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Pediatric parapneumonic empyema, Spain

Ignacio Obando1, Carmen Muñoz-Almagro, Luis A Arroyo

  • 1Virgen del Rocio Children's Hospital, Seville, Spain. iosantaella@telefonica.net

Emerging Infectious Diseases
|September 2, 2008
PubMed

Insights

Pediatric parapneumonic empyema (PPE) is rising, driven by Streptococcus pneumoniae. Molecular diagnostics reveal non-vaccine serotypes, particularly serotype 1, are key contributors to this increase.

Area of Science:

  • Pediatric Infectious Diseases
  • Microbiology
  • Molecular Diagnostics

Background:

  • Pediatric parapneumonic empyema (PPE) incidence is increasing globally.
  • Antimicrobial pretreatment often leads to negative cultures, masking pathogen contributions.
  • Streptococcus pneumoniae is a significant pathogen in PPE.

Purpose of the Study:

  • To identify causative serotypes and genotypes of PPE using molecular methods.
  • To correlate pneumococcal serotypes/genotypes with PPE incidence and severity.
  • To understand the impact of antimicrobial pretreatment on diagnostic yield.

Main Methods:

  • Prospective enrollment of 208 children with PPE.
  • Collection of blood and pleural fluid (PF) samples.
  • Molecular detection and multilocus sequence typing (MLST) for pneumococcal identification and genotyping.
  • Serotyping of identified pneumococcal isolates.

Main Results:

  • Pneumococci were detected in 79% of culture-positive and 84% of culture-negative samples.
  • Serotype 1 was identified in 48% of cases, belonging to 3 major circulating genotypes.
  • Significant variations in patient complication rates were observed based on serotype.
  • The rise in PPE is linked to non-vaccine serotypes, notably serotype 1.

Conclusions:

  • Molecular diagnostics are crucial for accurate pathogen identification in pretreated PPE cases.
  • Serotype 1 is a major driver of the increasing pediatric parapneumonic empyema.
  • Serotype-specific differences in disease severity highlight the need for targeted interventions.

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