Abstract:

Objective

To investigate the clinical characteristics and treatment of a pediatric necrotizing pneumonia （NP） case with coinfection of Streptococcus pneumoniae and Epstein-Barr virus（EBV）.

Methods

A retrospective analysis was conducted on the medical records of a child with NP admitted to The Affiliated Qingyuan Hospital （Qingyuan People's Hospital）， Guangzhou Medical University in April 15th， 2024， and relevant literatures were reviewed by searching Wanfang data， China National Knowledge Infrastructure （CNKI） and PubMed.

Results

The patient was a 2-year-old female， who was admitted to our hospital due to coughing for longer than 10 days， recurrent fever for 6 days and dyspnea for 3 days.The chest CT showed consolidation and multiple cavity formation in the middle lobe of the right lung， accompanied by pleural effusion on the right side.Microbiological analysis was performed on the bronchoalveolar lavage fluid （BALF） sample.Traditional pathogen detection methods detected no pathogenic microorganisms；however， targeted next generation sequencing （tNGS） revealed Streptococcus pneumoniae and human gammaherpesvirus 4 （Epstein-Barr virus， EBV） with high read counts， as well as Haemophilusinfluenzae and Human mastadenovirus C with low read counts.The treatment measures included the use of antibiotics，expectorants， anticoagulants， glucocorticoids， intravenous immunoglobulin and other drugs， as well as bilevel positive airway pressure therapy （BiPAP）， flexible bronchoscopy intervention therapy， etc.After 21 days of treatment， the patient recovered clinically and discharged.During the follow-up of over 3 months，the child remained in good condition.Literatures showed that common pathogens causing NP in children in China include Mycoplasma pneumoniae， Streptococcus pneumoniae， Staphylococcus aureus， Pseudomonas aeruginosa， Haemophilus influenzae， adenovirus and influenza virus， etc.Currently， one adult case of EBVassociated NP has been documented in medical literature， whereas no pediatric case have been reported in either domestic or international studies.

Conclusions

EBV may be involved in the pathogenesis of NP in children， but the evidence is not yet sufficient.The tNGS based on pathogenic microorganisms can help the etiological diagnosis of NP in children and improve the precision of antimicrobial therapy， but need to be carefully interpreted in clinical practice.

Key words: Necrotizing pneumonia, Epstein-Barr virus, Streptococcus pneumoniae, Targeted nextgeneration sequencing, Children