Clinico-etiological profile of Empyema Thoracis in children: A Descriptive Analysis
Abstract
Empyema is an uncommon complication of childhood pneumonia. Although mortality rates in pediatric empyema are very low, empyema causes significant morbidity including substantial health care costs and burden of care. A descriptive observational study was conducted on 40 Empyema Thoracis in 0-12 years aged. Empyema was diagnosed as per “GOLDEN CRITERIA. Clinical profile including signs and symptoms was recorded with biosocial profile. Blood and Plural fluid examinations were also done. Microbiology and histo-pathological examinations were also done. Data collected were analysed, qualitative data were expressed in percentage and quantitative data were expressed in mean ± SD. Mean age of children was 5.01 years with slight female predominance (M:F = 2:3). Mean haemoglobine was 9.45 g/dl, Total leucocytes count (TLC) 17,293 with platelet counts 2.69 lakhs. PH of blood and plural fluid was 7.39 and 6.98 respectively. Cough was the most common complain (in 72%) followed by fever, breathlessness and chest pain. Likewise tackypnea was the most common sign elicited followed by pallor conjunctiva and cervical lymphadenopathy. On examination trachea was shifted either on right or left side in 52% cases, Creptations were observed in 72.5% of cases and Ronchi were observed in one (2.5%) case. Dullness on percussion, decrease air entry and decreased vocal resonance was observed in all the cases. Gram positive cocci and Gram negative bacilli were observed in 25% and 2.5% cases respectively. Out of these micro-organism, Streptococci, Staphylococci and Klebsela Pneumonae were found in 7.5%, 12.5% and 2.55 of cases respectively. Acute inflammation was found in 7.5%, chronic inflammation was found in 7% whereas Koch's was found in 18% of cases in histology.
Keywords
Download Options
Introduction
Empyema is defined as pus in the pleural space. Empyema is an uncommon complication of childhood pneumonia and general pediatricians may only see a few cases in their career. 1 Although mortality rates in pediatric empyema are very low, empyema causes significant morbidity including substantial health care costs and burden of care.
Half of the patients with empyema develop it as a complication of pneumonia.2 Factors that predispose a patient to pulmonary infection and empyema are poor orodental hygiene, periodontal disease, mental retardation, cardiac failure, sedative drug use, corticosteroid or immune-suppressive therapy and aspiration syndromes. 3-6 Other factors which can predispose to empyema are IV drug abuse, sub diaphragmatic infection, lung abscess, retropharyngeal abscess, abscessed mediastinal lymph nodes, paravertebral abscess, introduction of organism related to upper abdominal surgery, trauma, thoracic surgery or thorcocentesis.4-7
Conclusion
In these emphysema cases, mean hemoglobin, Total leucocytes count (TLC) and platelet counts were in normal range. PH of blood and plural fluid was 7.39 and 6.98 respectively. Cough was the most common complain followed by fever, breathlessness and chest pain. Likewise tackypnea was the most common sign elicited followed by pallor conjunctiva and cervical lymphadenopathy. On examination trachea was shifted either on right or left side in about half of cases, Creptations were observed in majority of cases and Ronchi were observed in very few. Dullness on percussion, decrease air entry and decreased vocal resonance was observed in all the cases. Gram positive cocci were most observed micro-organism. Most observed micro-organism was Staphylococci followed by Streptococci and Klebsela Pneumonae. Koch's was found in about one fifth of cases otherwise Acute inflammation chronic inflammation was found in about one tenth of cases.