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Pneumococcal empyema in childhood
Abstract:
Two serotypes, uncommon in pediatric infections, accounted for a disproportionately large number of cases of pneumococcal empyema at the Children's Hospital of Pittsburgh. Eight of ten empyemas were caused by types 1 or 3, and two additional cases of mixed infection involved the type 3 pneumococcus. The type 3 pneumococcal empyemas tended to be more severe than those due to other serotypes. Counterimmunoelectrophoresis (CIE) appeared to be more useful than culture in establishing the cause of this condition; in seven of ten cases, the pleural fluid was CIE positive while cultures of blood and pleural fluid were negative. In each of the seven culture-negative cases, antibiotics had been given prior to hospitalization. One case of type 7 pneumococcal empyema illustrated the potential value of the Ouchterlony test for the etiologic diagnosis of this condition.
Insights
Pneumococcal empyema in children was primarily caused by uncommon serotypes 1 and 3. Counterimmunoelectrophoresis (CIE) proved more effective than culture for diagnosis, especially after antibiotic treatment.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonary Medicine
- Clinical Microbiology
Background:
- Pneumococcal empyema is a serious lung infection in children.
- Specific pneumococcal serotypes are rarely associated with pediatric infections but may cause severe disease.
- Accurate and timely diagnosis is crucial for effective treatment.
Purpose of the Study:
- To investigate the causative serotypes of pneumococcal empyema in pediatric patients.
- To compare the diagnostic utility of counterimmunoelectrophoresis (CIE) and culture methods.
- To evaluate the severity of empyema caused by different pneumococcal serotypes.
Main Methods:
- Retrospective analysis of pediatric empyema cases at Children's Hospital of Pittsburgh.
- Serotyping of Streptococcus pneumoniae isolates from pleural fluid and blood cultures.
- Comparison of diagnostic results from CIE and traditional culture methods.
- Assessment of clinical severity based on patient outcomes.
Main Results:
- Two uncommon serotypes, types 1 and 3, accounted for the majority of empyema cases (8/10).
- Type 3 pneumococcal empyemas were associated with increased disease severity.
- Counterimmunoelectrophoresis (CIE) detected pneumococcal antigens in 7/10 culture-negative cases, often following prior antibiotic administration.
- The Ouchterlony test showed potential utility in diagnosing a type 7 empyema case.
Conclusions:
- Streptococcus pneumoniae types 1 and 3 are significant, though uncommon, causes of pediatric empyema.
- CIE offers a valuable diagnostic advantage over culture, particularly in culture-negative cases due to prior antibiotic use.
- Prompt etiologic diagnosis using methods like CIE is essential for managing pediatric pneumococcal empyema.