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Category: Volume 06 Issue 09 September 2018
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Title: Clinico-Bacteriological Profile and Outcome of Empyema Thoracis in Children below 12 Years of Age

Authors: Shriya Akanksha, Abhijeet Dutta, Aritra Guha

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.18

Abstract

Introduction: Empyema thoracis is a condition where pus is collected in the pleural cavity. It is a significant cause of pediatric hospital admission and pediatric morbidity especially in developing countries. The objective of this study is to evaluate the clinico-bacteriological profile and outcome of empyema thoracis in children below 12 yrs of age.

Method:  Patients below 12 yrs of age suffering from empyema thoracis were included in this study. After proper history taking and complete examination routine and specific investigations were done. The pleural fluid was studied for cytology, gram staining, microscopy, culture and sensitivity pattern. All the patients were treated with chest tube drainage and antibiotic therapy. Outcome and complications were noted.

Result:  The most common age of presentation was 1-5 yrs (60%) with 64% patients being male. Pleural fluid study showed the culture was positive in 30% cases. Staphylococcus aureus was the most common organism isolated (53%) followed by mycobacterium species, Streptococcus pneumonie, Klebsiella and E coli. Intercostal drainage and antibiotic was the mainstay of treatment.. Majority patients responded to the treatment, however 22% cases were referred to higher centres for surgical interventions. Pyothorax and pleural thickening were the most common complications and majority patients survived (94%).

Conclusion: Early diagnosis and intervention significantly reduces morbidity in a case of empyema thoracis. Antibiotics and chest drainage is an effective method of treating empyema thoracis in resource poor settings. In this region of Shushrutanagar, Staphylococcus aureus was the most common organism isolated from pleural fluid. Thus prophylactic administration of appropriate antibiotics even prior to c/s report may lead to a better outcome.

References

  1. Balachandran A, Shivbalan, Thangavelu S, Vijayasekaram D, Subramnayam L. Empyema Thoracis. Indian Journal of Pediatrics.2003 October; 70:803-6.
  2. Khanna SK. Empyema thoracis in children. Indian Journal of Pediatrics. 1984; 51(412):593-601.
  3. Goyal Vikas, Kumar A, Gupta M, Sandhu SPH, Dhir S. Empyema in children: Still a challenge in developing countries.2014; 11(3):206-210.
  4. Baranwal AK, Singh M, Marwaha RK, Kumar L. Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia. Arch Dis Child.2003; 88:1009-1014.
  5. Laishram N, Ngangom D. Empyema thoracids In Children: A Clinical Study. J Evolution Med Dent Sci. 2016 January; 5(1):46-49.
  6. Kumar A, Sethi GR, Mantan M, Aggarwal SK, and Garg A. Indian Pediatrics. 2013 September; 50.
  7. Narayanappa D, Rasmi N, Prasad NA, Kumar A. Clinico-bacterial profile and outcome of empyema. Indian Paediatrics. 2013; 50:783-5.
  8. Borade A, Badbade K, Gulawani S, Agarkhedkar S, Dhongade R. Empyema Thoracus in Children: Experience from tertiary care hospital in Pune, India. Asian Journal of Clinical Pediatrics and Neonatology. 2014 Jan-March; 2(1):19-22.
  9. Saleem AF, Shaikh AS, Khan RS, Khan F, Faruque AV, Khan MAM. Empyema Thoracis in Children: Clinical Presenta-tion, Management and Complications. Journal of the College of Physicians and Surgeons Pakistan. 2014; 24(8):573-576.
  10. Laishram N, Ngangom D. Empyema thoracids In Children: A Clinical Study. J Evolution Med Dent Sci. 2016 January; 5(1):46-49.
  11. Kumar A, Sethi GR, Mantan M, Aggarwal SK, and Garg A. Indian Pediatrics. 2013 September; 50.
  12. Lingayat AM, Wankhade PR. Study of clinical profile, etiological bacterial agents and outcome in pediatric patients of empyema. Indian Journal of Basic and Applied Medical Research. 2015 March; 4(2):502-509.
  13. Eastham KM, Freeman R, Kearns AM, Eltringham G, Clark J, Leeming J, Spencer DA. Clinical features, aetiology and outcome of empyema in children in the north east of England. Thorax.2004; 59:522-525.
  14. Baranwal AK, Singh M, Marwaha RK, Kumar L. Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia. Arch Dis Child.2003; 88:1009-1014.
  15. Goyal Vikas, Kumar A, Gupta M, Sandhu SPH, Dhir S. Empyema in children: Still a challenge in developing countries.2014; 11(3):206-210.
  16. Hardie W, Bokulic R, Victor F, Garcia, Shirley F, Reising, Christe CDC. Pneumococcal Pleural Empyemas in Children. Clinical Infectious Diseases. 1996; 22:1057-63.
  17. Schulz KD, Fann LL, Pinsky J, Ochoa L, Smith EO, Kaplan SL, and Brandt ML. The changing face of pleural empyemas in children: epidemiology and management. Paediatrics. 2004 June; 113(6):1735-40.
  18. Ramireddy K, Krishna YSR. A Study of Pediatric Empyema Thoracis in a Tertiary Care Hospital. International Journal of Contemporary Medical Research. 2016 October; 3(6):2838-40.
  19. Dalavi SB, Gurav PD and Dalavi VS. Empyema thoracis in children: A prospective study in rural India. International Journal Of Recent Trends in Science and Technology. 2016 February; 18(1):144-48.
  20. Patwari AK, Bisht S, Srinivasan A, et al. Aetiology of pneumonia in hospitalized children. J Trop Pediatr.1996; 42(1):15-20.
  21. Brook I. Microbiology of empyema in children and adolescents.Pediatrics.1990; 85:722-6.
  22. Maziah W, Choo KE, Ray JG, et al. Empyema thoracis in hospitalised children in Kelantan, Malaysia. J Trop Pediatr. 1995; 41:185-8.
  23. Mongeto EDO, Kombo BB, Legg-Jack TE. Thoracic empyema: a study 56 patients. Arch Dis Child.1993; 69:587-8.
  24. Mishra OP, Das BK, Jain AK, et al. Clinico-bacteriological study of empyema thoracis in children. J Trop Pediatr.1993; 39:380-1.
  25. Asindi AA, Efem SE, Asuquo ME. Clinical and bacteriological study on childhood empyema in south eastern Nigeria. East Afr Med J. 1992; 69:78-82.
  26. Ghosh S, Chakraborty CK, Chatterjee BD. Clinico-bacteriological study of empyema thoracis in infants and children. J Indian Med Assoc. 1990; 88:189-90.

Corresponding Author

Shriya Akanksha

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