Fatores preditivos para drenagem de derrames pleurais parapneumônicos em crianças

Mocelin, Helena Teresinha; Fischer, Gilberto Bueno

doi:10.1590/s0102-35862001000400003

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…Alternatively, the use of a culture‐independent method, IMT, is proposed in PF, presenting a promising increase in sensitivity compared with culture. In a previous study involving children to whom empirical antibiotic therapy was administered and from whom PF samples were obtained, 25% of cultures were positive for any pathogen; 61.9%, for S. pneumoniae . In the present study, PF sample analyses showed a positive antigen test in 23 out of 43 patients (67.6%) and a qPCR‐positive reaction for the lytA gene in 24 out of 32 patients (70.6%) among culture‐negative specimens.…”

Section: Discussionsupporting

confidence: 59%

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Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Pizzutti

Perez

Barbiero³

et al. 2019

Pediatric Pulmonology

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Objective To evaluate culture‐independent procedures (immunochromatography and quantitative polymerase chain reaction [qPCR]) in the detection and susceptibility of Streptococcus pneumoniae directly from culture‐negative pleural fluid (PF) in children. Method Detection of S. pneumoniae in PF of children with parapneumonic effusion and/or empyema by using two culture‐independent methods: an immunochromatographic membrane test (IMT) which identifies the pneumococcal C antigen, and a real‐time PCR test to detect pneumococcal genes lytA and pbp2b, a marker of susceptibility of β‐lactam agents, in PF samples. Results We tested 36 PF specimens and recorded the previous use of antimicrobials. In the final analysis, 34 samples were included. IMT and qPCR presented positive results in 23 (67.6%) and 24 (70.6%) of the samples, respectively, showing a moderate agreement (k = 0.518) between the two methods. From the 36 children included, 34 (94.4%) had antibiotic data available by the time when PFs were collected. Thirty‐four (100%) children had been given treatment before PF sampling, with 33 (97%) receiving β‐lactam antibiotics administered empirically. Of the 24 lytA real‐time positive samples, 21 (87.5%) were also positive for pbp2b, a marker of β‐lactam susceptibility. Conclusion The reduced sensitivity of culture for pneumococcal detection can be improved through the addition of IMT and qPCR analysis. The utility of qPCR combining detection of lytA and a marker of β‐lactam susceptibility should be explored further.

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Section: Discussionsupporting

confidence: 59%

“…25% of cultures were positive for any pathogen; 61.9%, for S. pneumoniae 27. In the present study, PF sample analyses showed a positive antigen test in 23 out of 43 patients (67.6%) and a qPCR-positive reaction for the lytA gene in 24 out of 32 patients (70.6%) among culture-negative specimens.…”

supporting

confidence: 48%

Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Pizzutti

Perez

Barbiero³

et al. 2019

Pediatric Pulmonology

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“…Complicated PPE is an exudate that can be purulent, culture or Gram staining revealing bacteria and biochemical analysis revealing pH < 7, glucose < 40 mg/dL, and lactate dehydrogenase > 1,000 IU/L. (20) Mocelin et al (21) found that pleural fluid glucose < 40 mg/dL and pleural fluid pH < 7.0 had a sensitivity of 76% and 55%, respectively, for the diagnosis of complicated PPE, the sensitivity of pleural fluid pH having increased to 79% when the cut-off point was increased to 7.2. In 2010, Maranhão et al (22) quantified total proteins in pleural fluid in order to diagnose pleural exudates.…”

Section: Discussionmentioning

confidence: 99%

Pneumonia adquirida na comunidade e derrame pleural parapneumônico relacionados a Mycoplasma pneumoniae em crianças e adolescentes

Vervloet

Tironi

et al. 2012

J. bras. pneumol.

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OBJETIVO: Determinar a prevalência e as características da pneumonia adquirida na comunidade (PAC) e derrames pleurais parapneumônicos (DPP) relacionados a Mycoplasma pneumoniae em um grupo de crianças e adolescentes. MÉTODOS: Estudo observacional retrospectivo com 121 pacientes hospitalizados com PAC e DPP em um hospital de referência terciária, entre 2000 e 2008, divididos em seis grupos (G1 a G6) segundo o agente etiológico: M. pneumoniae com ou sem coinfecção, em 44 pacientes; outros agentes que não M. pneumoniae, em 77; M. pneumoniae sem coinfecção, em 34; Streptococcus pneumoniae, em 36; Staphylococcus aureus, em 31; e coinfecção M. pneumoniae/S. pneumoniae, em 9, respectivamente. RESULTADOS: Na comparação entre os grupos, G1 apresentou frequências maiores em gênero feminino, tosse seca, uso prévio de beta-lactâmicos e na duração dos sintomas até a admissão, assim como menor uso de assistência ventilatória e de drenagem torácica que G2, enquanto G3 teve maiores frequências em uso prévio de beta-lactâmicos e tosse seca, maior duração dos sintomas antes da admissão e menor frequência de uso de drenos torácicos que G4 e G5, ao passo que G3 teve média de idade maior e menor frequência de náuseas/vômitos que G4, assim como menor uso de assistência ventilatória que G5. A coinfecção M. pneumoniae/S. pneumoniae aumentou a duração dos sintomas até a admissão. CONCLUSÕES: Nesta amostra, a prevalência de PAC e DPP por M. pneumoniae foi de 12,75%. Embora a doença apresentasse quadros mais leves que aquela por outros organismos, a evolução foi mais prolongada. Nossos dados sugerem a necessidade de uma maior diligência na investigação de M. pneumoniae em crianças e adolescentes com PAC e DPP em nosso meio.

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“…The main complication is pleural empyema, which is seen in 10% of cases. (1,2) Treatments for empyema previously included only antibiotics, thoracentesis, thoracostomy (with open or closed drainage) and thoracotomy. (1,3) With the advent of minimally invasive surgery, thoracoscopy was added to the therapeutic armamentarium.…”

Section: Introductionmentioning

confidence: 99%

“…(1,2) Treatments for empyema previously included only antibiotics, thoracentesis, thoracostomy (with open or closed drainage) and thoracotomy. (1,3) With the advent of minimally invasive surgery, thoracoscopy was added to the therapeutic armamentarium. (4,5) Thoracoscopy provides a broad view of the pleural cavity, as well as allowing the sectioning of pleural adherences, the suction of collections and the removal of excess fibrin deposited on the parietal and visceral pleurae.…”

Section: Introductionmentioning

confidence: 99%

Pneumonia necrosante em crianças submetidas à toracoscopia por empiema pleural: incidência, tratamento e evolução clínica

Macedo¹,

Meyer²,

Oliveira³

2010

J. bras. pneumol.

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Objective: To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. Methods: A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). Results: The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79%) had undergone thoracic drainage prior to thoracoscopy, 11 (46%) presented with pneumothorax, and 16 (67%) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36%) had undergone thoracic drainage prior to thoracoscopy, 9 (32%) presented pneumothorax, and 5 (18%) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. Conclusions: Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.Keywords: Empyema, pleural; Thoracoscopy; Pneumonia; Child. ResumoObjetivo: Analisar a incidência de pneumonia necrosante (PN) em crianças submetidas a toracoscopia e comparar pacientes com e sem PN em relação às diferentes apresentações e evolução clínica. Métodos: Estudo retrospectivo de crianças portadoras de empiema e submetidas a toracoscopia. A toracoscopia foi realizada em pacientes não submetidos a drenagem torácica prévia e evidência de derrame septado ou pneumotórax, assim como naqueles submetidos previamente a drenagem torácica e pneumotórax persistente ou febre e secreção purulenta. Baseado na presença de PN durante a toracoscopia, os pacientes foram divididos em dois grupos: com PN e sem PN. Resultados: Participaram do estudo 52 pacientes. Dos 24 pacientes com PN, 19 (79%) foram submetidos a drenagem torácica anterior à toracoscopia, 11 (46%) apresentaram pneumotórax, e 16 (67%) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo de drenagem e de hospitalização foram, respectivamente, 18 e 19 dias. Dos 28 pacientes sem PN, 10 (36%) foram submetidos a drenagem torácica anterior à toracoscopia, 9 (32%) apresentaram pneumotórax, e 5 (18%) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo médio de drenagem e de hospitalização foram, respectivamente, 6 e 10 dias. Conclusões: A PN deve ser suspeitada na presença de pneumotórax. A toracoscopia precoce pode ser uma opç...

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Fatores preditivos para drenagem de derrames pleurais parapneumônicos em crianças

Cited by 7 publications

References 17 publications

Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Pneumonia adquirida na comunidade e derrame pleural parapneumônico relacionados a Mycoplasma pneumoniae em crianças e adolescentes

Pneumonia necrosante em crianças submetidas à toracoscopia por empiema pleural: incidência, tratamento e evolução clínica

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