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Category: Volume 05 Issue 11 November 2017
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Title: Clinical and Etiological Profile, Outcome and Prognostic Factors in Children less than 12 years with Empyema Thoracis Attending an Urban Referral Centre

Authors: Bagavathy Perumal, Arul Prasadh, Nivothini, Pavithra, Soorya, Shanmugapriya

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.93

Abstract

Background: Empyema thoracis, an accumulation of pus in the pleural space is most often associated with pneumonia due to Streptococcus pneumoniae, although Staphylococcus aureus is most common in developing nations and in post-traumatic empyema. Empyema is most frequently encountered in infants and preschool children. It

occurs in 5 - 10% of children with bacterial pneumonia. This study was conducted to find the etiological profile of empyema in our setup, and factors that influence the outcome of empyema. This may help in effective management of empyema thoracis in future.

Methodology: All the children 1 month to 12 years old diagnosed as having empyema thoracis during the period June 2003 - October 2004, attending our hospital and willing to adhere to our study protocol were enrolled in our study.

Detailed history was elicited from the patient and a thorough clinical examination done. Diagnosis was confirmed with proper investigations. Pleural aspiration was done and pleural aspirate subjected to biochemical examination, gram staining was done and sample was sent for pus culture and sensitivity.

Complete blood count, X-ray chest, ultrasonogram of chest if needed, Mantoux were done. Blood was also sent for blood culture. Tube thoracostomy was done in all patients confirmed to have empyema thoracis. Inter Costal Drainage Tube of adequate size was inserted to ensure proper and complete drainage.

Results: In our study we find that gram positive organisms were isolated in 49% of culture proven cases and gram negative organisms were isolated from 51% of culture proven empyema thoracis cases.

Locality wise distribution helps us to compare the adequacy of treatment in urban and rural areas.

70% of children presenting with empyema thoracis had undernutrition. Duration of illness also significantly affect the outcome. When the duration of illness is > 7 days prior to insertion of ICD tube chances are high that the empyema would have progressed beyond stage I and empyema is in stage II or III.

Conclusion: Gram negative organisms were more isolated from the children with empyema thoracis.empyema thoracis is more common among undernourished children.Duration of illness also significantly affect outcome.

References

  1. Glenna B Winnie 'Empyema' in the Nelson Textbook of Pediatrics, 17" Edition, ed: Behrman. Kliegman. Jenson. Elsevier. 1462, 1463.
  2. Chambers, Henry F. " Infectious Diseases : Bacterial and chlamydial". In current medical diagnosis and Treatment, 37th Ed Stephen McPhee et a1 stamford : Appleton and Lange, 1997.
  3. Peter H. Michelson, Assistant Professor, Department of Paediatrics, Children Hospital of Pittsburg, University of Pittsburg - e Medicine.
  4. Whyte, Richard I. ' Pleural effusion and Empyema Thoracis' In Conns Current Therapy 1996, ed. Robert E.Rake1, Philadelphia : W.B. Saunders Co : 1996.
  5. Bryant RE et al. Pleural empyema. Clin Infect Dis 1996 May; 22 (5) : 747 - 762.
  6. 'Thoracostomy Tube Drainage'. In the Merck Mancial of Diagnosis and Therapy, 16th
  7. Rodolfa Majluf, Children Hospital, Buenos Aires, Argentina.
  8. C. Sit et al. 'Urokinase in the treatment of Childhood Empyema'. Thorax 2003; 58 : 93 – 94
  9. Gupta SK et al. Indian J Chest Dis Allied Sci. 1989 Jan - Mar; 31 (1) : 15 - 20.
  10. Athanassiadi K et al. Thoracic condiovascular surgery 2003 Dec; 51 (6) : 338 - 341.
  11. Hilliard et al. Arch Dis Child. 2003 Oct; 88 (10) : 915 - 917.
  12. Anstadt et al. Arn.J.Med. Sci. 2003 July ; 326 (1) : 9 - 14.
  13. Huang FL et al. J. Microbiol Immunolo Infect. 2002 June; 35 (2) : 115 - 120.
  14. Carey JA et al. Arch Dis Child. 1998 Dec; 79 (6) : 510 -513.
  15. Mandal et al. Ann. Thorac. Surg. 1998 Nov ; 66 (5) : 1782 -1786.
  16. Chan W et al. J Pediatr Surg. 1997 June; 32 (6) : 870 - 872.
  17. Le Mense GP et al. Chest. 1995 June; 107 (6) : 1532 - 1537.
  18. Maziah W et al. J. Trop Pediatr. 1995 June; 41 (3) : 185 - 188.
  19. Kennedy AS et al. Arch Surg. 1991 Oct; 126 (10) : 1287 - 1291.
  20. Ghosh S et al. J. Indian Med Assoc. 1990 Jul; 88 (7) : 189 -190.
  21. Beg MH et al. Ann Trop Paediatr. 1987 Jun; 7 (2) : 109 - 112.
  22. Wehr CJ, Adkins RB Jr. South Med J. 1986 Feb;79(2): 171-176.
  23. Asindi AA, Efem SE, Asuquo ME. East Afi Med J. 1992 Feb;69(2):78-82.
  24. Chu MW et al. Can J Surgery 2001. Aug; 44 (4) : 284 - 288.
  25. Cham CW et al. Thorax 1993 Sep; 48 (4) : 925 - 927.
  26. Le Mense GP et al. Chest. 1995 June; 107 (6) : 1532 - 1537.
  27. Maziah W et al. J. Trop Pediatr. 1995 June; 41 (3) : 185 - 188.
  28. Kennedy AS et al. Arch Surg. 1991 Oct; 126 (10) : 1287 - 1291.

Corresponding Author

Arul Prasadh

Assistant Professor, Department of Pediatrics,

Kanyakumari Government Medical College