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Inflammatory rebound and postinfectious inflammatory response in children with pleural infection: A single-center

Clément Poirault1, Alice Hadchouel1, Charlotte Roy1

  • 1Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France.

Pediatric Pulmonology
|January 11, 2024
PubMed

Insights

An inflammatory rebound occurred in 38% of children with pleural infection (PI). This suggests corticosteroids may benefit children with PI if given early, between days 2 and 5.

Area of Science:

  • Pediatric Infectious Diseases
  • Critical Care Medicine
  • Inflammation Research

Background:

  • Pleural inflammation is central to pediatric pleural infection (PI).
  • Corticosteroid therapy is being explored for PI, but optimal timing and patient selection are unclear.
  • Investigating inflammatory trajectories in pediatric PI is crucial for treatment optimization.

Purpose of the Study:

  • To analyze inflammatory patterns in children diagnosed with pleural infection (PI).
  • To identify factors associated with disease progression and treatment response.
  • To inform the timing of potential corticosteroid interventions in pediatric PI.

Main Methods:

  • Retrospective single-center study of pediatric PI cases (3 months to 17 years, 11 months).
  • Included patients with PI caused by Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus.
  • Defined inflammatory rebound as a C-reactive protein (CRP) increase of ≥50 mg/L after an initial decrease of ≥50 mg/L.

Main Results:

  • Fifty-three pediatric PI cases were analyzed.
  • An inflammatory rebound was observed in 20 patients (38%), particularly those with S. pyogenes.
  • Patients experiencing inflammatory rebound had prolonged fever and longer hospital stays.

Conclusions:

  • Nearly 40% of pediatric PI patients exhibited an inflammatory rebound.
  • This rebound may represent an early postinfectious inflammatory response.
  • Corticosteroids might be most effective in pediatric PI if administered early (Days 2-5).
Abstract

Keywords:
corticosteroidsempyemagroup A streptococcusinflammationmixed effect modelspediatrics

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