Postpneumonic Pleural Suppuration in Children

Abstract

Postpneumonic pleural suppuration is a common condition seen in paediatric practice in Nigeria. One hundred and twenty cases seen at the University of Nigeria Teaching Hospital, Enugu, over a 4-year period were reviewed. The patients were aged between 1 1/2 months and 16 years. History of antecedent measles was elicited in 27 of the children, and 70% of the patients presented to the hospital later than 7 days after the onset of symptoms of pleura suppuration. From the pleural aspirates of 106 cases (88.3%) Staphylococcus aureus was cultured in 31.2%, but there were no organisms cultured in 39.4%. Twenty-nine children were treated by chemotherapy only; 11 of them (37.9%) died. Sixty-eight cases had tube drainage of the pleural collections, with 6 deaths (8.8%). Twenty-three patients had thoracotomy, evacuation of the suppurative lesion and decortication of the lung, with no mortality. There was overall hospital mortality of 14.2%, the highest mortality being in children who had associated measles, gastroenteritis, anaemia or malnutrition. Early surgical drainage by tube thoracostomy or by thoracotomy and decortication in addition to appropriate and adequate antibiotic therapy is the treatment of choice.

Outcome of tube thoracostomy in paediatric non-traumatic pleural fluid collections

“…This major thoracic operation has been proven superior to tube thoracostomy in both adult and paediatric empyema thoracis, and can be utilized as the primary treatment. [2,3,8] Procedure-related complication rate was only about 3%. This is low when compared to other studies, [1,10] and could be attributable to the fact all cases of paediatric tube thoracostomies in the study centre are either undertaken by thoracic surgeon or supervised as such when done by resident doctors.…”

“…[2,3] This is largely because of the persistently ravaging poverty, ignorance and infections. [4] The thoracic surgeons practicing in Nigeria are frequently consulted to review and manage paediatric patients presenting with nontraumatic pleural fluid collection.…”

Percutaneous needle pleural biopsies in pleural effusion of uncertain aetiology in a Nigerian teaching hospital

“…An increased risk of periodontal disease is well-recorded in diabetes, 1,2 and is said to be particularly associated with poorly glycaemically controlled disease, 6,7 though, much of the evidence for this latter association is anecdotal. There is, however, evidence that diabetic patients with periodontal disease have increased rates of retinopathy.…”

“…The reversible anaemia is not a precursor stage to the aplastic anaemia, as it seems committed progenitor cells are affected rather than stem cells, as seen in aplastic anaemia. 2 Animal models have now been developed to investigate these effects. 2,3 As a result of concerns regarding anaemia, there is a commonly held idea in tropical paediatrics that chloramphenicol should not be given to children for more than 2 weeks.…”

“…2 Animal models have now been developed to investigate these effects. 2,3 As a result of concerns regarding anaemia, there is a commonly held idea in tropical paediatrics that chloramphenicol should not be given to children for more than 2 weeks. We have heard this advice in several occasions but were unable to find any strong evidence to support it.…”