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parapneumonic effusion in pediatrics

Michael C Tracy, Roshni Mathew
PURPOSE OF REVIEW: This review aims to provide clinicians engaged in the care of infants and children an update on the current understanding of the epidemiology, etiology, diagnostic evaluation, and clinical management of complicated pneumonia. The review provides timely information surrounding areas of consensus and ongoing research. RECENT FINDINGS: The epidemiology and etiologies of complicated pneumonia continue to evolve over the past several decades in context of the introduction of new vaccines...
March 9, 2018: Current Opinion in Pediatrics
Tahereh Haji, Adam Byrne, Tom Kovesi
Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015...
March 3, 2018: Children
Enrique Bernaola, Francisco Gil, Mercedes Herranz, Alberto Gil-Setas, Marcela Guevara, Jesus Castilla
OBJECTIVE: The aim was to assess the effect of the non-systematic pneumococcal conjugate vaccine (PCV) on incidence of pneumonia associated with parapneumonic pleural effusion (PPE) in vaccinated and unvaccinated children. METHODS: Cases were patients aged <15 years who had been diagnosed with pneumonia associated with PPE in a tertiary hospital in Navarra (Spain) between 1995 and 2014. The population aged <15 years and covered by the public health service was used as reference...
September 20, 2017: Pediatric Infectious Disease Journal
Vikas Koppurapu, Nikhil Meena
A complex para-pneumonic effusion is a descriptive term for exudative effusions, which complicate or are likely to complicate the anatomy of the pleural space after pneumonia. We performed an online search was performed using the resources PubMed and Google Scholar to provide an update on the management of such effusions based on review of published literature. Search terms including pleural effusion (PE), parapneumonic effusion, and empyema were used. Relevant studies were identified and original articles were studied, compared and summarized...
July 2017: Journal of Thoracic Disease
Annamaria Deganello, Vasileios Rafailidis, Maria E Sellars, Aikaterini Ntoulia, Kleanthi Kalogerakou, Gary Ruiz, David O Cosgrove, Paul S Sidhu
Pediatric pneumonia can be complicated by necrotizing pneumonia or a parapneumonic effusion either in the form of an empyema or a clear effusion. Ultrasonography (US) and computed tomography represent well-established modalities for evaluation of complicated pediatric pneumonia. Contrast-enhanced ultrasound (CEUS) was recently introduced and is gaining increasing acceptance in pediatric imaging. In this case series, we present our initial experience with both intravenous and intracavitary use of CEUS in children with complicated pneumonia...
September 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Guilherme E Peterson, Samanta S Silva, Sérgio L Amantéa, Patrícia Miorelli, Paulo Sanches, Jane Kulczynski, Eliane Roesch, José Carlos Fraga
BACKGROUND: Pleural empyema is a well-known complication of pneumonia. If treatment is delayed, empyema may increase morbidity and mortality in affected patients. Therefore, the identification of empyema biomarkers in parapneumonic pleural effusion is desirable. Previous research has suggested complement activation products as candidate empyema markers. OBJECTIVE: To compare the levels of complement activation products C3a, C5a, and C5b9 in pleural effusion induced by Staphylococcus aureus (SA), Streptococcus pneumoniae (SP), or turpentine (control)...
June 2017: Pediatric Pulmonology
Charles A James, Leah E Braswell, Amir H Pezeshkmehr, Paula K Roberson, James A Parks, Mary B Moore
BACKGROUND: Complicated pleural effusion prolongs the hospital course of pneumonia. Chest tube placement with instillation of fibrinolytic medication allows efficient drain output and decreases hospital stay. OBJECTIVE: To evaluate experience with lower fibrinolytic dose for parapneumonic effusions and to assess potential dose stratification based on a simple ultrasound grading system. MATERIALS AND METHODS: We retrospectively reviewed the medical record to identify children and young adults who received fibrinolytic therapy for parapneumonic effusion and had chest tube placement by an interventional radiology service at a single children's hospital...
January 2017: Pediatric Radiology
Florian J Segerer, Karin Seeger, Anna Maier, Christine Hagemann, Christoph Schoen, Mark van der Linden, Andrea Streng, Markus A Rose, Johannes G Liese
OBJECTIVE: To evaluate the initial management of pediatric parapneumonic effusion or pleural empyema (PPE/PE) with regard to length of hospital stay (LOS). METHODS: Collection of pediatric PPE/PE cases using a nationwide surveillance system (ESPED) from 10/2010 to 06/2013, in all German pediatric hospitals. Inclusion of PPE/PE patients <18 years of age requiring drainage or with a PPE/PE persistence >7 days. Staging of PPE/PE based on reported pleural sonographic imaging...
April 2017: Pediatric Pulmonology
Jonathan Strutt, Anupam Kharbanda
Pediatric thoracostomy procedures are used in the emergency department to treat diseases of the pleural space. As children have unique thoracic anatomy and physiology, they may present with management challenges that the emergency clinician must consider. This issue reviews the use of chest tubes and pigtail catheters in pediatric patients, techniques and indications for placement, and possible complications. Diagnostic and treatment options for diseases of the pleural space, such as spontaneous pneumothorax, traumatic injury, and parapneumonic effusions/empyema, are examined...
November 2015: Pediatric Emergency Medicine Practice
Gaudenz M Hafen, Andrea-Claudia Grenzbach, Alexander Moeller, Mascha K Rochat
Treatment of parapneumonic effusion in children remains controversial in the literature and in clinical practice. The aim of this study was to determine whether mutual consensus exists in the diagnosis and treatment of parapneumonic effusion in Central European countries. A questionnaire was sent to all directors of pediatric respiratory units in four adjacent Central European countries (Austria, France, Germany, Switzerland). The response rate was 61.8%. Responses reflected acceptable agreement regarding initial diagnostic procedures, as most centers performed chest X-ray and biological exams, followed by ultrasound, thoracocentesis, or computed tomography...
April 2016: Pediatric Pulmonology
Y-H Wu, G-W Zhao, X-F Wang, M-S Wang
OBJECTIVE: Pleural effusion (PE) adenosine deaminase (ADA) has good performance in detection of tuberculous pleural effusion (TPE). However, few study was conducted for its value in pediatric patients. To evaluate PE ADA in diagnosis of pediatric TPE, a retrospective study was performed. PATIENTS AND METHODS: 204 pediatric PE patients were enrolled, and then were grouped into TPE group (77 cases, aged 11.51 ± 0.40 years) and non-TPE group (127 cases, aged 6.39 ± 0...
2015: European Review for Medical and Pharmacological Sciences
Jessica L Taylor, Meixia Liu, David S Hoff
OBJECTIVES: Medical treatment of complicated parapneumonic effusion or empyema in pediatric patients includes antibiotics and pleural space drainage. Intrapleural fibrinolysis may facilitate pleural drainage; however, there is a lack of consensus regarding the optimal dosing regimen. The primary purpose of this study was to evaluate the efficacy and safety of a large-dose intrapleural alteplase regimen in pediatric patients. Secondarily, this investigation sought to differentiate the clinical characteristics of responders and non-responders to intrapleural alteplase therapy...
March 2015: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Sheila J Hanson, Peter L Havens, Pippa M Simpson, Melodee L Nugent, Robert G Wells
OBJECTIVE: In this prospective, double-blind, randomized crossover trial, we determined the effect of intrapleural fibrinolysis with alteplase compared to that of normal saline irrigation on the thoracostomy tube output and pleural effusion volume in children with complicated parapneumonic effusion. METHODS: Twenty seven children, median age 3.5 years, referred to the interventional radiology service for thoracostomy tube drainage of a parapneumonic effusion were studied...
December 2015: Pediatric Pulmonology
Jeffrey M Pernica, Ioana Moldovan, Francis Chan, Robert Slinger
BACKGROUND: Community-acquired pneumonia (CAP) complicated by parapneumonic effusion/empyema is an infectious syndrome commonly encountered by physicians caring for children in Canada. OBJECTIVE: To investigate the incremental benefit of novel molecular testing for the microbiological diagnosis of pediatric CAP complicated by parapneumonic effusion/empyema in Canada. METHODS: A convenience sample of pleural fluid from 56 children who had been admitted to hospital in Ontario with CAP complicated by parapneumonic effusion between 2009 and 2011 was examined...
May 2014: Canadian Journal of Infectious Diseases & Medical Microbiology
Robert Slinger, Lucie Hyde, Ioana Moldovan, Francis Chan, Jeffrey M Pernica
BACKGROUND: To determine the serotypes of Streptococcus pneumoniae responsible for pneumonia complicated by parapneumonic effusion in children, we performed real-time PCR based pneumococcal "serotyping" directly on parapneumonic fluid samples. METHODS: Specimens were collected at two children's hospitals in Ontario, Canada from 2009 to 2011. Samples in which S. pneumoniae was detected by PCR were tested with serotype-specific 5'exonuclease PCR assays for the 13 serotypes contained in the 13-serotype pneumococcal vaccine...
July 24, 2014: BMC Pediatrics
Francesca Reali, Giuseppe Francesco Sferrazza Papa, Paolo Carlucci, Paola Fracasso, Fabiano Di Marco, Marzia Mandelli, Simone Soldi, Enrica Riva, Stefano Centanni
BACKGROUND: Lung ultrasound is a non-radiating accurate alternative tool to chest X-ray (CXR) in the diagnosis of community-acquired pneumonia (CAP) in adults. OBJECTIVES: The aim of our study was to define the accuracy of ultrasound in the diagnosis of CAP in children. METHODS: 107 consecutive children with suspected CAP underwent clinical examination, blood sample analysis, CXR and lung ultrasound on admission to the Pediatric Department of the San Paolo Hospital...
2014: Respiration; International Review of Thoracic Diseases
G Di Napoli, M Ronzini, G Paradies
Pneumonia is a common cause of pediatric hospitalization and almost 50% of children hospitalized for pneumonia develops meta pneumonic pleural effusion, most of which resolve spontaneously (1). The meta pneumonic effusion remains a major source of morbidity and mortality in the pediatric population and is a complication on the rise in both the U.S. (2) and Europe (3-6). There is no uniformity of treatment of the meta pneumonic effusion in its early stages and are still questioning some aspects of proper management, remains uncertain and not always shared the operative timing (7)...
May 2014: Il Giornale di Chirurgia
A Le Mée, C Mordacq, M Lagrée, A Deschildre, A Martinot, F Dubos
AIM: This study sought to evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals. METHODS: A nationwide survey of all 35 university hospitals took place in 2011 to assess practices for children with parapneumonic effusion, using a hypothetical clinical vignette and a standardised questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results and subsequent course...
September 2014: Acta Paediatrica
Kalliopi Kontouli, Elpis Hatziagorou, Fotis Kyrvasilis, Emmanuel Roilides, Maria Emporiadou, John Tsanakas
OBJECTIVES: a: To evaluate the long-term outcome of parapneumonic effusions (PPE) in children regarding lung function and exercise tolerance, (b) to investigate the role of bronchial asthma in the outcome of PPE. METHODS: The design of the study included 51 children with PPE, at least 2 years after the initial infection. They were divided in two groups. Group A (38 children) consisted of children with PPE but without asthma prior initial infection. Group B (13 children) included children with PPE and asthma prior infection...
June 2015: Pediatric Pulmonology
Koen Huysentruyt, Philippe Alliet, Marc Raes, Julie Willekens, Iris De Schutter, Elke De Wachter, Anne Malfroot, Thierry Devreker, Philippe Goyens, Yvan Vandenplas, Jean De Schepper
BACKGROUND & AIMS: Among children hospitalized for pneumonia, those with parapneumonic effusion (PPE) are at particular risk for nutritional deterioration. This study aimed to 1) investigate the evolution of the nutritional status during hospitalization and at outpatient follow-up; 2) determine clinical risk factors for weight loss during hospitalization; 3) describe the nutritional interventions for these children. METHODS: Retrospective chart review (January '07 - September '12) of 56 children with pneumonia, complicated by PPE in two Belgian hospitals for data on body weight and height at admission (t0) and discharge (t1), and two weeks (t2) and one month (t3) after discharge...
2014: PloS One
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