A study on clinical profile and etiological agents of empyema in hospitalised children in Jaipur, India

Background: Objective is to study the clinical profile and etiological agents of empyema in hospitalised children in Jaipur.Methods: This hospital based prospective study was carried out in the Department of Pediatrics, SMS Medical College, Jaipur between April 2016 to March 2017. Children between 1 month to 18 year of age having empyema thoracis (pleural tap showing pus cells under microscopy or on gross examination purulent exudates) were included in the study. Children with Empyema secondary to post-surgical or post-traumatic cause and with tubercular effusion were excluded from the study. Relevant history, clinical examination and investigation were done. Pleural fluid studies were done for cytology, biochemical analysis , culture and antibiotic sensitivity pattern.Results: Total 100 patients were included in study. Out of total 100 patients 62 (62%) were between 1 month to 5 years. Most common symptoms were fever (94%), breathlessness (87%) and cough (85%). 27% patients were severely malnourished as per IAP classification of PEM. Pleural fluid culture was positive in 29 (29%) patients. Most common organism isolated was Staphylococcus aureus (27%), 87.5% isolates of Staphylococcus aureus had sensitivity to vancomycin and linezolid.Conclusions: Empyema thoracis is frequently encountered complication of bacterial pneumonia. Fever, cough, and respiratory distress were the most common presenting complaints and severe acute malnutrition was an important risk factor. Staphylococcus aureus was found to be the most common organism for childhood empyema.

Empyema Thoracis in Children: A Short Term Outcome Study.

This study prospectively evaluates clinical course of pyogenic empyema thoracis in 25 children (2 mo – 12 y) treated with injectable antibiotics and chest tube drainage, and followed for 6 weeks. The median (range) age at presentation was 3 y (4 mo to 11 y). The pleural fluid culture was positive in 24% of patients. Staphylococcus aureus was the most commonly isolated organism. The median (range) duration of injectable antibiotics was 14(14-52) d; median duration of total antibiotics (injectable and oral) was 4 weeks. The median (range) duration of chest tube insertion and hospital stay was 8(5-45) and 14(14-56) days, respectively. All patients were discharged without any surgical intervention besides chest tube drainage. At discharge, pleural thickening was present in 84% and crowding of ribs was seen in 60% of the subjects on radiological examination. All these patients were asymptomatic at discharge. Chest deformity was present in 20% of the patients at 6-weeks follow up. Antibiotics and chest tube drainage is an effective method of treating pyogenic empyema thoracis in children in resource-poor settings.

A fatal case of empyema thoracis by Nocardia farcinica in an immunocompromised patient.

Empyema thoracis by Nocardia farcinica infection is uncommon. Here we report a rare and fatal infection in a 27-year-old HIV- seropositive male who presented with cough, expectoration, and breathlessness. Nocardia farcinica was isolated from sputum and pus from the pleural cavity. Confirmation of the isolate and minimum inhibitory concentrations (MIC) for various antibiotics was done at the Aerobic Actinomycetes Reference Laboratory, Centres for Disease Control and Prevention (CDC), Atlanta. Patient was treated with suitable antibiotics and antiretroviral drugs in spite of which he eventually succumbed to the disease.

Results of Application of Video-Assisted Thoracoscopic Surgery for the Treatment of Empyema Thoracis / 결핵및호흡기질환

BACKGROUND: Since video-assisted thoracoscopic surgery (VATS) was introduced as a new treatment modality for empyema thoracis, numerous reports have suggested that VATS is a more effective treatment method than the traditional methods that mainly use antibiotics and drainage apparatus. However, no confirmative evidence of the superiority of VATS over the traditional method has been provided yet. METHODS: We attempted to evaluate the efficacy of VATS for the treatment of empyema thoracis by reviewing past medical records and simple chest films. First, we divided the patients into two groups based on the treatment method: group A of 15 patients who were treated with the traditional method between January 2001 and December 2003, and group B of 9 patients who were treated with VATS between December 2003 and August 2006. The final outcomes used in this study were the number of days of hospital stay, chest tube duration, leukocytosis duration, febrile duration, and intravenous antibiotics usage duration. In addition, radiological improvements were compared. RESULTS: The mean age(+/-standard deviation) of 11 men and 4 women in group A was 58.2+/-15.7 years, and of 9 men and 2 women in group B was 51.6+/-9.5 years. Group B had a significantly shorter hospital stay (16.6+/-7.4 vs. 33.7+/-22.6 days; p=0.014), shorter chest tube duration (10.5+/-5.7 vs. 19.5+/-14.4 days; p=0.039), shorter leukocytosis duration (6.7+/-6.5 vs. 18.8+/-13.2 days; p=0.008), shorter febrile duration (0.8+/-1.8 vs. 9.4+/-9.2 days; p=0.004), and shorter duration of intravenous antibiotics usage (14.9+/-6.4 vs. 25.4+/-13.9 days; p=0.018). However, radiological improvements did not show any statistical differences. CONCLUSION: Early application of VATS for empyema thoracis treatment reduced hospital stay, thoracostomy tube duration, leukocytosis duration, febrile duration, and antibiotics usage duration in comparison with the traditional methods. The early performing of VATS might be an effective treatment modality for empyema thoracis.

Empyema thoracis in children

1. An unusual increase of empyema thoracis cases numbering a total of 30 cases were admitted to the NCH from January to December 1963. The marked increased during this year compared to previous years seems to parallel a rash of pneumonias observed in the city and suburbs and documented in other pediatric charity hospitals2. More cases were observed during the month of February. Again similar observations were made in other hospitals3. More cases with more severe manifestations were observed on children below 2 years. In this age group, more males were affected than females4. Mortality of 2 deaths were observed in those below 2 years5. A preceding respiratory infection was elicited in 83.3 cases usually occurring 1-2 weeks before the onset of empyema6. The staphyloccous was the predominant organism identified. It was isolated in pure cultures in 5 cases and in 4 out of mixed flora making a total of 9 in all 16 positive patients7. The principles of management were discussed and interpretation of results analyzed. (Summary)

Thoracotomy in the treatment of empyema thoracis in children

1. Forty-one cases of empyema thoracis treated with intercostal thoracotomy and open drainage are reported2. In more than 80 per cent of the bacteriologically examined cases the causative organism was pneumococcus3. The comparative study of the various reports on the therapy of empyema shows that pleurotomy gives a lower death rate, a shorter recovery period, and a higher percentage of cures, than closed drainage, ribresection, and repeated aspirations4. The average recovery period of the cases was 35.8 days. With properly timed operations and subsequent establishment and maintenance of adequate drainage, the period of convalescence was reduced to less than 24.88 days, the latter being the recovery period for uncomplicated empyema cases5. The optimum time for operation is in the fifth week after the onset of pneumonia. In the presence of infections other than empyema, better results were obtained when the operation was done within the optimum time for intervention, even if there were active but regressing complications, than when the operation was postponed to a later date when the coexisting infection had completely resolved6. Well-carried out lung gymnastics contributed to the early recovery from the temporary disabilities resulting from pleurotomy.(Summary)