Title: A Clinical Study of Empyema Thoracis in Children Admitted in Tertiary Care Hospital
Authors: Dr Trinadh Naidu Chandaka, Dr Jagadeeswararao Metta, Dr Attada Ajay Kumar, Dr Chinnarao G
Introduction: Empyema thoracis, accumulation of pus in the pleural cavity, is a dreaded complication of pneumonia, is in increasing trend. Early antibiotics with intercoastal tube drainage, advanced interventions like intraplueral fibrinolytic therapy, VATS have greatly reduced the mortality and morbidity.
Aims and Objectives
To study clinical presentation, course, bacteriological, radiological features, management and outcome of empyema thoracis.
Study Sample: 35 cases were studied during March 2017 to July 2018.
Inclusion Criteria: Children with pleural fluid with any of the characteristics like grossly purulent, loculation on ultrasonography, gram stain positive, WBC count >10000mm3 with neutrophilic predominance.
Exclusion Criteria: Secondary to trauma, surgery, tuberculosis.
Methods: Physical examination, Blood (CBC,ESR, Blood culture), Radiological (Xray, Usg, CECT), Thorococentesis (pleural fluid analysis).
Observations and Results: Male(60%) >female(40%), maximum incidence (45.7%) was noted in 3-5 years age group with lowest incidence in below 1yr(5.7%). Major organism isolated was Staphylococcus aureus(17.14%), Pneumococcal(11.42%), pseudomonas(8.57%), culture negative (51.42%). Chest Xray with associated lung lesions like consolidation (82.85%),collapse(45.71%),mediastinal shift(34.28%). 32 0f 35 cases were treated with combination of IV antibiotics and chest tube drainage alone. 3cases underwent Decortication probably due to late presentation to hospital.
Conclusion: More common among males and in 3-5 age groups. More common etiological agent is Staphylococcus aureus. Mainstay of treatment is antibiotics with intercoastal tube drainage. Decortication done for loculated empyema where ICTD is inadequate. Early diagnosis, prompt treatment with antibiotics and ICTD, abates need for surgical interventions, decreases mortality and morbidity.