Evaluation and outcome of parapneumonic effusion among children attending Assiut University Pediatric Hospital

Abstract

Background Empyema is the most frequent suppurative complication of bacterial pneumonia in childhood. As parapneumonic effusion (PPE) progresses, fibrin and cellular debris accumulate, the purulent fluid becomes septated, and a thick peel forms over the pleura. Aim To describe and compare clinical, laboratory, microbiological findings in patients with PPE and to verify the prognostic accuracy of pleural fluid C-reactive protein in disease progression. Patients and methods In all, 25 children aged from 1 month to 16 years, with PPE and empyema were enrolled in this prospective study, which was carried out at Assiut University Children Hospital, from January 1, 2019 to June 30, 2019. Results Fever and dyspnea occurred in 88 and 64% of patients, respectively. Right effusion occurred in 64% of patients. Hemoglobin was less than 10 g/dl in 72% of patients. Pleural fluid C-reactive protein after 1 week, decreased significantly (15.21 ± 9.45 vs. 50.70 ± 20.85 mg/dl). Blood culture showed no growth in 11 (44%) patients while six (24%) patients had Staphylococcus aureus. Pleural culture revealed no growth in 13 (52%) patients while S. aureus was found in seven (28%) patients. Conclusion S. aureus is the most common isolated organism in both blood and pleural fluid positive cultures. All children received the recommended antibiotics for the treatment of empyema and empyema drainage with an intercostal tube without using fibrinolytic therapy and only 12% of the children were advised for surgical treatment in the form of open thoracotomy with decortication.