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[Clinical course and treatment of pleural empyema in children]
Insights
Early recognition of pediatric purulent pleurisy is crucial. Prompt diagnosis and treatment in children over three years old improve outcomes and prevent complications like empyema.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Thoracic Surgery
Context:
- Purulent pleurisy, though rare, can lead to poor functional prognosis, especially when masked by prior antibiotic use.
- This study retrospectively analyzed 20 children with large-cavity purulent pleurisy treated between 1987 and 1993.
- Two groups were studied: infants with staphylococcal infection and older children with delayed presentation.
Purpose:
- To evaluate the clinical, bacteriological, and radiological findings in pediatric purulent pleurisy.
- To assess the treatment outcomes and long-term prognosis based on age and delay in diagnosis.
- To highlight the importance of early intervention for effective pleural effusion management.
Summary:
- Infants with Staphylococcus aureus infection showed rapid recovery with early treatment.
- Older children with delayed presentation (mean 14 days) experienced more complex empyema requiring repeated interventions (chest tubes, decortication).
- Ultrasonography and computed tomography aided diagnosis and treatment adaptation.
Impact:
- Early recognition and drainage of purulent pleurisy in children over three years old are vital to prevent fibrinous effusion and difficult follow-up.
- Delayed treatment correlates with increased need for repeated chest drainages or surgery.
- Despite initial challenges, long-term chest X-ray outcomes were favorable for all patients studied.
Background:
Purulent pleurisy has become rare. It is often masked by previous antibiotic treatment so that functional prognosis may be poor.
Patients And Methods:
Twenty children with purulent pleurisy of the large cavity admitted from 1987 to 1993 were included in the study: there were nine infants (age 5 to 18 months) with pleuro-pulmonary staphylococcal infection (group I) and 11 children (4-13 years) (group II). Clinical, biological, bacteriological and radiologic findings were analysed retrospectively as was the outcome.
Results:
Patients of group I were admitted in poor general condition. X-ray showed moderate effusion and characteristic signs of staphylococcal infection. The bacteria identified in seven patients (77%) was S aureus. Recovery was rapid with antibiotics and simple local treatment. X-rays were normal two months after hospital discharge in seven patients (77%). One infant presented cicatricial bullous emphysema which required segmental resection. Patients of group II were admitted for moderate respiratory signs after a relatively long delay (14 days) since the onset of symptoms. X-rays showed considerable effusion in all and mediastinal shift in five patients (45%). Streptococcus pneumoniae was identified in one patient only. Local treatment of empyema was difficult; the effusion, already fibrinous, required repeated use of chest tubes in eight cases and surgical decortication in three. X-rays, performed 2 months after hospital discharge, were normal in only three patients. Long-term course was nevertheless favorable since chest X-rays at 5 months were normal in all children of both groups.
Conclusions:
Early recognition of purulent pleurisy is important in children aged over 3 years to ensure effective drainage before the effusion becomes fibrinous. All patients in whom the first tube was inserted after more than 10 days had a difficult follow-up requiring repeated chest drainages or surgery. Ultrasonography was a useful aid for diagnosis and local treatment. Computed tomography was useful for adapting treatment after several days of course.