Necrotizing Pneumonia

Necrotizing pneumonia is a rare and severe complication of bacterial community-acquired
pneumonia (CAP) and constitutes a major complication with prolonged ill health.
Compromise of the bronchial and lung blood supply leads to devitalization of lung
parenchyma. The lack of blood supply to the under perfused areas also impedes
delivery of antibiotics, allowing for uncontrolled infection and further destruction of
lung tissue. Pulmonary gangrene is the “final stage in a continuum of progressive
devitalization of pulmonary parenchyma” and is characterized by “sloughing of a
pulmonary segment or lobe”.

Necrotizing changes may be seen in ~7% of those with bacterial pneumonia. It can affect patients of any age and is
increasingly being reported in the pediatric population.
Progression of uncomplicated pneumonia to necrotizing pneumonia can occur either because the bacteria are very virulent
or due to patient related factors including diminished immunity.

It can result from a large number of pathogens, which include:
 Staphylococcus aureus particularly in young immunocompetent patients
Klebsiella pneumoniae (Klebsiella pneumonia) 
 Enterobacter spp.
 Nocardia spp. (pulmonary Nocardia infection)
 Actinomyces spp. (thoracic actinomyces infection)
 Pseudomonas spp. (Pseudomonas aeruginosa pneumonia)
 Pneumococcus spp.: especially type III Pneumococcal sp. 
 Haemophilus influenzae (pulmonary Haemophilus influenzae infection

Normal pulmonary parenchymal architecture within the necrotic segment is often lost . 
Treatment depends on the underlying agent while prognosis depends on the severity of the pathogen as well as the
susceptibility of the host. In general, complete recovery can be anticipated in children with bacteremic necrotizing
pneumococcal pneumonia contrary to what is seen in adults.
In some centers, pulmonary resection has been carried out as a surgical option and has shown to reduce morbidity and

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