少、咯血和高死亡率，以前曾在儿童和年轻人中描述过。我们建立了该综合征与金黄色葡萄球菌产生PVL之间的关系。我们认为，病毒感染构成了改变呼吸道上皮细胞的先决条件，继而允许金黄色葡萄球菌入侵。PVL的坏死性作用导致大量出血性坏死性肺炎。葡萄球菌坏死性肺炎是一种新的疾病，其发生频率可能被低估了。需要进一步的研究来确定预后因素、金黄色葡萄球菌携带和病毒感染的作用。对这一新综合征的描述可能会导致儿童葡萄球菌性肺炎的治疗发生变化。(C)2001年版《爱思唯尔科学与医学》。
Between 1986 and 1999, 8 cases of severe pneumonia due Staphylococcus aureus strains producing the Panton and Valentine leucotoxin (PVL) were referred to the French reference centre for staphylococcal toxaemia. All but one patient were children and to determine the clinical features of these pneumonia we conducted a prospective surveillance during 1999. Staphylococcal pneumonia was defined according to usual standards. All the strains were tested for the gene coding PVL, the cases associated with PVL positive strains were considered as study group. Nosocomial pneumonia were excluded. 52 cases were referred and 16 were PVL positive. These pneumonia occurred in younger patients (median age = 14.8 vs. 70.1) which were previously healthy (40% of underlying disease in control) Remarkable features were the presence of viral infection in the preceding day (75% vs. 9%), the frequency of shock (81% vs. 53%), respiratory distress (75% vs. 53%) and hemoptysia (38% vs. 3%). Leucopenia was present in 79% of cases. Mortality was higher in the PVL group (75% vs. 47%). Severe staphylococcal pneumonia with shock, leucopenia, hemoptysia and high mortality rate have been previously described in children and young adults. We established the relationship between this syndrom and the PVL production by S. aureus. We believe that viral infection constitue the prerequisite altering the respiratory epithelium which secondary allows S. aureus invasion. The necrotizing action of the PVL leads to the massive haemorragic necrotic pneumonia. Staphyloccocal necrotizing pneumonia is a new entity which frequency is probably underestimated. Further studies are needed to determinate the prognosis factors, the role of S. aureus carriage and of viral infections. The description of this new syndrome could lead to changes in the management of staphylococcal pneumonia in children. (C) 2001 Editions scientifiques et medicales Elsevier SAS.