Pleural disease in infants and children: management updates

Soares, Jennifer; Redding, Gregory J.

doi:10.1007/s13665-016-0134-z

Cited by 2 publications

(1 citation statement)

References 59 publications

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“…Pre-emptive fibrinolytic therapy is the preferred protocol at RCWMCH for patients with bacterial PE, as it decreases hospital stay, has similar efficacy to video-assisted thoracoscopic surgery, and decreases the need for surgical drainage. [8 , 27] The fact that six TB patients received fibrinolysis highlights the difficulty of distinguishing TB and bacterial infection at the time of presentation. More than two-thirds of patients (74%) across all groups had a chest drain inserted.…”

Section: Discussionmentioning

confidence: 99%

Aetiology and presentation of childhood pleural infections in the post-pneumococcal conjugate vaccine era in South Africa

Golden

Chaya

Reichmuth

et al. 2021

AJTCCM

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Background. Complications of respiratory infections including pleural effusion (PE) are associated with a high morbidity. Differentiating between PE caused by Mycobacterium tuberculosis (Mtb) infection and other bacterial infections in endemic areas is difficult in children, thus, impacting treatment. Objective. To investigate the aetiology of PE and features distinguishing tuberculosis (TB) from bacterial PE in children. Methods. We conducted a prospective study in children with PE admitted to a tertiary hospital in Cape Town from December 2017 to December 2019. Clinical information and routine laboratory investigations were compared between children with bacterial, Mtb or unclassified PE, categorised according to study definitions. Results. A total of 91 patients were included in the present study and their median age was 31 months (interquartile range (IQR) 11.8 - 102.1). The aetiology was bacterial in 40% (n=37), Mtb in 39% (n=36) and unclassified in 20% (n=18) of patients. Staphylococcus aureus was the most common bacterial isolate, confirmed in 65% (n=24/37) patients, and Streptococcus pneumoniae was confirmed in only 8% of patients. TB was microbiologically confirmed in 33% (n=12/36) of patients. Patients with TB were older (91.6 v. 11.8 months; p<0.001), with more weight loss (28 v. 12 patients; p<0.001), and longer cough duration (10 v. 4 days; p<0.001) than those with other bacterial PE. In contrast, the latter had significantly higher serum C-reactive protein (median 250 v. 122 mg/L; p<0.001), procalcitonin (11 v. 0.5 mg/L; p<0.001), pleural fluid lactate dehydrogenase (7 280 v. 544 U/L; p<0.001), and adenosine deaminase levels (162 v. 48 U/L; p<0.001) and lower glucose levels (1.3 v. 4 mmol/L; p<0.001). Conclusion. Post 13-valent pneumococcal conjugate vaccine, S. aureus is the dominant cause of PE in children using traditional culture methods, while Mtb remains a common cause of PE in our setting. Useful clinical and laboratory differences between Mtb and other bacterial PE were identified, but the cause of PE in 20% of children was underdetermined. Molecular testing of pleural fluid for respiratory pathogens may be useful in such children.

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Section: Discussionmentioning

confidence: 99%