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Aetiology of pleural effusions in children living in a high TB endemic setting

S Wordui1, A Masu2, L Golden2

  • 1Department of Paediatrics and Child Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa;, Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana.

The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease
|June 1, 2024
PubMed

Insights

Polymerase chain reaction (PCR) testing aids in diagnosing bacterial pleural effusion in children, especially in TB-endemic areas. This method improves pathogen detection and reduces unconfirmed cases.

Area of Science:

  • Pediatric infectious diseases
  • Respiratory medicine
  • Diagnostic microbiology

Background:

  • Diagnosing pediatric pleural effusion is challenging in tuberculosis-endemic regions.
  • Distinguishing bacterial causes from other etiologies requires effective diagnostic tools.

Purpose of the Study:

  • To evaluate the utility of polymerase chain reaction (PCR) and biochemical tests in identifying bacterial pleural effusion in children.
  • To compare PCR with traditional methods for pathogen detection in pleural fluid.

Main Methods:

  • Cross-sectional, post-hoc analysis of children with pleural effusion in a South African tertiary hospital.
  • Inclusion of new PCR data from stored pleural fluid samples.
  • Aetiological classification based on microbiological confirmation.

Main Results:

  • Bacterial causes accounted for 40% of pleural effusions; Staphylococcus aureus and Streptococcus pneumoniae were common pathogens.
  • PCR enhanced pathogen detection, reducing the number of children with unconfirmed aetiologies from 48 to 32.
  • High pleural fluid lactate dehydrogenase (LDH) levels (≥1,716 U/L) effectively discriminated bacterial from other pleural effusions (86% sensitivity, 95% specificity).

Conclusions:

  • PCR significantly improves pathogen detection rates in pediatric pleural effusions.
  • The use of PCR reduces the proportion of unconfirmed aetiologies, aiding in clinical management.
  • Biochemical markers like LDH can assist in differentiating bacterial pleural effusion.

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