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The microbiological diagnosis of pleural effusion is based largely on classical microbiology methods, but these methods have a high rate of false negative results. Some previous studies have shown improved diagnostic performance for pathogens such as Streptococcus pneumoniae using molecular biology methods. We present the use of a multiplex PCR platform (BIOFIRE FILMARRAY Pneumonia Panel) for the aetiological diagnosis of pleural effusion in paediatric pneumonia. We present a case series of 17 pleural fluid samples that were processed by culture-based microbiology and molecular biology methods. Microbiological isolation was successful in four cases (25â%) through traditional culture methods. In contrast, the molecular biology panels allowed for detection in 16 out of 17 cases (94â%). The results from these panels led to a change in management for nine out of the 17 cases (52â%). This study found an increase in aetiological diagnosis in complicated pneumonia in children by using molecular biology methods, which led to a significant change in patient management.
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BACKGROUND: Pleural empyema secondary to a ruptured amoebic liver abscess is a rare complication in the pediatric population. CASE REPORT: We report the case of a 13-year-old male with right flank abdominal pain, productive cough with foul-smelling sputum, fever, and respiratory distress. Physical examination revealed breathlessness, decreased vesicular murmur in the right hemithorax, abdominal distension, hepatomegaly, and lower limb edema. Laboratory tests revealed mild anemia, leukocytosis without eosinophilia, elevated alkaline phosphatase, hypoalbuminemia, and positive immunoglobulin G antibodies against Entamoeba histolytica in pleural fluid. He required a chest tube and treatment with metronidazole. After 2 months of follow-up, the abscesses disappeared, and the empyema decreased. CONCLUSIONS: Massive pleural empyema secondary to a ruptured liver abscess is a rare complication. The epidemiological link associated with the symptoms and serological tests can help in the diagnosis.
INTRODUCCIÓN: El empiema pleural secundario a ruptura de absceso amebiano hepático es una complicación poco frecuente en la población pediátrica. CASO CLÍNICO: Se reporta el caso de un paciente de sexo masculino de 13 años que presentó dolor abdominal en flanco derecho, tos productiva con esputo de mal olor, fiebre y dificultad respiratoria. Al examen físico se encontró amplexación y murmullo vesicular disminuido en hemitórax derecho, distensión abdominal, hepatomegalia y edema de miembros inferiores. Los resultados del laboratorio evidenciaron anemia leve, leucocitosis sin eosinofilia, elevación de fosfatasa alcalina, hipoalbuminemia y anticuerpos IgG contra Entamoeba histolytica positivo en líquido pleural. Requirió tubo de drenaje torácico y tratamiento con metronidazol. A los dos meses de seguimiento los abscesos desaparecieron y el empiema disminuyó. CONCLUSIONES: El empiema pleural masivo secundario a ruptura de absceso hepático es una complicación poco frecuente. El nexo epidemiológico asociado con la sintomatología y pruebas serológicas pueden ser de ayuda en el diagnóstico.
Assuntos
Empiema Pleural , Abscesso Hepático Amebiano , Criança , Masculino , Humanos , Adolescente , Abscesso Hepático Amebiano/complicações , Abscesso Hepático Amebiano/diagnóstico , Empiema Pleural/diagnóstico , Empiema Pleural/etiologia , Abscesso , Dor AbdominalRESUMO
Abstract Background: Pleural empyema secondary to a ruptured amoebic liver abscess is a rare complication in the pediatric population. Case report: We report the case of a 13-year-old male with right flank abdominal pain, productive cough with foul-smelling sputum, fever, and respiratory distress. Physical examination revealed breathlessness, decreased vesicular murmur in the right hemithorax, abdominal distension, hepatomegaly, and lower limb edema. Laboratory tests revealed mild anemia, leukocytosis without eosinophilia, elevated alkaline phosphatase, hypoalbuminemia, and positive immunoglobulin G antibodies against Entamoeba histolytica in pleural fluid. He required a chest tube and treatment with metronidazole. After 2 months of follow-up, the abscesses disappeared, and the empyema decreased. Conclusions: Massive pleural empyema secondary to a ruptured liver abscess is a rare complication. The epidemiological link associated with the symptoms and serological tests can help in the diagnosis.
Resumen Introducción: El empiema pleural secundario a ruptura de absceso amebiano hepático es una complicación poco frecuente en la población pediátrica. Caso clínico: Se reporta el caso de un paciente de sexo masculino de 13 años que presentó dolor abdominal en flanco derecho, tos productiva con esputo de mal olor, fiebre y dificultad respiratoria. Al examen físico se encontró amplexación y murmullo vesicular disminuido en hemitórax derecho, distensión abdominal, hepatomegalia y edema de miembros inferiores. Los resultados del laboratorio evidenciaron anemia leve, leucocitosis sin eosinofilia, elevación de fosfatasa alcalina, hipoalbuminemia y anticuerpos IgG contra Entamoeba histolytica positivo en líquido pleural. Requirió tubo de drenaje torácico y tratamiento con metronidazol. A los dos meses de seguimiento los abscesos desaparecieron y el empiema disminuyó. Conclusiones: El empiema pleural masivo secundario a ruptura de absceso hepático es una complicación poco frecuente. El nexo epidemiológico asociado con la sintomatología y pruebas serológicas pueden ser de ayuda en el diagnóstico.
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Se presenta el caso de un paciente joven inmunocompetente, con antecedente de tuberculosis pulmonar, que acude al hospital por un cuadro clínico subagudo de fiebre persistente, baja de peso, disnea y abolición del murmullo vesicular. La tomografía de tórax mostró un extenso empiema en hemitórax izquierdo. Se le toman muestras para detección de gérmenes comunes y se le colocan un tubo de drenaje torácico y se inicia antibioticoterapia. La prueba de MALDI-TOF MS identificó a Parvimonas micra, una bacteria anaerobia, comensal de la flora oral, asociado a periodontitis severa, escasamente reportado en empiema pleural, especialmente, en personas inmunocompetentes. En la evaluación odontológica se realizó el diagnóstico de gingivitis y pericoronaritis de la tercera molar. El paciente evolucionó favorablemente. Se sugiere que, en casos de empiemas pleurales subagudos o crónicos, se debe considerar, además de las micobacterias, como agente etiológico al Parvimonas micra, y optar por exámenes como MALDI-TOF MS o secuenciamiento del 16S rRNA, colocación de tubo de tórax, cobertura antibiótica empírica y evaluación odontológica.
We present the case of a young immunocompetent patient, with a history of pulmonary tuberculosis, who attended the hospital with a subacute clinical picture of persistent fever, weight loss, dyspnea and abolition of vesicular murmur. Chest CT scan showed an extensive empyema in the left hemithorax. Samples were taken for detection of common germs. Then, a chest drainage tube was placed and antibiotic therapy started. The MALDI-TOF MS test identified Parvimonas micra, an anaerobic bacterium, commensal to the oral flora, associated with severe periodontitis, but rarely reported in cases of pleural empyema, especially in immunocompetent patients. Gingivitis and pericoronaritis of the third molar were diagnosed during oral evaluation. The patient progressed favorably. Parvimonas micra should be considered as a possible etiological agent in cases of subacute or chronic pleural empyema, in addition to mycobacteria. Tests such as MALDI-TOF MS or 16S rRNA sequencing, chest tube placement, empirical antibiotic coverage and an adequate oral evaluation should be considered in these cases.
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Humanos , Masculino , PeriodontiteRESUMO
Introducción: la neumonía es la principal causa de derrame pleural (DP) en los niños. Un elevado número de los pacientes ingresan a las unidades de cuidados intensivos pediátricos con derrame pleural paraneumónico (DPP), terminando en el empiema pleural. Objetivo: identificar los factores de riesgo que influyen de forma independiente en la aparición de neumonía adquirida en la comunidad, complicada con empiema pleural. Métodos: se realizó un estudio observacional analítico de casos y controles, se seleccionaron 30 casos y 90 controles. Con una proporción de 1:3. Se realizó el análisis estadístico univariado y multivariado. Resultados: en el análisis univariado, la edad menor de 5 años y el sexo masculino se mostraron sin influencia estadísticamente significativa, mientras que el multivariado mostró que el factor con independencia más importante fue el uso previo de antimicrobiano (OR 6,329 ajustado IC 95% 2,764-8,678), seguido del diagnóstico tardío (OR ajustado 5,492IC 95% 2,559-8,522) y la presencia de comorbilidad (OR ajustado 4,341 IC 95% 2,321−7,529) de manera similar. Conclusiones: los factores de mayor riesgo que contribuyeron al riesgo de desarrollar la neumonía complicada con empiema pleural fueron el uso previo de antimicrobiano, el diagnóstico tardío de empiema y la presencia de comorbilidad.
Introduction: pneumonia is the main cause of pleural effusion (PE) in children. A high number of patients enter pediatric intensive care units with parapneumonic pleural effusion (PPE), ending in pleural empyema. Objective: to identify the risk factors that independently influences the occurrence of community-acquired pneumonia, complicated by pleural empyema. Methods: an analytical observational study of cases and controls was carried out, 30 cases and 90 controls were selected. With a ratio of 1:3. Univariate and multivariate statistical analysis was performed. Results: in the univariate analysis, age under 5 years and male sex showed no statistically significant influence, while the multivariate analysis showed that the most important independent factor was the previous use of antimicrobial (OR 6.329 adjusted CI 95% 2.764-8.678), followed by late diagnosis (adjusted OR 5.492 CI 95% 2.559-8.522) and the presence of comorbidity (adjusted OR 4.341 CI 95% 2.321−7.529) similarly. Conclusions: the highest risk factors that contributed to the risk of developing pneumonia complicated with pleural empyema were previous use of antimicrobials, late diagnosis of empyema, and the presence of comorbidity.
Introdução: A pneumonia é a principal causa de derrame pleural (DP) em crianças. Um número elevado de pacientes é admitido em unidades de terapia intensiva pediátrica com derrame pleural parapneumônico (DPP), terminando em empiema pleural. Objetivo: Identificar os fatores de risco que influenciam independentemente a ocorrência de pneumonia adquirida na comunidade complicada por empiema pleural. Métodos: Foi realizado um estudo observacional analítico caso-controle, selecionados 30 casos e 90 controles. Com uma proporção de 1:3. Foram realizadas análises estatísticas univariada e multivariada. Resultados: Na análise univariada, idade menor de 5 anos e sexo masculino não foram estatisticamente significativos, enquanto a análise multivariada mostrou que o fator independente mais importante foi o uso prévio de antimicrobianos (OR ajustado 6,329 IC 95% 2,764-8,678), seguido pelo diagnóstico tardio (OR ajustado 5,492 IC 95% 2,559-8,522) e presença de comorbidade (OR ajustado 4,341 IC 95% 2,321−7, 529) da mesma forma. Conclusões: Os maiores fatores de risco que contribuíram para o desenvolvimento de pneumonia complicada com empiema pleural foram o uso prévio de antimicrobianos, o diagnóstico tardio de empiema e a presença de comorbidade.
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La Organización Mundial de la Salud (OMS) informa que ocurren 1.1 millones de casos de tuberculosis (TBC) en niños <15 años. En Chile se observa un aumento de casos en el tiempo. La pandemia por SARS-Cov2 ha implicado una disminución de la pesquisa y un retardo de la atención y diagnóstico de TBC. Se presenta dos casos clínicos de tuberculosis en adolescentes. El primero corresponde a un adolescente con una tuberculosis pulmonar de difícil y tardío diagnóstico, habiéndose descartado inicialmente TBC por estudio molecular y PPD no reactivo. El segundo caso corresponde a un adolescente con una tuberculosis pulmonar y extrapulmonar de diagnóstico tardío, de 8 meses de evolución, posterior a un cuadro leve de Covid.
The World Health Organization (WHO) reports that 1.1 million cases of tuberculosis (TB) occur in children <15 years of age. In Chile, an increase in cases is observed over time. The SARS-Cov2 pandemic has led to a decrease in screening and a delay in care and diagnosis of TB. Two clinical cases of tuberculosis in adolescents are presented. The first corresponds to an adolescent with TB of difficult and late diagnosis, having initially ruled out TB by molecular study and non-reactive PPD. The second case corresponds to an adolescent with pulmonary and extrapulmonary tuberculosis of late diagnosis, of 8 months of evolution, after a mild respiratory infection of Covid.
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Humanos , Masculino , Feminino , Adolescente , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Extrapulmonar/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Empiema Pleural/diagnóstico por imagem , Diagnóstico Diferencial , Diagnóstico TardioRESUMO
INTRODUCTION: Boerhaave syndrome consists of a spontaneous perforation of the esophagus, with high mortality. OBJECTIVE: To describe a case with Boerhaave syndrome with double esophageal perforation. CASE REPORT: 33-year-old female who came to the hospital for emetic symptoms, followed by retrosternal chest pain; chest drainage is performed. Esophageal perforation was diagnosed late and he was transferred to a tertiary level institution. Successive treatments were performed: videothoracoscopy and pleural decortication; alimentary jejunostomy; esophageal stent placement, diagnosis of new perforation, pyloric exclusion, new stent placement, and esophageal exclusion. CONCLUSIONS: The delay in diagnosis contributed to the fatal outcome of the patient.
INTRODUCCIÓN: El síndrome de Boerhaave consiste en una perforación espontánea del esófago, con alta mortalidad. OBJETIVO: Describir un caso de síndrome de Boerhaave con doble perforación esofágica. CASO CLÍNICO: Mujer de 33 años que acude al hospital por un cuadro emético, seguido de dolor torácico retroesternal; se realiza drenaje torácico. Se diagnostica tardíamente perforación esofágica y se traslada a una institución de nivel terciario. Se realizaron sucesivos tratamientos: videotoracoscopia y decorticación pleural, yeyunostomía alimentaria, colocación de endoprótesis esofágica, diagnóstico de nueva perforación, exclusión pilórica, colocación de nueva endoprótesis y exclusión esofágica. CONCLUSIONES: El retardo en el diagnóstico contribuyó al desenlace fatal de la paciente.
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Perfuração Esofágica , Doenças do Mediastino , Adulto , Dor no Peito , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Feminino , Humanos , Masculino , Doenças do Mediastino/complicações , Doenças do Mediastino/cirurgia , Ruptura EspontâneaRESUMO
El tratamiento quirúrgico del empiema ha evolucionado, desde la medicina hipocrática, a través de los años, teniendo como premisa el drenaje. Con los avances médicos, el abordaje mínimamente invasivo se ha convertido en el estándar, dejando de lado otras técnicas quirúrgicas. La toracostomía abierta, en pacientes seleccionados, puede llegar a ser la última y mejor opción para el control del foco infeccioso: es una opción quirúrgica para el tratamiento de los empiemas en pacientes mórbidos y en fase de organización, cuando otros tratamientos han fallado, con una aceptable morbilidad y mortalidad. Esta técnica debe estar en el arsenal terapéutico del cirujano. Presentamos una serie de 4 casos de pacientes con empiema en fase de organización, en los cuales el riesgo quirúrgico era muy alto, por lo que se optó por realizar una toracostomía abierta, con éxito
The surgical treatment of empyema has evolved from Hippocratic medicine over the years, with drainage as its premise. With medical advances, the minimally invasive approach has become the standard, leaving aside other surgical techniques. Open thoracostomy, in selected patients, may become the last and best option for the control of the infectious focus: it is a surgical option for the treatment of empyemas in morbid patients and in the organization phase when other treatments have failed, with an acceptable morbidity and mortality. This technique should be in the surgeon's therapeutic arsenal. We present a series of four cases of patients with empyema in the organization phase, in which the surgical risk was very high, so it was decided to perform an open thoracostomy, which turn out successful
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Humanos , Toracotomia , Cirurgia Torácica , Empiema Pleural , Cirurgia Torácica VídeoassistidaRESUMO
El género Gemella spp corresponde a cocos gram positivos, anaerobios facultativos, catalasa negativos, no móviles y no formadores de esporas, usualmente comensales de la cavidad oral, que no suelen ser patógenos en pacientes inmunocompetentes. Sin embargo, puede comportarse como germen oportunista en pacientes inmunosuprimidos o con otros factores de riesgo como mala higiene dental, cirugía gastrointestinal, enfermedades metabólicas entre otras, y se asocia con endocarditis, meningitis y en menor medida compromiso pulmonar. La información respecto a la susceptibilidad antimicrobiana es limitada y se asemeja a la de S viridans, por lo que la penicilina y ampicilina son los medicamentos de elección, sin tener claridad en cuanto a duración del tratamiento, usualmente considerando llevar a 4 semanas o hasta el drenaje de la colección. Éste reporte de caso describe una paciente con tuberculosis en tratamiento, que desarrolla una infección invasiva con documentación de empiema y bacteriemia secundaria por Gemella morbillorum, representando la asociación poco común de ésta infección bacteriana con tuberculosis.
Gemella spp. corresponds to gram positive cocci, facultative anaerobes, negative catalase, non mobile and non spore producers, part of colonizing flora of the oral cavity that are not common pathogens in immunocompetent patients. Nevertheless it may behave as an opportunistic germ in immunosuppressed patients or with other risk factors that include bad dental hygiene, bowel surgery, and metabolic diseases among others. It's associated with infections such as endocarditis, meningitis and less frecuently can implicate the lung. The information regarding antimicrobial susceptibility is limited and resembles S viridans, so penicillin and ampicillin are the medications of choice, without being clear about the duration of treatment, usually giving 4 weeks or until collection drain. This case report describes a patient with known tuberculosis diagnosis and under treatment, that develops an invasive infection with empyema and secondary bloodstream infection by Gemella morbillorum, depicting a previously uncommon but described association of this bacterial infection with tuberculosis.
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Humanos , Feminino , Idoso , Tuberculose , Cocos Gram-Positivos , Gemella , Infecções Bacterianas , Fatores de Risco , Bacteriemia , Sepse , Empiema , Ampicilina , InfecçõesRESUMO
ABSTRACT Objective: To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy. Case description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Pleural fluid cultures grew Streptococcus anginosus. On day 11, the child had a clinical deterioration with recurrence of fever, hypoxia, and respiratory distress. At this point, considering the causative agent, he was submitted to video-assisted thoracoscopic decortication, with good progress thereafter. Comments: Streptococcus anginosus is a commensal bacterium of the human oral cavity capable of causing severe systemic infections. Although reports of complicated thoracic infections with this agent are rare in the pediatric population, they have been increasing in adults. Streptococcus anginosus has a high capacity to form abscess and empyema, requiring different therapeutic approaches when compared to complicated pneumonia caused by other agents.
RESUMO Objetivo: Alertar para a patogenicidade do Streptococcus anginosus que, apesar de raro em pediatria, pode causar infeções graves que necessitam de tratamento invasivo e antibioterapia de longo curso para obter um melhor prognóstico. Descrição do caso: Criança de seis anos, com atraso do desenvolvimento psicomotor, avaliado no serviço de urgência por febre e dificuldade respiratória. O exame físico, juntamente com os exames complementares, revelou uma pneumonia complicada com empiema no hemitórax esquerdo, tendo iniciado antibioterapia e sido submetido à drenagem do líquido pleural. Foi identificado Streptococcus anginosus nesse líquido. No 11º dia de doença, a criança agravou o seu estado clínico, com recidiva da febre, hipoxemia e dificuldade respiratória. Considerando-se o microrganismo identificado, o paciente foi submetido à decorticação pulmonar por videotoracoscopia, com boa evolução clínica posterior. Comentários: Streptococcus anginosus é uma bactéria comensal da cavidade oral humana, que pode causar infecções sistêmicas graves. Apesar de serem raros os casos descritos em pediatria, têm sido cada vez mais descritas infecções torácicas complicadas em adultos. Esse microrganismo também tem a capacidade de formar abcessos e empiemas, que precisam de intervenções terapêuticas diferentes, quando comparados a pneumonias complicadas causadas por outros agentes.
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Humanos , Masculino , Criança , Infecções Estreptocócicas/complicações , Empiema Pleural/microbiologia , Pneumonia Bacteriana/microbiologia , Streptococcus anginosus , Infecções Estreptocócicas/terapia , Infecções Estreptocócicas/diagnóstico por imagem , Drenagem , Empiema Pleural/terapia , Empiema Pleural/diagnóstico por imagem , Pneumonia Bacteriana/terapia , Pneumonia Bacteriana/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida , Transtornos do Neurodesenvolvimento/complicações , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: Previous publications have proved the effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal pleural empyema (PnPE) in children, with little emergence of other pathogens. We searched the literature to establish whether PCV13 reduces PnPE, and to identify other pathogens causing pleural empyemas (PEs). MATERIAL AND METHODS: From October 2005 to January 2018 (12.3 years) we performed active surveillance for all cases of PE at the General Hospital of Tijuana, Mexico. Isolates from pleural fluid (PF) were identified by conventional culture, and since 2014, polymerase chain reaction (PCR) was added for all culture-negative PFs. Streptococcus pneumoniae serotypes were detected by either Quellung reaction (Statens Serum Institute®) or PCR. Clinical, imagenological, laboratorial and microbiological evaluation was performed on each patient. Statistical analysis was purely descriptive. RESULTS: A total of 64 PEs were identified (5.28/year). Median age was 51 months (1-191), hospitalization days 18 (4-35). Decortication was performed in 42%, and two children died (3.2%). Bacterial identification was obtained from 51 (80%). S. pneumoniae was the leading cause (29 = 56.8%), followed by Staphylococcus aureus (14 = 27.4%), Streptococcus pyogenes (3-5 = 9%) and others (5 = 9.8%). PCV13 was initiated in May 2012, and its impact on serotype-specific PnPE was 81% (much fewer than serotype 3) and for all PnPE 56.1%; however, for all PE -2.1% due to an increase of PE caused by S. aureus for all but one methicillin-resistant S. aureus (MRSA). CONCLUSIONS: Following 12.3 years of active surveillance, PCV13 has shown impact on both serotype-specific and all PnPEs; however, an increase of PEs by MRSA has emerged. Continuous surveillance is crucial to establish whether this epidemiological finding is transitory or not.
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OBJECTIVE: To evaluate trends in procedures used to treat children hospitalized in the US with empyema during a period that included the release of guidelines endorsing chest tube placement as an acceptable first-line alternative to video-assisted thoracoscopic surgery. STUDY DESIGN: We used National Inpatient Samples to describe empyema-related discharges of children ages 0-17 years during 2008-2014. We evaluated trends using inverse variance weighted linear regression and characterized treatment failure using multivariable logistic regression to identify factors associated with having more than 1 procedure. RESULTS: Empyema-related discharges declined from 3 in 100 000 children to 2 in 100 000 during 2008-2014 (P = .04, linear trend). There was no significant change in the proportion of discharges having 1 procedure (66.1% to 64.1%) or in the proportion having 2 or more procedures (22.1% to 21.6%). The proportion coded for video-assisted thoracoscopic surgery as the only procedure declined (41.4% to 36.2%; P = .03), and the proportions coded for 1 chest tube (14.6% to 20.9%; P = .04) and 2 chest tube procedures (0.9% to 3.5%; P < .01) both increased. The median length of stay for empyema-related discharges remained unchanged (9.3 days to 9.8 days; P = .053). Having more than 1 procedure was associated with continuous mechanical ventilation (adjusted OR, 2.7; 95% CI, 1.8-4.1) but not with age, sex, payer, chronic conditions, transfer admission, hospital size, or census region. CONCLUSIONS: The use of video-assisted thoracoscopic surgery to treat children in the US hospitalized with empyema seems to be decreasing without associated increases in length of stay or need for additional drainage procedures.
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Empiema Pleural/cirurgia , Hospitalização/estatística & dados numéricos , Tempo de Internação/tendências , Cirurgia Torácica Vídeoassistida/tendências , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Gerenciamento Clínico , Drenagem/métodos , Drenagem/estatística & dados numéricos , Empiema Pleural/diagnóstico por imagem , Empiema Pleural/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Pacientes Internados/estatística & dados numéricos , Modelos Logísticos , Masculino , Análise Multivariada , Alta do Paciente/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Estados UnidosRESUMO
Abstract Objectives To evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage. Methods The medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Patients were divided into two groups: in group 1, videothoracoscopic surgery was performed as the initial procedure; in group 2, videothoracoscopic surgery was performed after previous chest tube drainage. Results Videothoracoscopic surgery was effective in 73 children (92.4%); the other six (7.6%) needed another procedure. Sixty patients (75.9%) were submitted directly to videothoracoscopic surgery (group 1) and 19 (24%) primarily underwent chest tube drainage (group 2). Primary videothoracoscopic surgery was associated with a decrease of hospital stay (p = 0.05), time to resolution (p = 0.024), and time with a chest tube (p < 0.001). However, there was no difference between the groups regarding the time until fever resolution, time with a chest tube, and the hospital stay after videothoracoscopic surgery. No differences were observed between groups regarding the need for further surgery and the presence of complications. Conclusions Videothoracoscopic surgery is a highly effective procedure for treating children with complicated parapneumonic pleural effusion. When videothoracoscopic surgery is indicated in the presence of loculations (stage II or fibrinopurulent), no difference were observed in time of clinical improvement and hospital stay among the patients with or without chest tube drainage before videothoracoscopic surgery.
Resumo Objetivos Avaliar a eficácia da cirurgia torácica videoassistida no tratamento de derrame pleural parapneumônico complicado e determinar se há diferença no resultado da cirurgia torácica videoassistida realizada antes ou depois da drenagem torácica. Métodos Analisamos retrospectivamente prontuários médicos de 79 crianças (idade média de 35 meses) submetidas a cirurgia torácica videoassistida de janeiro de 2000 a dezembro de 2011. O mesmo algoritmo de tratamento foi utilizado no manejo de todos os pacientes. Os pacientes foram divididos em dois grupos: o Grupo 1 foi submetido a cirurgia torácica videoassistida como procedimento inicial; o Grupo 2 foi submetido a cirurgia torácica videoassistida após drenagem torácica prévia. Resultados A cirurgia torácica videoassistida foi eficaz em 73 crianças (92,4%); as outras seis (7,6%) necessitaram outro procedimento. Sessenta pacientes (75,9%) foram diretamente submetidos a cirurgia torácica videoassistida (Grupo 1) e 19 (24%) foram primeiramente submetidos a drenagem torácica (Grupo 2). A cirurgia torácica videoassistida primária foi associada à redução do tempo de internação (p = 0,05), do tempo para resolução (p = 0,024) e do tempo com o tubo torácico (p < 0,001). Contudo, não houve diferença entre os grupos a respeito do tempo até que não tivessem mais febre, do tempo com o tubo torácico e do tempo de internação após a cirurgia torácica videoassistida. Não foram observadas diferenças entre os grupos com relação à necessidade de cirurgia adicional e à presença de complicações. Conclusões A cirurgia torácica videoassistida é um procedimento altamente eficaz para tratar crianças com derrame pleural parapneumônico complicado. Quando a cirurgia torácica vídeoassistida é indicada na presença de loculações (fase II ou fibrinopurulenta) não há diferença no tempo de melhora clínica e no tempo de internação entre os pacientes com ou sem drenagem torácica antes da cirurgia torácica videoassistida.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Derrame Pleural/cirurgia , Pneumonia/cirurgia , Tubos Torácicos , Drenagem/métodos , Cirurgia Torácica Vídeoassistida , Derrame Pleural/etiologia , Pneumonia/complicações , Fatores de Tempo , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage. METHODS: The medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Patients were divided into two groups: in group 1, videothoracoscopic surgery was performed as the initial procedure; in group 2, videothoracoscopic surgery was performed after previous chest tube drainage. RESULTS: Videothoracoscopic surgery was effective in 73 children (92.4%); the other six (7.6%) needed another procedure. Sixty patients (75.9%) were submitted directly to videothoracoscopic surgery (group 1) and 19 (24%) primarily underwent chest tube drainage (group 2). Primary videothoracoscopic surgery was associated with a decrease of hospital stay (p=0.05), time to resolution (p=0.024), and time with a chest tube (p<0.001). However, there was no difference between the groups regarding the time until fever resolution, time with a chest tube, and the hospital stay after videothoracoscopic surgery. No differences were observed between groups regarding the need for further surgery and the presence of complications. CONCLUSIONS: Videothoracoscopic surgery is a highly effective procedure for treating children with complicated parapneumonic pleural effusion. When videothoracoscopic surgery is indicated in the presence of loculations (stage II or fibrinopurulent), no difference were observed in time of clinical improvement and hospital stay among the patients with or without chest tube drainage before videothoracoscopic surgery.
Assuntos
Tubos Torácicos , Drenagem/métodos , Derrame Pleural/cirurgia , Pneumonia/cirurgia , Cirurgia Torácica Vídeoassistida , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Derrame Pleural/etiologia , Pneumonia/complicações , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
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). METHODS: Thirty-nine male Wistar rats (mean weight 414 g; 290-546 g) were allocated as follows: 17 animals in the SA group, 12 in the SP group, and 10 in the control group. Bacteria or turpentine were injected into the pleural space. After 12 hr, intrapleural fluid was collected using ultrasound-guided thoracentesis. Levels of complement activation products were determined using ELISA kits. RESULTS: Two SA and one SP animals died before 12 hr. Mean levels were as follows: C3a: 1066.82 µg/ml (937.29-1196.35 µg/ml) in SA, 1188.28 µg/ml (1095.65-1280.92 µg/ml) in SP, and 679.13 µg/ml (601.29-756.98 µg/ml) in controls (P < 0.001); C5a: 55.727 ng/ml (41.22-70.23 ng/ml) in SA, 520.107 ng/ml (278.92-761.3 ng/ml) in SP, and 5.268 ng/ml (1.68-8.85 ng/ml) in controls (P < 0.001); C5b9: 15.02 ng/ml (13.1-16.94 ng/ml) in SA, 16.63 ng/ml (14.37-18.9 ng/ml) in SP, and 14.05 ng/ml (9.8-18.29 ng/ml) in controls (P = 0.692). ROC analysis revealed an area under the curve of 0.987 (95% CI: 0.953-1) for C3a; 1 (1-1) for C5a; and 0.757 for C5b9 (0.523-0.990). CONCLUSIONS: In the present rat model, complement activation fragments C3a and C5a accurately detected infected pleural effusion. Pediatr Pulmonol. 2017;52:757-762. © 2017 Wiley Periodicals, Inc.
Assuntos
Ativação do Complemento , Empiema Pleural/imunologia , Derrame Pleural/imunologia , Animais , Complemento C3a/imunologia , Complemento C5a/imunologia , Complexo de Ataque à Membrana do Sistema Complemento/imunologia , Empiema Pleural/etiologia , Masculino , Derrame Pleural/etiologia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/imunologia , Ratos Wistar , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/imunologia , Staphylococcus aureus , Streptococcus pneumoniaeRESUMO
Introducción: la colección purulenta en la cavidad pleural es causa de complicaciones, por procesos infecciosos pulmonares, y de alta mortalidad. Con frecuencia se trata de enfermos con deterioro del estado general, situación que se agrava en enfermos de edades geriátricas. Objetivo: mostrar la experiencia en el uso de la toracostomía con resección costal y anestesia local en el Hospital Universitario Manuel Fajardo para la atención de enfermos con empiema pleural. Métodos: se estudiaron 24 pacientes con empiema pleural atendidos desde enero de 1998 hasta octubre de 2015, con edad avanzada y estado físico precario en el Hospital Universitario Manuel Fajardo a los que se les realizó una ventana pleurocutánea con anestesia local. Resultados: La edad promedio fue de edad 72 años; 75 por ciento presentó enfermedades asociadas. La relación hombre/mujer fue de 3 a 1. La causa más frecuente fue el derrame paraneumónico infestado, 100 por ciento tuvo antecedentes de pleurostomía. Hubo cultivo negativo en 20,8 por ciento pacientes. Los gérmenes más frecuentes fueron el estreptococo, estafilococo y gérmenes gramnegativos. Las costillas resecadas fueron los arcos costales anteriores sexto y séptimo y el tiempo promedio de cierre de las ventanas fue de 8 meses, sin mortalidad quirúrgica. Conclusión: la ventana torácica pleurocutánea es un procedimiento quirúrgico de baja mortalidad, ideal para solucionar una cavidad pleural tabicada con gran utilidad en enfermos de edades geriátricas y con estado físico precario, por la factibilidad de realizarla con anestesia local(AU)
Introduction: pleural cavity purulent collection causes high mortality and complications in lung infections processes. It often comes to patients with deterioration of general condition, a situation muchworsened in patients of geriatric age. Objective: to show the experience in using costal thoracostomy and local anesthesia in care for elderly patients with pleural empyema and poor physical condition. Methods: study carried out in 24 patients with pleural empyema, advanced age and poor physical condition cared for from January 1998 to October 2015 at Comandante Manuel Fajardo University Hospital and who also underwent pleurocutaneous window with local anesthesia. Results: average age was 72 years. The male/female ratio was 3 to 1. 75 percent of the patients presented associated diseases. The most frequent cause was infested parapneumonic effusion. There was pleurostomy history in 100 percent of the cases, negative culture in 20.8 percent, while the most common germs were streptococcus, staphylococcus and gram-negative bacteria. The resected ribs were the sixth and seventh previous costal arches. El average windows closing time was 8 months. There was no surgical mortality. Conclusion: pleurocutaneous thoracic window is a surgical procedure with low mortality, ideal to settle a pleural cavity tabicada with great utility in patients at geriatric age and in precarious physical condition, from the feasibility of being performing under local anesthesia(AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Anestesia Local/métodos , Empiema Pleural/complicações , Pneumopatias/complicações , Cavidade Pleural , Toracostomia/métodosRESUMO
La neumonía es una de las principales causas de mortalidad en las Américas, entre el 20 a 40% evolucionan a derrame pleural, sólo 0,6-2% evolucionan a empiema pleural. El empiema crónico se asocia a engrosamiento pleural, puede ser total o abarcar el parénquima pulmonar (paquipleuritis). Presentamos paciente adolescente, con neumonía al que se le realizó toracentesis con resultado de gram y cultivo positivo para Esta lococos sp, sin citoquímica, fue tratado como derrame pleural simple con diferentes antibióticos por 17 días sin mejoría. Posteriormente en hospital especializado, se realizó toracentesis guiada por ultrasonido que reportó masa heterogénea tabicada, se realizó decorticación de empiema loculado gigante izquierdo y liberación de atrapamiento pulmonar. Se dio alta médica con persistencia de paquipleuritis residual que resolvió espontáneamente a los seis meses. En la neumonía con derrame pleural es importante durante el tratamiento, correlacionar; clínica, citoquímica, pH, estudios de imagen y respuesta a los antibióticos.
Pneumonia is a leading cause of mortality in America, between 20-40% progresses to pleural e usion, only 0.6-2% evolve to pleural empyema. Chronic empyema associated with pleural thickening, can be total or cover the lung parenchyma (pleural thickening). Here we report a clinical case about an adolescent patient with pneumonia who had a thoracentesis with gram positive and positive culture for Staphylococcus sp, without cytochemical, it was treated as a simple pleural e usion with di erent antibiotics for 17 days without patient's improvement. Later on a specialized hospital, he had an ultrasound guided thoracentesis which reported that a partitioned heterogeneous mass was held. Decortication of giant loculated empyema and lung entrapment release was made. He was discharged with persistent residual pleural thickening which resolved spontaneously within six months. In pneumonia with pleural e usion, it is important during treatment to correlate clinical facts cytochemical, pH, imaging and response to antibiotics.
Assuntos
Adolescente , Pneumonia , Empiema PleuralRESUMO
The authors reported a lung infection by Rhodococcus equi in a 25 years-old male patient admitted to hospital with cough, dyspnea, fever, and previous diagnosis of pleural effusion. R. equi was isolated from pleural fluid and the patient acquired nosocomial infection by Acinetobacter baumannii, isolated from chest drain. The patient was treated with antibiotics. During hospitalization, he was diagnosed with non-Hodgkin lymphoma of precursor T-cell lymphoblastic lymphoma subtype in biopsy of pleura. After undergoing surgery for pulmonary decortication for drain empyema, the patient died due to septicemia(AU)
Los autores informan de una infección pulmonar por Rhodococcus equi en un paciente masculino de 25 años que fuera hospitalizado con tos seca, disnea, fiebre y diagnóstico previo de derrame pleural. R. equi se aisló del líquido pleural y el paciente adquiere una infección nosocomial con Acinetobacter baumannii aisladas de un drenaje torácico. El paciente recibió tratamiento con antibióticos y, durante la hospitalización, fue diagnosticado linfoma no Hodgkin subtipo de linfoma linfoblástico de precursoras de células T en la biopsia pleural. Después de la cirugía para decorticación pulmonar para la fuga de empiema, el paciente falleció debido a una septicemia(AU)
Assuntos
Humanos , Masculino , Adulto , Derrame Pleural/tratamento farmacológico , Linfoma não Hodgkin/complicações , Rhodococcus equi , Pneumopatias/tratamento farmacológico , Pneumopatias/epidemiologia , Brasil , Acinetobacter baumanniiRESUMO
El seudotumor inflamatorio es un proceso no neoplásico poco frecuente, caracterizado por un crecimiento irregular de células inflamatorias. Puede originarse en cualquier lugar del organismo y, en la mayoría de los casos, presenta un asentamiento local único y de características benignas. Se presentó el caso de un varón de 51 años, en el que se manifestó el seudotumor inflamatorio de forma nodular en el pulmón derecho, con evolución a un empiema pleural.
The inflammatory pseudo tumor is a few frequent non neoplastic process, characterized by an irregular increase of inflammatory cells. It can be originated in any place of the organism, and in most of the cases it has only one local settlement with benign characteristics. We presented the case of a male patient, aged 51 years who had the inflammatory pseudo tumor of nodular form in the right lung, with evolution to a pleural empyema.
RESUMO
OBJECTIVE: Serial C-reactive protein measurements have been used to diagnose and monitor the response to therapy in patients with pneumonia and other infectious diseases. Nonetheless, the role of C-reactive protein measurement after surgical treatment for pleural empyema is not well defined. The aim of this study is to describe the behavior of C-reactive protein levels after the surgical treatment of pleural empyema and to correlate this parameter with the patient's prognosis. METHODS: We retrospectively analyzed the records of patients with pleural empyema treated by either chest-tube drainage or surgery from January 2006 to December 2008. C-reactive protein levels were recorded preoperatively and 2 and 7 days postoperatively. The clinical outcome was binary: success or failure (mortality or the need for repeated pleural intervention). RESULTS: The study group comprised fifty-two patients. The median C-reactive protein values were as follows: 146 mg/L (pre-operative), 134 mg/L (post-operative day 2), and 116 mg/L (post-operative day 7). There was a trend toward a decrease in these values during the first week after surgery, but this difference was only statistically significant on day 7 after surgery. Over the first week after surgery, the C-reactive protein values decreased similarly in both groups (successful and failed treatment). No correlation between the preoperative C-reactive protein level and the clinical outcome was found. CONCLUSIONS: We observed that, in contrast to other medical conditions, C-reactive protein levels fall slowly during the first postoperative week in patients who have undergone surgical treatment for pleural empyema. No correlation between the perioperative C-reactive protein level and the clinical outcome was observed.