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Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis

Susanna Hernández-Bou1, Juan José García-García, Cristina Esteva

  • 1Department of Pediatrics, Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.

Pediatric Pulmonology
|November 14, 2009
PubMed

Insights

Parapneumonic pleural effusion (PPE) incidence in children has increased, with Streptococcus pneumoniae as the primary cause. Polymerase chain reaction (PCR) and antigen assays significantly improve diagnosis of this pediatric lung infection.

Area of Science:

  • Pediatric Infectious Diseases
  • Pulmonology
  • Microbiology

Background:

  • An increasing incidence and severity of parapneumonic pleural effusion (PPE) in pediatric populations have been observed.
  • Streptococcus pneumoniae is the primary etiological agent responsible for pediatric PPE.
  • Advancements in molecular and antigen detection techniques have enhanced the microbiological diagnosis of PPE.

Purpose of the Study:

  • To delineate the epidemiological trends and clinical features of parapneumonic pleural effusion in a pediatric cohort.
  • To assess the etiological agents and diagnostic methods for pediatric PPE.

Main Methods:

  • A prospective study was conducted on pediatric patients (<18 years) admitted with PPE.
  • The study took place in a tertiary-care pediatric hospital in Barcelona, Spain, from September 2003 to December 2006.
  • Epidemiological data, causative agents (including serotyping), and diagnostic test performance (PCR, antigen assays) were analyzed.

Main Results:

  • 190 cases of pediatric PPE were diagnosed, with incidence rising from 19.9 to 35.2 per 100,000 children between 2004 and 2006.
  • Streptococcus pneumoniae was identified in 82.9% of positive cultures, with non-vaccine serotypes (NVS) predominating (81.5%).
  • Polymerase chain reaction (PCR) increased etiological diagnosis from 21.6% to 42.1%; antigen assays showed 87.9% sensitivity and 100% specificity compared to PCR.

Conclusions:

  • The incidence of pediatric PPE has increased, mirroring community-acquired pneumonia (CAP) trends.
  • Streptococcus pneumoniae, particularly NVS, remains the main pathogen causing pediatric PPE.
  • PCR significantly enhances etiological diagnosis, while antigen assays offer a rapid, sensitive, and valid alternative for pneumococcal detection in pleural fluid.
Abstract

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