Community-acquired pleuropneumonia in children: Bacteriological and therapeutic challenges.

Background Community-acquired pleuropneumonia (CPP) is a common complication of pneumonia in children. It is serious given its high morbidity and significant mortality. Aim To study clinical and paraclinical features of CPP in children and to establish a common therapeutic strategy. Methods Our retrospective study included patients who were hospitalized for CPP between 2004 and 2012. All data were collected from patients' medical files. Statistical analysis was made by Epi-Info 6. Results One hundred and sixty four patients were registered. The mean age was 32 months (15 days - 14.5 years). The hospital incidence of CPP doubled between 2004 and 2012. The symptomatology was dominated by fever (93.9%), cough (56.7%) and dyspnea (48.1%). The pleural effusion was frequently moderately abundant and loculated. Pleural sample, performed in 53.6% of cases, was the most beneficial bacteriological examination (p=10-6 ). The bacteriological confirmation was attained in 44.5% of cases with the predominance of Staphylococcus aureus (59%) followed by Streptococcus pneumoniae (26%). The S. aureus occurred basically in most young infants (p=0.04) and was responsible for the most severe cases (p=0.01). The CPP management included heterogeneous intravenous antibiotics associated with a pleural drainage in 40% of cases. The quarter of our patients were transferred to an intensive care unit. Six patients died. Conclusion The bacteriological confirmation is difficult. Pleural aspiration is the key tool. S. aureus is the first microorganism followed by S. pneumoniae. A therapeutic strategy is proposed based on large spectrum intravenous antibiotics. The pleural drainage indication is limited.

Update on bacterial pneumonia and pleuropneumonia in the adult horse.

Bacterial infections of the lower respiratory tract in adult horses occur when bacteria from the nasopharynx reach the lower airways and overwhelm normal defense mechanisms. Although Streptococcus equi subsp zooepidemicus is the most commonly isolated bacterial species, mixed infections are possible. Tracheobronchial aspiration for microbiologic culture and sensitivity is suggested in cases presenting with severe clinical signs or not responding to treatment. Early intervention and appropriate antimicrobial selection results in a good prognosis for both survival and return to athletic function in most horses.

Granulomatous pleuritis caused by histoplasmosis in a healthy child.

Pneumonia with pleuritis is a rare presentation of histoplasmosis infection. We present a 12-year old previously healthy boy in whom histoplasmosis presented with pleuritis, confirmed by detection of antigen in empyema fluid.

[Complementary treatment of pneumonia with pleural effusion]. / Naturheilkundliche Behandlung einer Pleuropneumonie.

A 43-year-old male patient was diagnosed with acute sinistral pleuropneumonia and a pronounced thoracic pain syndrome. Despite of his painful ailments the patient refused antibiotic treatment. A complementary therapy comprising physiotherapy, hydrotherapy, herbal therapy and vitamin C, cupping and QiGong was initiated. A cantharidin blister was applied topically to the left thorax in order to treat the pain syndrome. The multimodal CAM treatment resulted in a rapid clinical and x-ray resolution of pneumonia, and cantharidin treatment effectively relieved pain. The case and the potential of topical cantharidin in pain syndromes are discussed.

Pleuroneumonías pediátricas en Hospital Clínico Regional Valdivia (HCRV): manejo médico-quirúrgico / Clinico-surgical management in children with pleuropneumonia: Hospital Clinico Regional Valdivia experience

Se define pleuroneumonía a las neumonías que presentan compromiso inflamatorio pleural, asociado o no a derrame pleural. Su tratamiento se basa en el empleo juicioso y precoz de antibióticos y/o drenaje pleural, y/o fibrinolíticos; y/o debridación por videotoracoscopía; y/o decorticación por toracotomÍa. El objetivo de nuestro trabajo fue determinar el comportamiento de las pleuroneumonías en HCRV, en pacientes menores de 15 años, caracterizando la clínica, su evolución, tratamientos efectuados y la efectividad de éstos; mediante un estudio descriptivo, retrospectivo de las fichas clínicas con diagnóstico de egreso de Pleuroneumonía en el HCRV, entre enero del 2000 y diciembre del 2005. Se registraron 75 casos de Pleuroneumonía en un número de 6 a 16 casos por año; en edades entre 6 meses y 14 años 10 meses; con predominio del grupo etario Lactantes. Uno de cada cuatro pacientes requirió algún tipo de intervención quirúrgica. Se concluye que las pleuroneumonías si bien son infrecuentes, significan una alta morbilidad para los pacientes y su manejo requiere de protocolos que permitan un actuar oportuno y seguro.

[Severe regional and distant complication of tonsillitis. Case report]. / Ciezkie powiklania regionalne i odlegle zapalenia migdalków podniebiennych. Opis przypadku.

The authors describe a 66-year-old male patient treated for angina that was complicated by para- and retropharyngeal phlegmon, mediastinitis and pleuropneumonia. The role of imaging procedures and bacteriological examination was found especially important in establishing the diagnosis and introducing the right treatment. Efficacy of external (transcutaneus) approach to the para- and retropharyngeal space and phlegmon drainage of these spaces preceded with tracheotomy and tonsillectomy was underlined. Surgical treatment was supplemented with multi-component antibiotic therapy and gammaglobulin administration.

[Lemierre's syndrome: a case report]. / Le syndrome de Lemierre: a propos d'une observation.

We report a case of Lemierre's syndrome with a pleuropulmonary complication. Lemierre's syndrome is a rare etiology of lung abscess. The diagnosis is clinical and microbiological (anaerobic organisms). This syndrome associates an acute oropharyngeal infection with septic thrombophlebitis of the internal jugular vein (sometimes many days before the lung lesion) and pulmonary abscess formation. Clinicians should be aware of this syndrome that is fatal in 10% of patients, usually after delayed or missed diagnosis. The frequency of Lemierre's syndrome would be higher if antibiotics were given only to pharyngitis patients positive for streptococcus.

Interleukin-10 gene therapy-mediated amelioration of bacterial pneumonia.

Respiratory infection by Actinobacillus pleuropneumoniae causes a highly pathogenic necrotizing pleuropneumonia with severe edema, hemorrhage and fever. Acute infection is characterized by expression of inflammatory cytokines, including interleukin-1 (IL-1), IL-6 and IL-8. To determine if high level production of inflammatory cytokines contributed to disease pathogenesis, we investigated if inhibiting macrophage activation with adenovirus type 5-expressed IL-10 (Ad-5/IL-10) reduced the severity of acute disease. Porcine tracheal epithelial cells infected with Ad-5/IL-10 produced bioactive human IL-10. When pigs were intratracheally infected with A. pleuropneumoniae, pigs pretreated with Ad-5/IL-10 showed a significant reduction in the amount of lung damage when compared to adenovirus type 5-expressing beta-galactosidase (Ad-5/beta-Gal)-treated and untreated pigs. In addition, serum zinc levels were unchanged, the lung weight/body weight ratio (an indicator of vascular leakage) was significantly reduced, and lung pathology scores were reduced. Myeloperoxidase activity in lung lavage fluid samples, an indicator of neutrophil invasion, was decreased to levels similar to that seen in pigs not infected with A. pleuropneumoniae. Reduction in inflammatory cytokine levels in lung lavage fluid samples correlated with the clinical observations in that pigs pretreated with Ad-5/IL-10 showed a corresponding reduction of IL-1 and tumor necrosis factor (TNF) compared with untreated and Ad-5/beta-Gal-treated pigs. IL-6 levels were unaffected by pretreatment with Ad-5/IL-10, consistent with observations that IL-6 was not derived from alveolar macrophages. Since inflammatory cytokines are expressed at high levels in acute bacterial pleuropneumonia, these results indicate that macrophage activation, involving overproduction of IL-1 and TNF, is a prime factor in infection-related cases of massive lung injury.

[Pleurisy: diagnostic and therapeutic management]. / Les pleurésies. Conduites diagnostique et thérapeutique.

Diagnosis of pleural effusion is difficult in children. The etiologies are numerous; however, infectious agents are more frequent. Thoracocentesis proves to be the first-line diagnostic tool. Light's criteria are the best for distinguishing whether the effusion is a transudate or an exudate. If the patient has an exudative pleural effusion, other tests are indicated to determine the etiology and in some cases the treatment: macroscopic appearance, cytology and differential white cell count (level of glucose, lactate dehydrogenase, adenosine deaminase, pH, bacterial cultures). Others investigations--biopsy of pleura by thoracoscopy or video-assisted thoracoscopy, bronchofibroscopy, CT scan--are sometimes useful. Intrapleural instillation of urokinase appears to be useful and safe. Evaluation is necessary for video-assisted thoracoscopy used early.

Thoracoscopy in the horse: diagnostic and therapeutic indications in 28 cases.

Thirty-two thoracoscopies were performed in 28 horses. Sixteen horses were affected with pleuropneumonia whereas 12 were affected with various other thoracic conditions. The indications for thoracoscopy was diagnostic in 19 cases, therapeutic in 11 cases and both diagnostic and therapeutic in 2 cases. Twenty-six thoracoscopies were done standing whereas 6 were performed under general anaesthesia. The specific procedures performed during thoracoscopy were exploratory only (7), biopsy of the lung and lymph nodes (10), drain placement into pleural effusions (2) and abscesses (5), exploration prior to thoracotomy (2), transection of pleural adhesions and decortication (1) and window pericardectomy (2). Diaphragmatic hernia repair (2) and partial pneumonectomy (1) were initiated thoracoscopically but conversion to thoracotomy was necessary for completion. Standing thoracoscopy was well tolerated in most horses. Transient exacerbation of pulmonary compromise evidenced by tachypnoea was readily alleviated by reinflation of the lung. Standing thoracoscopy provided good visualisation of the dorsal and lateral structures of the thorax. The ventral thoracic structures and the cranial ventral diaphragmatic surfaces of the lungs were best visualised in dorsal or lateral recumbency under general anaesthesia. Thoracoscopy is a safe and useful diagnostic and therapeutic tool in horses with thoracic diseases.

Prognosis for return to racing after recovery from infectious pleuropneumonia in thoroughbred racehorses: 70 cases (1984-1989).

OBJECTIVE: To determine the percentage of Thoroughbred racehorses that would be capable of racing performance after recovery from infectious pleuropneumonia. DESIGN: Retrospective case series. ANIMALS: 70 Thoroughbred horses that had recovered from pleuropneumonia. Only horses < or = 5 years old and horses > 5 years old known to be in race training at the time of illness were included in the study. RESULTS: Forty-three of the 70 (61%) horses raced after recovery, and 24 of the 43 (56%) won at least 1 race. Horses that required placement of an indwelling thoracic drain apparently did not have a worse prognosis than did horses that did not require placement of a drain. The prognosis for racing for horses that developed pleuropneumonia-associated complications (pulmonary abscess, cranial thoracic mass, bronchopleural fistula) was worse than the prognosis for horses that did not develop these complications. Duration of hospitalization was not considered indicative of outcome. CLINICAL IMPLICATIONS: In Thoroughbreds, the prognosis for return to racing after recovery from uncomplicated pleuropneumonia appears to be good.

Equine pleuropneumonia.

Pleuropneumonia is a clinically important equine disease, predisposed by a number of identifiable factors. Successful management is largely dependent on early identification and prompt initiation of appropriate treatment strategies. Rapid resolution of the disease process is associated with appropriate treatment commenced within 48 h of the causative insult. Lower airway contamination by oropharyngeal organisms and subsequent extension into the pulmonary parenchyma results in respiratory dysfunction and systemic toxaemia. Acute disease is associated with the isolation of facultatively anaerobic organisms, especially beta-haemolytic Streptococcus spp. and Pasteurellaceae. Delayed or inappropriate treatment is likely to result in chronic disease characterized by the involvement of anaerobic bacteria and a poor response to therapy. The primary mode of treatment for anaerobic infection of the human thorax is surgical drainage and resection of necrotic tissue but whilst such techniques have been described for the management of equine pleuropneumonia, the size of the equine thoracic cavity hinders accurate diagnostic evaluation and successful completion of such intervention. The chronic nature and cost of ongoing treatment and limitations on choice of antimicrobial agents warrant a poor prognosis for survival and a poorer prognosis for return to athletic endeavour.

Utilidad de los parámetros bioquímicos en el tratamiento del derrame pleural paraneumónico / Utility of the biochemistry parameter in the treatment of the plural effusion

Los criterios recomendados para el inmediato drenaje con tubo de tórax de pleuroneumonía exudativa son: Empiema, glucosa<40 mg/dl, LDH> 1000 IU/L, Ph<0.7. Se realizó un estudio prospectivo con 20 pacientes con pleuroneumonía exudativa en dos centroa hospitalarios de Caracas. Hospital Vargas y Hospital Periferíco de Catia desde Febrero del 94 hasta Septiembre 94, de los cuales 8 (40 por ciento) tenían almenos un criterio de complicación, 12 (60 por ciento) no cumplieron con ninguno de los criterios de complicación. Ningún paciente ameritó tubo de tórax para su resolución, todos curaron sólo con administración de antibiótico. De las pruebas realizadas sólo la de glucosa (p<0.05) demostró tener diferencia estadísticamente significativa, con una sensibilidad del 40 por ciento y especificidad del 100 por ciento, los demás test no demostraron, en este estudio, ninguna diferencia respecto a los dos grupos. No se estableció diferencia significativa entre días de hospitalización, fiebre, contaje blanco en sangre entre los dos grupos. El 60 por ciento de ls pleuroneumonía tenían como germen causal un gram positivo y 5 por ciento un gram negativo, y en un 35 por ciento no hubo crecimiento bacteriano. Nosotros concluimos que estos criterios son de valor limitado en el tratamiento del pleuroneumonías exudativas

[Treatment of parapneumonic empyema in children]. / Trattamento dell'empiema parapneumonico in età pediatrica.

A 31 case series of pleuropneumonia is presented, in a 7 year period. All patients were treated following same standards consisting of a pleural catheter insertion. Results support conservative treatment: short hospitalization and absence of psychological or physical traumas was achieved. Follow up is very good for all patients and none had invalidating consequences.

[Immunological reactions in acute destructive pneumonia in children]. / Immunologicheskie reaktsii pri ostroi destruktivnoi pnevmonii u detei.

Clinical examinations of 512 children with acute destructive pneumonia have shown high incidence (27.1%) of medicamentous allergic reactions, high level of sensibilization to antigens of the lung tissue. The use of small doses of polyglucin in experiment prevents the appearance of anaphylactic shock, and in patients with a destructive pneumonia it made the incidence of medicamentous allergic reactions 7 times less frequent.