Plevral Efüzyonla Hastaneye Yatan Çocukların Epidemiyolojik Ve Klinik Profili: Tek Merkez Deneyimi 2012-2022
Yıl 2023,
Cilt: 45 Sayı: 4, 597 - 604, 20.07.2023
Gürkan Bozan
,
Eylem Kıral
,
Mahmut Can Kızıl
,
Merve İşeri Nepesov
,
Yalçın Kara
,
Mehmet Surhan Arda
,
Huseyin Ilhan, Turkey
,
Çiğdem Öztunalı
,
Tercan Us
,
Ömer Kılıç
,
Ener Çağrı Dinleyici
Öz
Plevral efüzyon, çocuklarda ciddi morbidite ve mortaliteye yol açması sebebiyle, bakteriyel pnömoninin önemli bir bir komplikasyonudur. Bu çalışmanın amacı, çocuklarda plevral efüzyonun epidemiyolojik ve klinik özelliklerinin araştırılmasıdır.Ocak 2012-Aralık 2022 tarihleri arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi'nde izlenen plevral efüzyonlu çocukların tıbbi kayıtları retrospektif olarak değerlendirildi. Klinik ve etiyolojik özellikleri, laboratuvar ve radyoloji sonuçları ve tedavi rejimleri değerlendirildi. Yaşları 7 ila 216 ay (medyan 100 ay) arasında olan 59 çocuğun (%55,9'u kız) tıbbi kayıtları kaydedildi. Plevral efüzyon etiyolojisi; 37 çocukta (%62,7) parapnömonik efüzyon, sekiz çocukta (%13,5) tüberküloz plörezi idi. En yaygın bakteriyel patojenler Streptococcus pyogenes, Mycobacterium tuberculosis, Pseudomonas aeruginosa, Streptococcus pneumoniae ve Haemophilus influenzae idi. Pandemi sonrası dönemde tüberküloz plörezi vakaları azalırken, Streptococcus pyogenes'e bağlı plevral efüzyonlarda artış görülmektedir. Olguların %39'una tek başına medikal tedavi, %55'ine tüp torakostomi, %18,6'sına torakotomi ve dekortikasyon uygulandı. Çocukların %45,8'inin pediatrik yoğun bakım ünitesinde kalması gerekti. Medyan hastanede kalış süresi 12 gündü. Pediatrik plevral efüzyonların en sık nedeni bakteriyel ajanlara bağlı parapnömonik efüzyonlardır. COVID-19 pandemisinden sonra tüberküloz plörezi vakaları azalırken, Streptococcus pyogenes kaynaklı plevral efüzyon/ampiyemde artış görülmektedir.
Teşekkür
Çocuk Cerrahi Ve Radyoloji Ekibine Çok Teşekkür ediyoruz.
Kaynakça
- 1. Wiese AD, Griffin MR, Zhu Y, Mitchel EF Jr, Grijalva CG. Changes in empyema among U.S. children in the pneumococcal conjugate vaccine era. Vaccine. 2016;34(50):6243-6249.
- 2. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008 ;86(5):408-16.
- 3. Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, Thomson A; British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66 Suppl 2:ii1-23.
- 4. GBD 2019 LRI Collaborators. Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis.
2022 ;22(11):1626-1647.
- 5. Byington CL, Spencer LY, Johnson TA, Pavia AT, Allen D, Mason EO, Kaplan S, Carroll KC, Daly JA, Christenson JC, Samore MH. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis. 2002;34(4):434-40
- 6. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH Jr, Moore MR, St Peter SD, Stockwell JA, Swanson JT; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):e25-76.
- 7. Kaplan G, Yakut HI, Cinel G. A Retrospective Analysis; Etiological Evaluation of Pleural Effusion in Children, Clinical Presentation and Management. Turkish Journal of Pediatric Disease 2022; 16(1):37-41.
- 8. Utine GE, Ozçelik U, Kiper N, Doğru D, Yalçn E, Cobanoğlu N, Pekcan S, Kara A, Cengiz AB, Ceyhan M, Seçmeer G, Göçmen A. Pediatric pleural effusions: etiological evaluation in 492 patients over 29 years. Turk J Pediatr. 2009;51(3):214-9.
- 9. Liese JG, Schoen C, van der Linden M, Lehmann L, Goettler D, Keller S, Maier A, Segerer F, Rose MA, Streng A. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010-2017: a nationwide surveillance study. Clin Microbiol Infect. 2019 ;25(7):857-864.
- 10. Krenke K, Sadowy E, Podsiadły E, Hryniewicz W, Demkow U, Kulus M. Etiology of parapneumonic effusion and pleural empyema in children. The role of conventional and molecular microbiological tests. Respir Med. 2016;116:28-33.
- 11. Guy R, Henderson KL, Coelho J, Hughes H, Mason EL, Gerver SM, Demirjian A, Watson C, Sharp A, Brown CS, Lamagni T. Increase in invasive group A streptococcal infection notifications, England, 2022. Euro Surveill. 2023 ;28(1):2200942.
- 12. de Gier B, Marchal N, de Beer-Schuurman I, Te Wierik M, Hooiveld M; ISIS-AR Study Group; GAS Study group; de Melker HE, van Sorge NM; Members of the GAS study group; Members of the ISIS-AR study group. Increase in invasive group A streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022. Euro Surveill. 2023 Jan;28(1):2200941.
- 13. Bertran M, Amin-Chowdhury Z, Sheppard CL, Eletu S, Zamarreño DV, Ramsay ME, Litt D, Fry NK, Ladhani SN. Increased Incidence of Invasive Pneumococcal Disease among Children after COVID-19 Pandemic, England. Emerg Infect Dis. 2022 ;28(8):1669-1672.
- 14. Centers for Disease Control and Prevention (CDC). Increase in invasive group A strep infections, 2022. Atlanta: CDC; 2022. Available from: https://www.cdc.gov/groupastrep/igas-infections
- 15. Kizil MC, Kara Y, Bozan G, Arda S, Durmaz G, Kilic O, Dinleyici EC. Consecutive Seven Serious Cases with Invasive Group A Streptococcal Infections at December 2022-January 2023. Pediatr Infect Dis J. 2023;42(7):e254-e255.
- 16. Kara A, İlbay S, Topaç O, Arabulan EA, Tezer H, Tavukçu N, Şimşek Ç. Alteration in vaccination rates and an evaluation of physicians' perceptions of the possible impact of the SARS-CoV-2 pandemic on childhood vaccinations in Ankara, Turkey. Hum Vaccin Immunother. 2021 3;17(10):3457-3462.
- 17. Ullrich A, Schranz M, Rexroth U, Hamouda O, Schaade L, Diercke M, Boender TS; Robert Koch's Infectious Disease Surveillance Group. Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1-2016 - week 32-2020. Lancet Reg Health Eur. 2021;6:100103.
- 18. Ozdemir S, Oztomurcuk D, Oruc MA. Impact of the COVID-19 pandemic on tuberculosis patients and tuberculosis control programs in Turkey, review and analysis. Arch Public Health. 2022 ;80(1):252.
- 19. Gayretli-Aydın ZG, Tanır G, Bayhan Gİ, Aydın-Teke T, Öz FN, Metin-Akcan Ö, Kaman A. Evaluation of complicated and uncomplicated parapneumonic effusion in children. Turk J Pediatr. 2016;58(6):623-631.
- 20. Hacimustafaoglu M, Celebi S, Sarimehmet H, Gurpinar A, Ercan I. The evaluation and cluster analysis of parapneumonic effusion in childhood. J Trop Pediatr. 2006;52(1):52-5.
- 21. Pernica JM, Moldovan I, Chan F, Slinger R. Real-time polymerase chain reaction for microbiological diagnosis of parapneumonic effusions in Canadian children. Can J Infect Dis Med Microbiol. 2014;25(3):151-4.
Clinical and Etiological Profile of Hospitalized Children with Pleural Effusion: A single Center Experience Between 2012-2022
Yıl 2023,
Cilt: 45 Sayı: 4, 597 - 604, 20.07.2023
Gürkan Bozan
,
Eylem Kıral
,
Mahmut Can Kızıl
,
Merve İşeri Nepesov
,
Yalçın Kara
,
Mehmet Surhan Arda
,
Huseyin Ilhan, Turkey
,
Çiğdem Öztunalı
,
Tercan Us
,
Ömer Kılıç
,
Ener Çağrı Dinleyici
Öz
Pleural effusion is a complication of bacterial pneumonia that is of particular importance because of its significant morbidity and mortality in children. The aim of this study was to investigate the clinical and etiological profile of pleural effusion in children. Medical records of children with pleural effusion who were followed up at University Faculty of Medicine between January 2012 and December 2022 were retrospectively evaluated. Clinical and etiological features, laboratory and radiological results, and treatment regimens of were noted. Medical records of 59 children (55.9% girls) aged between 7 to 216 months (median 100 months) have been noted. The etiology of pleural effusion was parapneumonic effusion in 37 children (62.7%), tuberculous pleurisy in eight children (13.5%). The most common bacterial pathogens were Streptococcus pyogenes, Mycobacterium tuberculosis, Pseudomonas aeruginosa, Streptococcus pneumoniae and Haemophilus influenzae. In the early period of the COVID-19 pandemic, while cases of tuberculous pleurisy are decreasing, there is an increase in pleural effusions due to Streptococcus pyogenes. Medical treatment alone was given in 39% of cases, tube thoracostomy in 55%, thoracotomy and decortication in 18.6%. A 45.8% of children required pediatric intensive care unit stay. The median hospital stay was 12 days.
Conclusion: Parapneumonic effusions due to bacterial agents are the most common cause of pediatric pleural effusions. In the early period of the COVID-19 pandemic, while cases of tuberculosis pleurisy are decreasing, there is an increase in Streptococcus pyogenes-induced pleural effusion/empyema.
Kaynakça
- 1. Wiese AD, Griffin MR, Zhu Y, Mitchel EF Jr, Grijalva CG. Changes in empyema among U.S. children in the pneumococcal conjugate vaccine era. Vaccine. 2016;34(50):6243-6249.
- 2. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008 ;86(5):408-16.
- 3. Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, Thomson A; British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66 Suppl 2:ii1-23.
- 4. GBD 2019 LRI Collaborators. Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis.
2022 ;22(11):1626-1647.
- 5. Byington CL, Spencer LY, Johnson TA, Pavia AT, Allen D, Mason EO, Kaplan S, Carroll KC, Daly JA, Christenson JC, Samore MH. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis. 2002;34(4):434-40
- 6. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH Jr, Moore MR, St Peter SD, Stockwell JA, Swanson JT; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):e25-76.
- 7. Kaplan G, Yakut HI, Cinel G. A Retrospective Analysis; Etiological Evaluation of Pleural Effusion in Children, Clinical Presentation and Management. Turkish Journal of Pediatric Disease 2022; 16(1):37-41.
- 8. Utine GE, Ozçelik U, Kiper N, Doğru D, Yalçn E, Cobanoğlu N, Pekcan S, Kara A, Cengiz AB, Ceyhan M, Seçmeer G, Göçmen A. Pediatric pleural effusions: etiological evaluation in 492 patients over 29 years. Turk J Pediatr. 2009;51(3):214-9.
- 9. Liese JG, Schoen C, van der Linden M, Lehmann L, Goettler D, Keller S, Maier A, Segerer F, Rose MA, Streng A. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010-2017: a nationwide surveillance study. Clin Microbiol Infect. 2019 ;25(7):857-864.
- 10. Krenke K, Sadowy E, Podsiadły E, Hryniewicz W, Demkow U, Kulus M. Etiology of parapneumonic effusion and pleural empyema in children. The role of conventional and molecular microbiological tests. Respir Med. 2016;116:28-33.
- 11. Guy R, Henderson KL, Coelho J, Hughes H, Mason EL, Gerver SM, Demirjian A, Watson C, Sharp A, Brown CS, Lamagni T. Increase in invasive group A streptococcal infection notifications, England, 2022. Euro Surveill. 2023 ;28(1):2200942.
- 12. de Gier B, Marchal N, de Beer-Schuurman I, Te Wierik M, Hooiveld M; ISIS-AR Study Group; GAS Study group; de Melker HE, van Sorge NM; Members of the GAS study group; Members of the ISIS-AR study group. Increase in invasive group A streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022. Euro Surveill. 2023 Jan;28(1):2200941.
- 13. Bertran M, Amin-Chowdhury Z, Sheppard CL, Eletu S, Zamarreño DV, Ramsay ME, Litt D, Fry NK, Ladhani SN. Increased Incidence of Invasive Pneumococcal Disease among Children after COVID-19 Pandemic, England. Emerg Infect Dis. 2022 ;28(8):1669-1672.
- 14. Centers for Disease Control and Prevention (CDC). Increase in invasive group A strep infections, 2022. Atlanta: CDC; 2022. Available from: https://www.cdc.gov/groupastrep/igas-infections
- 15. Kizil MC, Kara Y, Bozan G, Arda S, Durmaz G, Kilic O, Dinleyici EC. Consecutive Seven Serious Cases with Invasive Group A Streptococcal Infections at December 2022-January 2023. Pediatr Infect Dis J. 2023;42(7):e254-e255.
- 16. Kara A, İlbay S, Topaç O, Arabulan EA, Tezer H, Tavukçu N, Şimşek Ç. Alteration in vaccination rates and an evaluation of physicians' perceptions of the possible impact of the SARS-CoV-2 pandemic on childhood vaccinations in Ankara, Turkey. Hum Vaccin Immunother. 2021 3;17(10):3457-3462.
- 17. Ullrich A, Schranz M, Rexroth U, Hamouda O, Schaade L, Diercke M, Boender TS; Robert Koch's Infectious Disease Surveillance Group. Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1-2016 - week 32-2020. Lancet Reg Health Eur. 2021;6:100103.
- 18. Ozdemir S, Oztomurcuk D, Oruc MA. Impact of the COVID-19 pandemic on tuberculosis patients and tuberculosis control programs in Turkey, review and analysis. Arch Public Health. 2022 ;80(1):252.
- 19. Gayretli-Aydın ZG, Tanır G, Bayhan Gİ, Aydın-Teke T, Öz FN, Metin-Akcan Ö, Kaman A. Evaluation of complicated and uncomplicated parapneumonic effusion in children. Turk J Pediatr. 2016;58(6):623-631.
- 20. Hacimustafaoglu M, Celebi S, Sarimehmet H, Gurpinar A, Ercan I. The evaluation and cluster analysis of parapneumonic effusion in childhood. J Trop Pediatr. 2006;52(1):52-5.
- 21. Pernica JM, Moldovan I, Chan F, Slinger R. Real-time polymerase chain reaction for microbiological diagnosis of parapneumonic effusions in Canadian children. Can J Infect Dis Med Microbiol. 2014;25(3):151-4.