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Clinical management and outcome of childhood lung abscess: a 16-year experience
Pei-Chun Chan1, Li-Min Huang, Ping-Sheng Wu
1Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Insights
Pediatric lung abscesses often occur in children with underlying health issues. Early diagnostic aspiration aids in identifying pathogens like oral anaerobes and Staphylococcus aureus, crucial for effective treatment.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Childhood lung abscess is a serious condition requiring evaluation of its clinical course.
- A significant proportion of pediatric lung abscess cases are secondary to underlying chronic diseases.
Purpose of the Study:
- To evaluate the clinical manifestations, management strategies, and outcomes of pediatric lung abscess.
- To identify predisposing factors, pathogens, and treatment effectiveness in childhood lung abscess.
Main Methods:
- Retrospective chart review of 27 pediatric patients diagnosed with lung abscess (ICD-9 CM code 503.1) between 1987 and 2003.
- Analysis of patient demographics, underlying conditions, diagnostic procedures (including aspiration), pathogen identification, treatment interventions, and patient outcomes.
- Review of predisposing factors for primary and secondary lung abscesses.
Main Results:
- 70% of cases were secondary lung abscesses in children with chronic conditions (e.g., hematologic disorders, congenital heart disease).
- Diagnostic aspiration yielded positive pathogen identification in 63.6% of cases; common pathogens included oral flora, Staphylococcus aureus, and gram-negative bacteria.
- Mortality was 18.5%, and sequelae such as bronchiectasis and lung fibrosis occurred in 15% of patients.
Conclusions:
- Underlying medical conditions are prevalent in pediatric lung abscess cases, emphasizing the need for comprehensive management.
- Early percutaneous aspiration is vital for pathogen identification, guiding targeted antibiotic therapy.
- Management should consider common pathogens in primary abscesses (oral anaerobes, S. aureus) and gram-negative organisms in secondary cases.
Abstract:
In order to evaluate the clinical manifestations, management and outcome of childhood lung abscess, a retrospective chart review of 27 pediatric patients with International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9 CM) code of 503.1 (lung abscess) from August 1987 to August 2003 was conducted. Among the 27 patients (14 males and 13 females), 30% (8/27) were primary lung abscess and 70% (19/27) had underlying chronic diseases (secondary lung abscess). The predisposing factors of the primary group (n = 8) included 6 cases of respiratory tract infection, 1 with choking during swimming, and 1 with laceration wound. The underlying diseases in the secondary group (n = 19) included 10 cases of hematologic disorder (52%), 3 of congenital heart disease, 2 of central nervous system anomalies, and 1 each of hyperimmunoglobulin E syndrome, chronic lung disease, liver cirrhosis with fistula formation, and Swyer-James syndrome. Eleven patients (41%) underwent diagnostic tapping, including echo-guided aspiration (10 cases) and computed tomography-guided percutaneous needle aspiration (1 case). Positive yield rate from aspiration of lung abscess was 63.6% (7/11). Surgical intervention was performed in 8 (42%) of the secondary group and in 1 patient from the primary group. The pathogens were identified in 11 patients (41%): 5 with oral flora, 2 with Staphylococcus aureus plus other pathogens, 1 with S. aureus alone, 1 with Pseudomonas aeruginosa plus Proteus mirabilis, 1 with P. aeruginosa alone, and 1 with Aspergillus. The average duration of parenteral antibiotic use was 40 days. Five cases (18.5%) died due to poor control of the underlying diseases, and 4 of the patients (15%) had sequelae (2 with bronchiectasis and 2 with lung fibrosis). Seventy percent of lung abscess occurred in children with underlying medical conditions. Early percutaneous aspiration has an important role in identification of pathogens. Oral anaerobes and S. aureus are the core pathogens in primary lung abscess and gram-negative pathogens should also be considered in secondary lung abscess.
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