Necrotizing Pneumonia Prognosis That You Need To Know

necrotizing pneumonia prognosis

Necrotizing pneumonia is a rare but serious complication of lung infection where lung tissue dies due to bacterial invasion. Although it can affect individuals of any age, children and young adults are more likely to be affected by it.

Let’s start with what it is, necrotizing pneumonia prognosis, causes, treatment, and how to prevent it.

What is Necrotizing Pneumonia?

Necrotizing pneumonia is a type of pneumonia characterized by the development of necrosis (cell death) within infected lung tissue. It is also known as “cavitary pneumonia” or “cavitary necrosis”.

Cavitary pneumonia can also damage the blood vessels in the lungs, affecting the delivery of oxygen and antibiotics to the site of infection. If not treated promptly it can result in respiratory failure, sepsis (blood infection), and death.

Necrotizing pneumonia is not a specific disease, but a complication of different types of lung infections caused by different microorganisms.

Necrotizing Pneumonia Prognosis

Symptoms are similar to regular pneumonia, but they are more severe and persistent. These include:

  1. High fever
  2. Severe chest pain
  3. Difficulty breathing
  4. Cough and bad breath – bad breath
  5. Weight loss
  6. Tiredness
  7. Confusion
  8. Acute respiratory failure
  9. Coughing up blood or pus
  10. Excessive fatigue
  11. Dangerously low blood pressure
  12. An abnormal decrease in white blood cells
  13. Headache
  14. Nausea and vomiting
  15. Pain in joints

Causes of Necrotizing Pneumonia

Necrotizing pneumonia is caused by bacteria. The bacteria evoke an inflammatory response that releases toxins and causes vasculitis with venous thrombosis. This means that the blood vessels in the lungs swell and become blocked by blood clots, cutting off the supply of oxygen to the lung tissue.

As a result, the lung tissue dies and liquefies, forming cavities or abscesses that may contain pus or air.

There are several types of bacteria that can cause it, but some of the most common are:

1. Staphylococcus aureus.

This is a type of bacteria that normally lives in the skin and nose but can cause serious infections if it enters the bloodstream or lungs.

Do you know that some strains of this bacteria are resistant to antibiotics (methicillin-resistant Staphylococcus aureus or MRSA) and can produce a toxin called Panton-Valentine Leukocidin (PVL) that destroys white blood cells and causes lung necrosis.

2. Streptococcus pneumoniae.

This is a type of bacteria that can cause pneumonia, meningitis, ear infections, and sinus infections. It is also known as pneumococcus.

It has several different strains or serotypes. Some serotypes are more likely to cause necrotizing pneumonia than others, especially type III.

3. Klebsiella pneumoniae.

This is a type of bacteria that belongs to the Enterobacteriaceae family and can cause urinary tract infections, wound infections, and pneumonia. It can form a thick capsule that protects it from the immune system and antibiotics.

It can also cause a severe form of pneumonia called Klebsiella pneumonia, which is characterized by bloody sputum and tissue destruction.

Other bacteria that can cause necrotizing pneumonia include Haemophilus influenzae, Pseudomonas aeruginosa, Nocardia spp, Actinomyces spp, Mycoplasma pneumoniae, Acinetobacter baumannii, Streptococcus pyogenes, Stenotrophomonas maltophilia, Fusobacterium nucleatum, Bacteroides fragilis, Aspergillus spp, Histoplasma Capsulatum, influenza virus, and adenovirus.

Also Read: Multifocal Pneumonia Icd 10: What It Is, Causes And Treatment.

Risk Factors for Necrotizing Pneumonia

Anyone can be affected by it but some people are more at risk than others. Some risk factors are:

1. Co-existing health problems.

People with diabetes mellitus, alcohol use disorders, corticosteroid therapy, smoking, gastrectomy, substance use disorders, or HIV/AIDS are more likely to develop it than healthy people.

2. Age.

It can affect people of any age, but it is more common in adults than children. However, in children, it can also develop due to Staphylococcus aureus or Streptococcus pneumoniae infection.

3. Previous lung infection.

People who have had a previous lung infection or foreign material entering the lungs are more likely to develop it than people who have not.

Diagnosis of Necrotizing Pneumonia

It can be difficult to diagnose because its symptoms are similar to those of typical pneumonia, such as fever, cough, and shortness of breath. However, some signs that may suggest it are:

  • Severe chest pain that increases when breathing or coughing.
  • Cough containing blood or pus.
  • Bad breath.
  • Weight loss or less growth (in children).
  • Respiratory failure or septic shock.

To confirm the diagnosis, chest imaging is required. Chest X-ray may show lung congestion or abscess, but chest CT scan is more sensitive and specific to detect typical features such as:

  • Loss of lung structure and volume.
  • Multiple small thin-walled cavities within the infected area.
  • Peripheral growth and central necrosis of the lesion.
  • Air-fluid levels or gas bubbles in cavities.
  • Pleural effusion or empyema (fluid or pus in the space between the lung and the chest wall).

In addition to imaging, laboratory tests can also help diagnose. These include:

  • Blood tests to check for increased white blood cell count, C-reactive protein, and inflammatory markers.
  • Blood culture to identify the causative organism and its antibiotic sensitivity.
  • Sputum culture or bronchoalveolar lavage (BAL) to obtain samples from the lower respiratory tract for microbiological analysis.
  • Tuberculosis (TB) testing is done to rule out necrotizing changes in the lungs as the cause of cavitary lung disease.

Treatment of Necrotizing Pneumonia

Treatment includes two main components:

  1. Antibiotic therapy and,
  2. Supportive care.

Antibiotic therapy should be started as soon as possible after the diagnosis and should cover the most common pathogens that cause it.

The choice of antibiotics depends on local resistance patterns, the patient’s allergies, and related diseases.

The duration of antibiotic therapy varies depending on the clinical response, resolution of radiological findings, and the presence of complications. Generally, it is recommended to take antibiotics for at least 4 to 6 weeks.

Some common antibiotics that are used:

  • Penicillin or amoxicillin-clavulanate for pneumococcal infection.
  • Vancomycin or linezolid for methicillin-resistant staphylococcal infections.
  • Ceftriaxone or ciprofloxacin for Klebsiella infection.
  • Trimethoprim-sulfamethoxazole or minocycline for Nocardia infection.
  • Penicillin or clindamycin for Actinomyces infections.

Supportive care includes measures to control fever, pain, and inflammation, such as acetaminophen, nonsteroidal anti-inflammatory drugs, or corticosteroids.

Supportive care also includes oxygen therapy, fluid resuscitation, and nutritional support for patients suffering from hypoxia, dehydration, or malnutrition. In some cases, mechanical ventilation or extracorporeal membrane oxygenation may be required for patients with severe respiratory failure.

In some cases, necrotizing pneumonia may require surgical intervention. If the patient develops complications such as sepsis, empyema (pus in the pleural space), bronchopleural fistula (communication between the bronchus and the pleural space), or lung abscess (collection of pus in the lung), surgery may be indicated.

Surgery may include removal of infected fluid or pus, debridement of necrotic tissue, or resection of the affected lung segment or lobe.

What are the outcomes of necrotizing pneumonia?

Results depend on many factors, such as

  • Type and severity of infection
  • Timeliness and adequacy of treatment
  • and the presence or absence of complications.

Other outcomes include:

  • 46.6% of patients required chest tubes.
  • 6.1% of patients underwent video-assisted thoracoscopic surgery.
  • 27.6% of patients were mechanically ventilated.
  • 16.7% of patients had pneumothorax.
  • 27.4% of patients had pyothorax.
  • 31% of patients had pulmonary embolism.
  • The 14-day average duration of intravenous anti-biotherapy.
  • The 21-day average duration of intravenous and oral treatment.
  • 18 patients needed pleural drainage.
  • 11 patients needed fibrinolytic.

Some factors that are associated with poor outcomes are:

  • Delayed diagnosis or treatment.
  • Older age.
  • Comorbidities.
  • Multiple organ failure.
  • Methicillin-resistant Staphylococcus aureus infection.
  • Pneumococcal serotype 3 infection.
  • Bilateral lung involvement.
  • Large cavity size.

Is necrotizing pneumonia deadly?

The mortality rate for necrotizing pneumonia varies:

  1. 4.1% for children.
  2. 56% for community-acquired necrotizing pneumonia and the average survival time was 10 days.
  3. 75% for post-COVID-19 necrotizing pneumonia.

Necrotizing Pneumonia prevention

It can be prevented by avoiding or treating risk factors that cause lung infections, such as:

  1. Smoking and drinking.
  2. Diabetes.
  3. Chronic lung disease, such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis, causes inflammation and blockage in the airways.
  4. Immunodeficiencies, such as HIV infection, cancer, chemotherapy, or organ transplant, reduce the ability to fight infection.
  5. Malnutrition affects the immune system and the healing process.

Additionally, vaccination against pneumococcus and influenza may help prevent necrotizing pneumonia caused by these organisms.

Pneumococcal vaccine is recommended for all children under 5 years of age, adults over 65 years of age, and people with certain medical conditions that increase the risk of pneumococcal infection.

The influenza vaccine is recommended for everyone over the age of 6 months, especially those who are at higher risk of complications from influenza.

The Bottom line

Necrotizing pneumonia is a rare but serious complication of lung infection that can cause tissue death and gangrene in the lungs.

It can cause serious symptoms such as high fever, chest pain, difficulty breathing, and cough with bloody or purulent sputum. It is diagnosed by clinical signs, blood tests, and chest imaging.

It can be treated with supportive care, antibiotics, and sometimes surgery.

In one study, the mortality rate was 4.1%. In this study, 46.6% of patients required chest tubes, 6.1% underwent video-assisted thoracoscopic surgery, and 27.6% were mechanically ventilated.

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