ÇOCUKLARDA PARAPNÖMONİK EFÜZYONLAR: BEŞ YILLIK DENEYİM

Year 2017, Volume: 7 Issue: 4, 340 - 347, 27.12.2017

Atilla Çifci , Şamil Hızlı , Aysel Yöney

https://doi.org/10.16899/gopctd.360197

Abstract

 Amaç: Çocuklarda solunum yolu enfeksiyonlarının morbidite ve mortaliteye neden olan en önemli komplikasyonlarının başında parapnömonik efüzyonlar gelmektedir. Parapnömonik efüzyon, altta yatan pnömoni ile ilişkili plevral boşlukta gelişen eksüda özelliğindeki sıvı birikimidir. Hastada parapnömonik efüzyon düşünüldüğünde tedavinin erken ve uygun antibiyotiklerle başlanması hayat kurtarıcıdır. Klinik ve laboratuvar bulgularında yeterli düzelme olmayan hastalarda girişimsel ve cerrahi tedavilerin uygun zamanda başlanması morbidite ve mortalitenin azalmasında önemli yer tutmaktadır. 

Gereç ve Yöntem: Bu çalışmada tek bir merkeze beş yıllık süre içinde solunum yolu enfeksiyonu nedeniyle başvuran hastalardan parapnömonik efüzyon gelişen 100 çocuğun klinik ve laboratuvar bulguları irdelenmiştir. 

Bulgular: Hastaların ortalama yaşı 52 ay (1,5-156 ay), 52si (%52) erkek, %71’i beş yaş altında idi. Hastane kalış süreleri ortalama 19,6±7,6 gün (1-45 gün) idi. En sık başvuru semptomu ateş, en sık bulgu taşikardi ve retraksiyonlar, en sık laboratuvar bulgusu ise beyaz küre yüksekliğiydi. Plevral sıvı kültüründe en sık üreyen mikroorganizma Staphylococcus aureus idi. 

Sonuç: Bu çalışma sayesinde, enfeksiyona yol açan patojenlerin belirlenmesi ile spesifik tedavilerin daha erken dönemde başlanmasının morbidite ve mortalitenin önlenmesine yönelik çok önemli katkılar sağlayacağını vurgulamak istedik.

Keywords

Parapnömonik efüzyon, ampiyem, çocuklar, kültür, tedavi

PARAPNEUMONIC EFFUSIONS IN CHILDREN: FIVE YEARS EXPERIENCE

Abstract

Aim: Most severe complication of respiratory tract infections that s causing morbidity and mortality in children is parapneumonic effusion(PPE). PPE is a pleural exudate that is related with primary pneumonia. The early and appropriate antibiotic treatment is very important in follow-up of patients who are diagnosed as parapneumonic effusion and also the timing of interventional and surgical treatment is important to decrease morbidity and mortalitiy  in whom clinical and laboratory findings are not cured enough. 

Materials and Methods: In this study, the clinical and laboratory findings of parapneumonic effusion one hundred patients applied to one center in five years time are discussed. 

Results: The mean age of patients were 52 months(1.5-156), 52 were male(52%).The 71% of patients were smaller than five years old. The mean duration of hospitalization of patients were 19.6 days(1-45 days). Most frequent spymptom in application was fever, most frequent sign were tachycardia and retractions, most frequent laboratory anormality was high white blood count. The most frequent microorganism in pleural fluid culture was S.aureus. 

Conclusion: The determination of pathogens causing parapneumonic effusions in our country is very important for starting most suitable treatment early and to decrease morbidity and mortality.

Keywords

Parapneumonic effusion, empyema, children, culture, treatment

References

• Kaynaklar 1. Letheulle J, Kerjouan M, Bénézit F, et al.[Parapneumonic pleural effusions: Epidemiology, diagnosis, classification and management].Rev Mal Respir. 2015;32(4):344-57.
• 2. Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60 Suppl 1:i1-21.
• 3. Mishra O.P,Das B.K,Jain A.K,Lahini T.K,Sen PC,Bhargara V. Clinicobacteriological study of empyema thoracis in children. Journal of Tropical Pediatrics 1993; 39: 380-388.
• 4. Maziah W,Choo KE,Ray JG, et al. Empyema thoracis inhostipalized children. in Kelantian, Malaysia. J Trop Pediatr 1995; 41: 185-188.
• 5. Chan W, Keyser Gauvin E, Davis G.M,et. al.Empyema thoracis in children 26 year review of the Montreal children's hospital experience. Journal of Pediatric Surgery 1997;32 870-872
• 6. Göçmen A,Kiper N,Toppare M, et al..Conservative treatment of empyema in children. Respiration 1993; 60: 182-185.
• 7. Hassan l, Mobongunje O, Paediatric Empyema Thoracis in Zaria, Nigeria Annals of Tropical Paediatrics 1992; 12: 265-271.
• 8. Hassan l, Mobongunje O, Paediatric Empyema Thoracis in Zaria, Nigeria Annals of Tropical Paediatrics 1992; 12: 265-271.
• 9. Mahalu W, Nathoo KJ. Empyema in Children: A. Review of 52 Cases.Central African Journal of Medicine 1992; 38: 136-138.
• 10. Mishra O.P, Das B.K,Jain A.K,Lahini T.K, et al. Clinicobacteriological study of empyema thoracis in children. Journal of Tropical Pediatrics 1993; 39: 380-388.
• 11. Pia Toikka, Raimo Virkki, et al. Bacteriemic pneumococal pneumonia in children. Clinical Infectious Diseases 1999; 29: 568-572.
• 12. Fontanet A.L, Mc Cauley R.G.K, Gayette Y, et. al. Incidence management and outcome of childhood empyema: A prospective study of children in Cambodian Refugee Camps. Am J Trop Med Hyg 1993; 49: 789-798.
• 13. Hassan l, Mobongunje O, Paediatric empyema thoracis in Zaria, Nigeria. Annals of Tropical Paediatrics 1992; 12: 265-271.
• 14. Lewis KT, Bukstein DA. Parapneumonic Empyema in Children: Diagnosis and Management. Am Familiy Physician 1992; 46: 1443-1455.
• 15. Freig B.J, et. al. Parapneumonic Effusions and Empyema in Hospitalized Child. A Retrospective Revievv of 227 Cases. Pediatr infect Dis. J, 1984; 3: 578-579.
• 16. Kending E.L. Disorders of the respiratory tract in children: Pleural effusions and empyema. Philadelphia, WB, Saunders Company 1996: 292-301.
• 17. Hoff SJ, Neblet W, Edvvars KM, et al. Parapnomonic empyema in children: decortication Hastens recovery in patients with severe pleural infections Pediatr Infect Dis J 1991; 10;194-199.
• 18. Hortal M, Mogdasy C, Russi J.C, Deleon C. Microbial agents associated with pneumonia in children from Uruguay. Reviews of Infectiosus Diseases 1990; 12: 915-921.
• 19. Stovroff M, Teague G, Heiss KF, Parker P, Ricketts RR. Thorascopy in the Management of Pediatric Empyema . J Pediatr Surg 1995; 30: 1211-1215
• 20. Stovroff M, Teague G, Heiss KF, Parker P, Ricketts RR. Thorascopy in the Management of Pediatric Empyema. J Pediatr Surg 1995; 30: 1211-1215.
• 21. Berger HA, Morganroth ML. Immediate drainage is not required for patients with complicated parapneumonic effusions. Chest 1993;97:731-735.
• 22. Hoff SJ, Neblet W, Edvvars KM, et al. Parapnomonic Empyema in Children: Decortication Hastens Recovery in Patients with Severe Pleural İnfections Pediatr Infect Dis J 1991; 10;194-199.