NEKROTIČNA PNEUMONIJA PROUZROKOVANA STREPTOKOKUSOM PNEUMONIJE KOD PETOGODIŠNJEG DEČAKA - PRIKAZ SLUČAJA
DOI:
https://doi.org/10.46793/PP250218019BKljučne reči:
dete, nekroza, pneumonija, komplikacije, Streptococcus pneumoniae, prevencijaApstrakt
Uvod: Nekrotična pneumonija je jedna od ozbiljnih komplikacija vanbolnički stečene pneumonije, koja je uzrokovana infekcijom posebno virulentnim bakterijama, od kojih je najčešća Streptococcus pneumoniae. Obično se javlja kod prethodno zdrave dece i dovodi do prolongiranog kliničkog toka i pored primene odgovarajuće antibiotske terapije.
Prikaz slučaja: Petogodišnji dečak, koji je redovno vakcinisan i bez hroničnih bolesti, razboleo se 14 dana pre prijema u bolnicu pojavom febrilnosti i kašlja, a potom i otežanog disanja i bola sa desne strane trbuha. Neposredno pred prijem započeta je peroralna terapija azitromicinom. Kako su se tegobe održavale, ambulantno je načinjena radiološka dijagnostika i postavljena dijagnoza pleuropneumonije, te je dete upućeno na hospitalno lečenje. Tokom hospitalizacije nakon načinjenog ultrazvuka i kompjuterizovane tomografije toraksa ustanovljena je obostrana nekrotična pneumonija uz masivni desnostrani pleuralni izliv, kao i tromboza na spoju leve jugularne i potključne vene. Sprovedeno je lečenje primenom parenteralne antibiotske terapije, torakalne drenaže uz primenu alteplaze, kao i antikoagulantne terapije. Pleuralni izliv je po svojim biohemijskim karakteristikama odgovarao empijemu, dok je kultura bila pozitivna na Streptococcus pneumoniae. Bolest je zahtevala prolongiranu hospitalizaciju u trajanju od 24 dana uz povoljan klinički tok.
Zaključak: Razvoj nekrotične pneumonije treba razmotriti kod svakog deteta sa pneumonijom koja ne pokazuje poboljšanje nakon 72 sata od primenjene adekvatne antibiotske terapije. Rana dijagnoza i primena pravovremene terapije su ključne za povoljan ishod lečenja, dok je redovna vakcinacija osnovna mera prevencije.
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