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Pleural infection in children
1Section of Pediatric Respirology, Children's Hospital of Winnipeg, Manitoba, Canada.
Insights
Pediatric pleural effusions are less frequently complicated by empyema than in the past. Current diagnostic and treatment strategies for pediatric pleural effusion lack consensus, necessitating further research.
Area of Science:
- Pediatric Pulmonology
- Thoracic Medicine
- Infectious Diseases
Background:
- Pleural effusion is a common condition in children.
- The incidence of complicated parapneumonic effusions and empyema has decreased over the past decades.
- Current diagnostic and treatment approaches for pediatric pleural effusions remain controversial.
Purpose of the Study:
- To review the physiology of pleural liquid formation and stages of pleural effusion.
- To analyze recent clinical experience with pediatric pleural effusions.
- To highlight controversies in diagnosis and treatment of pediatric pleural effusions.
Main Methods:
- Retrospective review of hospitalized patients with pleural effusions.
- Analysis of clinical data, including etiology, diagnostic methods, and treatment outcomes.
- Comparison with historical data from 20-30 years prior.
Main Results:
- Parapneumonic effusions accounted for 50% of pleural effusions in recent cases.
- Empyema was diagnosed in only 7% of patients with parapneumonic effusions, a significant decrease from historical rates (over 40%).
- Only 27% of patients required tube thoracostomy for drainage.
Conclusions:
- The prevalence of empyema complicating pediatric pneumonia has significantly declined.
- Diagnostic and treatment strategies for pediatric pleural effusions require further investigation and standardization.
- A multicentered prospective study is needed to establish evidence-based guidelines for managing pediatric pleural effusions.
Abstract:
The physiology of pleural liquid formation and stages of pleural effusion are reviewed in this article in our recent experience, only 50% of pleural effusions in hospitalized patients were parapneumonic and only about 7% of these patients could be classified as having an empyema. These findings are in contrast to children 20 to 30 years ago in whom over 40% of parapneumonic effusions were empyemas. Diagnostic approaches are also controversial. The accuracy, sensitivity and specificity of various biochemical tests of pleural fluid have not been assessed in children. It seems reasonable to avoid thoracentesis if the clinician is certain of etiology of the pleural effusion from the history, physical examination, and supporting laboratory data. Treatment is also controversial. Indeed, most patients recover without tube thoracostomy. In our series, only 27% of patients were treated with tube drainage. It is suggested that drainage is necessary to relieve respiratory difficulty or pleuritic pain when effusions are relatively large. The need to drain all empyemas is also a controversial issue both in the child and adult. Clearly, what is needed is a carefully designed multicentered prospective study of pleural effusion in children.