Complication Of Pneumonia In Children Research Articles

1691. Use of multiplex PCR in pleural effusion: a case series study in a pediatric reference center in Colombia

Abstract Background The microbiological diagnosis of pleural effusion (PE) is largely based on methods of classical microbiology. Culture-based methods allow for testing of bacterial susceptibility tests, but these methods take time and frequently have false negative results. We describe the utility of multiplex PCR in pleural fluid for the diagnosis of complicated pneumonia in children using a commercial platform for respiratory samples. Methods We conducted a case series of children with complicated pneumonia by PE, empyema or necrotizing pneumonia. Pleural fluid was sent for laboratory to culture, cytochemical and molecular biology testing analysis between 2021 and 2022 in a reference children hospital in Bogotá, Colombia. We used BIOFIRE® FILMARRAY® Pneumonia Panel plus (BioFire Diagnostics, Salt Lake City, Utah). The results were strictly analyzed by a multidisciplinary team. Any change in patient’s therapeutics was decided by this group. Results We identified 17 samples that were processed for multiplex-PCR from 16 patients (Table 1). Median age was 3 years (IQR 2-4 years). Pleural empyema was the most common presentation (7/17, 41%), followed by free pleural effusion (6/17, 35%) and necrotizing pneumonia with empyema (4/17, 23,5%). Pathogens were documented in 16 out of 17 (94%) molecular panels performed. Streptococcus pneumoniae was detected in 11/17 (64.7%) multiplex PCR tests, adenovirus was detected in 7/17 (41.1%), and H. influenzae in 2/17 (11.7%) tests. Pneumococcus was isolated in classical cultures in 4 patients (23.5%), of which only one was in pleural fluid. Changes in antibiotic management in 9/17 (52.9%) of the patients. In 5 patients, there was an increase in the antibiotic spectrum, and in 4 patients, there was a decrease in it. Conclusion Although the use of this multiplex PCR device is not approved by the FDA for use in pleural fluid samples (off-label), this case series described its usefulness and importance in contexts where there is no other approved PCR technology for these samples. Disclosures All Authors: No reported disclosures

Use of multiplex PCR in pleural effusion: is it necessary to change the paradigm of culture-based methods?

The microbiological diagnosis of pleural effusion is based largely on classical microbiology methods, but these methods have a high rate of false negative results. Some previous studies have shown improved diagnostic performance for pathogens such as Streptococcus pneumoniae using molecular biology methods. We present the use of a multiplex PCR platform (BIOFIRE FILMARRAY Pneumonia Panel) for the aetiological diagnosis of pleural effusion in paediatric pneumonia. We present a case series of 17 pleural fluid samples that were processed by culture-based microbiology and molecular biology methods. Microbiological isolation was successful in four cases (25 %) through traditional culture methods. In contrast, the molecular biology panels allowed for detection in 16 out of 17 cases (94 %). The results from these panels led to a change in management for nine out of the 17 cases (52 %). This study found an increase in aetiological diagnosis in complicated pneumonia in children by using molecular biology methods, which led to a significant change in patient management.

Measles-Related Pneumonia Association on Severely Wasting Children

In developing countries, measles is a highly contagious infectious disease that is transmitted through droplets or aerosols and can be fatal in complicated cases. Risk factors attributable to measles severity include age, nutritional and immunization status. Children who are severely wasting are more likely to develop measles-related complications; one of the most frequent complications is pneumonia, which is responsible for most measles-related morbidity and mortality. Through this study, we aim to assess the association between severely wasting nutritional status and the complications of measles-related pneumonia. A retrospective cohort analytic study of 45 children aged 1 to ≤ 60 months old was conducted. The study was conducted based on measles prevalence data in Hermina Podomoro General Hospital Paediatric Ward in the period April 2022 – March 2023. Nutritional status was assessed through WHO W/H Z-Score for children ≤ 60 months old. Pneumonia complication was diagnosed by clinical findings and chest radiograph. Data analysis was performed using the chi-square test with IBM SPSS Statistics Version 27. There were 39 children included in this study. Children aged >48 – £ 60 months had the highest proportion of confirmed measles cases (30.8%). Measles clinical symptoms of koplik’s spot, macopapular rash, and fever were found in all enrolled patients. We found 64.1% of patients had severely wasting nutritional status, with 53.8% cases undergoing pneumonia complications, and 46.1% of enrolled patients had both severely wasting nutritional status and pneumonia complications. Analytic bivariate analysis found a statistically significant association between severely wasting nutritional status and pneumonia complication (p=0.02, p<0.05). There is an association between severely wasting nutritional status and the complication of pneumonia in children with measles.

The Role of Computed Tomography in Diagnosing and Treating Community-Acquired Bacterial or Viral Pneumonia in Children

Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.

Аналіз результатів бактеріологічної діагностики ускладненої пневмонії в дітей та резистентності збудників до протимікробних препаратів

Purpose - to analyze the results of bacteriological diagnosis of complicated pneumonia in children and antibiotic resistance in isolated pathogens. Materials and methods. There were analyzed inpatient medical records (form 003/o) of 1,175 patients with complicated pneumonia at the age from 2 months to 18 years treated at the Ivano-Frankivsk Regional Children’s Clinical Hospital of the Ivano-Frankivsk Regional Council during 2012-2020. Due to the severity of illness, 827 (70.4%) children were hospitalized to the anesthesiology department and intensive care unit. Among patients with community-acquired pneumonia, there were 248 (29.9%) one-year-old children. The rest of children (n=348 - 29.6%) were diagnosed with nosocomial pneumonia, including ventilator-associated pneumonia in 103 (29.6%) children. In most cases (n=1,092 - 92.9%), complicated pneumonia developed secondary to purulent endobronchitis. Purulent pulmonary and pulmonary pleural pathological processes were less common (n=83 - 7.1%). A total of 3,196 bacteriological studies were carried out, including studies of bronchial aspirate (n=2,695 - 84.3%), pleural effusion (n=175 - 5.5%), and blood culture for sterility (n=326 - 10.2%). Bacteriological studies were carried out in accordance with the Order of the Ministry of Health of Ukraine No. 167 on Approval of the Methodological Guidelines «Determination of the Sensitivity of Microorganisms to Antibacterial Drugs» dated April 05, 2007. Results. During bacteriological investigation of bronchial tree aspirate, the positive results were obtained in 773 (28.7%) cases, there were isolated 956 pathogens, including 183 (23.7%) cases had a mixed infection. Gram-negative bacterial pathogens prevailed: Pseudomonas aeruginosaе (n=383 - 48.1%), Klebsiella рneumoniae (n=140 - 17.6%) and Acinetobacter baumannii (n=104 - 13.0%). Gram-negative bacteria isolated from blood cultures were characterized by high resistance to the following reserve antimicrobials: carbapenems (68.4%-52.9%), fourth-generation cephalosporins (cefepime - 65.6%), third-generation cephalosporins (52.5%-31.6%) and to a lesser extent, to cephalosporins/beta-lactamase inhibitors. There was an upward trend in the resistance of isolated pathogens to fluoroquinolones, penicillin / beta lactamase inhibitors. Gram-positive bacterial pathogens demonstrating high resistance to almost all antibiotic groups accounted for 16.6%, with Staphylocоccus aureus (76.1%) being the most predominant pathogen. Conclusions. Over the past eight years, a high frequency of infecting by gram-negative microorganisms among patients with complicated pneumonia has been observed and high antibiotic resistance of isolated pathogens, especially to reserve antimicrobials, has been proven. Pseudomonas aeruginasaе, Klebsiella pneumoniaе, Acinetobacter baumannii are dominant among gram-negative pathogens causing complicated pneumonia. Gram-positive bacterial pathogens of complicated pneumonia accounted for 16.6%, with Staphylocоccus aureus being the most predominant bacterium, and demonstrated a fairly high antibiotic resistance. Both the compliance with the indications, dosage and treatment regimens and consideration of antibiotic sensitivity of pathogens in every medical institution are the most important prerequisites for reducing antibiotic resistance, as well as slowing down the spread of antifungal resistance and preventing generalized mycosis. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was adopted by the Local Ethics Committee of the institutions specified in the work. The informed consent of the parents or guardians of the children was obtained for the study. No conflict of interests was declared by the authors. Keywords: children, complicated pneumonia, bacteriological diagnosis, antibiotic resistance.

РОЛЬ СИСТЕМЫ ГЕМОСТАЗА В РАЗВИТИИ ДЕСТРУКТИВНОЙ ПНЕВМОНИИ У ДЕТЕЙ: ОБЗОР ЛИТЕРАТУРЫ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ

Complicated pneumonia in children remains an urgent problem in pediatrics because of increasing frequency of its current occurrence. The pathogenetic mechanisms of lung destruction have not been sufficiently studied as yet. The article presents an overview of current bibliographical data on the importance of the hemostasis system in the development of the infectious and inflammatory process in pneumonias. The clinical observations of various forms of destructive pneumonia in children are given as well.

Empyema and Parapneumonic effusions in children admitted to a teaching hospital in Ghana. -A retrospective review

Background
 Parapneumonic effusions (PPE) and Empyema are serious complications of pneumonia in children that are associated with higher morbidity and prolonged hospital stay. The introduction of the pneumococcal conjugate vaccines (PCV 13) have led to a reported decline in the episodes of complicated pneumonia in children. The organisms commonly associated with PPE and Empyema are Streptococcus pneumoniae and Staphylococcus aureus though Mycobacterium tuberculosis has also been reported. There is paucity of data on children with PPE and Empyema in Ghana. We aimed to describe the profile, mode of presentation and outcomes in children admitted with PPE and Empyema to the Komfo Anokye Teaching Hospital.
 Methods
 A retrospective review of medical records (folders) and electronic data on children with PPE and Empyema admitted to the pulmonology unit from January 2018 to December 2020 were retrieved. Demographic records, immunization status, clinical presentation, length of hospital stay and outcome of admission were extracted using a Microsoft Excel. Data was then analysed with STATA version 16.
 Results
 Records were available for 51 children; the median age was 42 months IQR (22.5-96) and 68.6% (n=35) were males. In all 84.2% (n=38), had received all immunisations up to date for age. At presentation, 9.5% (n=4/42) had oxygen saturation <90%, whilst 43.9% (n=18/41) had axillary temperature > 38oC. The median respiratory rate was 47.5 IQR (32.8-57). The Median white cell count was 15.84 X10 9/l IQR (11.9-24.73) and median hemoglobin was 9.6 g/dl IQR (8.6-11.7). Pleural aspirate culture isolated Staphylococcus aureus for 6 patients. The rest were either not available or had no bacterial growth. Amoxicillin clavulanic acid and ceftriaxone were the most commonly used antibiotics. The median length of hospital stay was 9 days IQR (7-12) while the median length of chest tube insertion was 7 days IQR (5.5-9). In all 7.8 (n-4/51) patients died.
 Conclusion
 Both young and older children are affected with PPE/empyema. There is a good uptake of vaccines among children admitted for PPE/empyema, Staphylococcus aureus is the most common bacterial isolated from pleural aspirate culture. Most children admitted with complicated PPE/Empyema survived.

The importance of ultrasound in the diagnosis of pleura complications of acute destructive pneumonia in children

Background. The problem of timely diagnosis of complications of acute destructive pneumonia accompanied by pyofibrothorax remains relevant. The study was aimed to investigate the features of ultrasound diagnosis (ultrasound) of the condition of the visceral and parietal pleural lamina in acute destructive pneumonia in children at different stages of the disease. Materials and methods. In the departments of purulent surgery and pulmonology of the Regional Children’s Hospital of Dnipro for the period of 5 years, there were observed about 475 children aged from 1 to 17 years with pneumonia, purulent-destructive changes in the lungs and pleura. For analysis and further study, we choose a group of 50 patients of different age groups, who underwent ultrasound in real time without prior preparation of patients. The condition of the parietal and visceral pleural lamina at the different stages of diagnosis and treatment was studied. Results. A group of patients aged from 4 to 10 years was performed an ultrasound of the pleural cavities in real time without prior preparation on the paraspinal, scapular, axillary, midclavicular, and thoracic lines when admitted to the hospital and on the first day of treatment. Ultrasound was used to determine the structure and volume of free fluid as well as the condition of the parietal and visceral pleural lamina, their thickness, and other features. The use of ultrasound allowed diagnosing the early manifestations of pyofibrothorax and determining the condition of the parietal and visceral pleural lamina in the children with destructive pneumonia. Conclusion. Further improvement of the algorithm of ultrasound diagnosis of acute destructive pneumonia in children with pyofibrothorax will reduce radiation exposure to a child’s body, increase the efficiency of the development and improvement of treatment methods at the stages of pyofibrotorax, reduce the duration of inpatient treatment.

Inpatient outcomes for children receiving empiric methicillin‐resistant Staphylococcus aureus coverage for complicated pneumonia

AbstractRigorous evidence for antibiotic management of pediatric complicated pneumonia is lacking, likely contributing to variation in empiric antibiotic(s). Using the Pediatric Health Information System database, we sought to describe use and clinical outcomes of children hospitalized with complicated pneumonia who received empiric antibiotic regimens with and without methicillin‐resistant Staphylococcus aureus (MRSA) coverage. We evaluated empiric antibiotic selection on Day 0–1, grouping based on use of an antibiotic with or without MRSA coverage. We used generalized linear mixed effects models to examine the association of MRSA coverage and outcomes. Across 46 children's hospitals, 71.5% of children (N = 1279) received an empiric antibiotic regimen with MRSA coverage. In adjusted analyses, length of stay, need for repeat pleural drainage procedures, 7‐day emergency department revisits and 7‐day readmissions were similar between groups. Future prospective studies examining the need for MRSA coverage may assist in refining national treatment guidelines for complicated pneumonia in children.

Influence of Individualized Nursing Mode on the Incidence of Clinical Symptoms and Complications of Pneumonia in Children

Influence of Individualized Nursing Mode on the Incidence of Clinical Symptoms and Complications of Pneumonia in Children

Risk Factors Of Complicated Pneumonia In Children

Introduction: Pneumonia causes morbidity and mortality in children worldwide. Pediatric patients with complicated pneumonia have a poor prognosis and are more at risk of death. Objective To identify risk factors for complications in pediatric patients with pneumonia.
 Method: This research was a case-control study, involving children with pneumonia aged 1-59 months in Dr. Soetomo in 2016-2020. The sample was divided into two groups. Patients who had complications at first admission were classified as a case group. Whereas patients without complications at first admission were classified as a control group. Samples for the case group were obtained by using total sampling method, while the control group employed random sampling technique. Data were collected from medical records and analyzed by chi-square test.
 Result: A total of 44 case group samples and 53 control group samples were involved during this study. Among investigated variables, male gender (OR=2,842; 95% CI, 1,24-6,49) and anemia (OR=3,283; 95% CI, 1,26-8,49) might increase the risk of complicated pneumonia. Meanwhile other variables, namely age, comorbidities, birth weight, malnutrition, and immunization status did not have a significant relationship with the incidence of complications in pneumonia patients.
 Conclusion: Male gender and anemia are risk of complicated pneumonia.

Early recognition of necrotizing pneumonia in children based on non-contrast-enhanced computed tomography radiomics signatures.

BackgroundNecrotizing pneumonia (NP) is an infrequent but severe complication of pneumonia in children. In the early stages of NP, CT imaging shows lung consolidation, which cannot be detected in time. This study aimed to explore the ability of non-contrast-enhanced CT radiomics features to recognize NP in early stage.MethodsThis was a retrospective study, and 250 patients who presented with lung consolidation on initial CT images were included in this study. After a follow-up period of 1–3 weeks, 116 patients developed NP, whose CT or X-ray shows cavitation or liquefied necrosis. Manual segmentation of lesion sites in the initial non-contrast-enhanced CT scans was performed with RadCloud (Huiying Medical Technology Co., Ltd., China), and 1,409 radiomics features were extracted. We used Variance threshold (0.8), SelectKBest, and the least absolute shrinkage and selection operator (LASSO) methods for feature dimension reduction. Three machine learning algorithms, k-nearest neighbor (KNN), support vector machine (SVM), and logistic regression (LR) models, were established to recognize NP early. To assess the recognition performance, the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and other indicators were used in the validation cohort.ResultsRadiomics features helped to recognize NP in early stage in both the training and validation cohorts. The AUC (sensitivity, specificity) for the training and validation cohorts were 0.81 (0.73, 0.68) and 0.71 (0.61, 0.65) for KNN, respectively; 0.81 (0.72, 0.70) and 0.77 (0.66, 0.65) for SVM, respectively; and 0.82 (0.73, 0.73) and 0.76 (0.63, 0.70) for LR, respectively. Recall and F1-scores determined that LR performed better at diagnosing early NP, with the values of the above two indexes being 0.70 and 0.67, respectively.ConclusionsNon-contrast-enhanced CT-based radiomics models may be helpful for recognizing NP in early stage.

Factors associated with complicated pneumonia in children.

Community acquired pneumonia (CAP) is a leading cause of morbidity in children, despite advances in health care and anti-pneumococcal vaccine. Complicated pneumonia accounts for a significant burden with prolonged hospitalization. Finding risk factors for complicated pneumonia may help in tailoring management. We aimed to identify risk factors for developing complicated pneumonia and need for intervention. A retrospective single tertiary center study. Children admitted with a diagnosis of CAP and/or complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, and lung abscess) on January 2001-March 2020 were included. Demographic, clinical, and laboratory parameters were collected using MDclone, a data acquisition tool. Risk factors for complicated pneumonia (on admission or during hospitalization) and risk for intervention were analyzed. A total of 6778 children with pneumonia were included; 323 arrived at the Emergency Department with complicated pneumonia while 232 developed a complication during hospitalization. Risk factors for complicated pneumonia (on admission or during hospitalization) were Arab ethnicity, cardiac disease, increased age, and CRP and low O2 Sat (OR = 2.236 p < .001, OR = 4.376 p < .001, OR = 1.131 p < .001, OR = 1.065 p < .001 and OR = 0.959 p = .029, respectively). O2 Sat was lower, while fever and CRP were higher in patients with complicated pneumonia requiring intervention. Identifying children at risk for complicated pneumonia may help in decision-making in the Emergency Department and during hospitalization. The increased risk of the Arab population for complicated pneumonia requires further understanding. Addressing the underlying socioeconomic and ethnic health inequities may help to decrease the disease burden in this population.

MULTIMODAL APPROACH TO DIAGNOSTIC RADIOLOGY OF PULMONARY COMPLICATIONS OF PNEUMONIA IN CHILDREN

Introduction. Pneumonia and its complications are one of the leading causes of death in children worldwide. According to the WHO in 2017, 808,694 children under the age of 5 died of pneumonia, accounting for 15% of all deaths of children under the age of 5 worldwide. Materials and methods. The object of the study was 154 children with pulmonary and pleural complications of pneumonia in the age aspect from 3 months to 18 years, who were examined and treated at the clinic of the Tashkent Pediatric Medical Institute for the period from 2014 to 2019. A comprehensive examination of children was carried out at the TashPMI clinic. Digital radiography was the main and primary radiation method of investigation for suspected pulmonary complications of pneumonia in children. In case of destructive pneumonia, the zones of infiltration of the lung tissue (“darkening”) with a decrease in its airiness were determined on X-ray images. It was obligatory to perform radiographs in two projections – direct and lateral. Results and Discussion. We have identified radiation signs of pulmonary complications in children. Pulmonary complications accounted for 92 children, of whom 75 (57.0%) were diagnosed with pulmonary destruction and 17 (43.0%) with lung abscess. Destructive changes in lung tissue were found in young children, mainly up to 3 years of age. Conclusion. Thus, the results of our study showed that the use of high-tech methods of radiation examination significantly increases the accuracy of diagnosing lung lesions with complications of pneumonia at different stages of examination and treatment of patients.

Destructive pneumonias in children

Purpose . A complicated acute destructive pneumonia is one of the most severe purulent and septic diseases in children. The issue is pressing as a high level of lungs and pleura purulent morbidity among different age groups has been preserved till now. Materials and methods . The article reviews Russian and foreign literature addressing the issues of destructive pneumonia epidemiology, reviewing etiological aspects of the disease and analyzing the most frequent pathological agents which result in destructive pneumonia. Moreover, the authors’ views on pathogenesis and pathomorphology of this disease and its clinical signs are presented. Effectiveness of diagnostic research methods in diagnosis verification is comparatively assessed. A special attention is given to various methods of antibacterial therapy and prevention of this severe disease. Conclusions . The authors conclude that destructive pneumonia is a severe complication of pneumonia in children. S. pneumoniae and S. Aureus refer to its basic causative agents. Further studies need to establish the host-pathogen interaction, improve the microbiological diagnosis and optimize conservative and surgical treatment.

Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines

What is already known? Complicated pneumonia is an area of debate, and a rapid diagnosis is essential for patient survival. Due to the importance of stage-adapted therapeutic decisions, different classification systems have been established. Depending on the stage of the disease, both antimicrobial and interventional approaches are indicated. Conservative management remains the mainstay for the management of parapneumonic effusion, and continuous pleural fluid drainage is not necessary in some children. However, an established consensus worldwide for the management of complicated pneumonia and thoracic empyema with different therapeutic algorithms lacks clear evidence to evaluate complex cases with minimally invasive intervention versus open decortication. Such controversy concerning the best surgical approach persists, especially for sick patients in intensive care who are not doing well despite chest tube or fibrinolytic agents. This article aimed to review current treatment standards for children with different phases of thoracic empyema and complicated pneumonia, this review article will discuss the usefulness of different diagnostic methods and most recent updates on management. 1. Outline the definition, pathophysiology and common causes 2. Review the diagnosis and current treatment standards for complicated pneumonia 3. Review different surgical approaches and their outcomes 4. Provide an update on the recent utilization of video-assisted thoracoscopy (VATS) 5. Review evidence regarding the best fibrinolytic agent 6. Review evidence concerning when to indicate decortication 7. Provide a simplified pathway for the management of complicated pneumonia (figure 9).

Evolutionary Particularities in a Case of Severe Pneumonia in Children – Case Report

Necrotizing pneumonia remains an uncommon complication of pneumonia in children, but its incidence is increasing. Pneumococcal infection is the predominant cause of severe necrotizing pneumonia in children, but methicillin resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL) staphylococcal infections are also important. We present the case of a four-year-old girl,with an unremarkable medical history, who was admitted in our hospital with a history of high fever, productive cough and tachypnea lasting for 10 days, progressive worsening despite empirical oral antibiotic. Following physical examination, laboratory investigations and thoracic radiography, we established the diagnosis of left lower lobe pneumonia with parapneumonic effusion, acute respiratory failure and sepsis. Medical treatment with systemic antibiotics was initiated, but the evolution was unfavorable. Seriated chest X-rays and also high resolution computed tomography with contrast of the lung were performed, revealing the progression to extensive necrotizing pneumonia with multiple cystic lesions causing right mediastinal deflection. The parenteral broad spectrum antibiotic regimen was adjusted, still with unfavorable evolution, requiring surgical treatment (left inferior lobectomy and pleural draining). Postoperatively, recovery was uneventful. The patient was discharged with clinical and laboratory improvement of his condition, a repeated chest X-ray showing good expansion of upper left parenchyma.

Long-term sequelae after lung abscess in children - Two tertiary centers' experience.

The aim of the study was to describe the epidemiology and clinical characteristic of children hospitalized with pneumonia complicated by lung abscess, as well as to evaluate the long-term sequelae of the disease. A retrospective review of medical records of all patients treated for pulmonary abscess in two tertiary centers was undertaken. Pulmonary function tests and lung ultrasound were performed at a follow-up. During the study period, 5151 children with pneumonia were admitted, and 49 (0.95%) cases were complicated with lung abscess. In 38 (77.5%) patients, lung abscess was treated solely with antibiotics, and in nine cases (16.3%) surgically. In 21 (51.21%) children complete radiological regression was documented. The mean time for radiological abnormalities regression was 84.14±51.57 days, regardless of the treatment mode. Fifteen patients were followed up at 61.6±28.3 months after discharge. Lung ultrasound revealed minor residual abnormalities: pleural thickening, subpleural consolidations and line B artefacts in 11 (73.3%) children. Pulmonary function tests results were abnormal in eight (53.3%) patients, the most frequent abnormality being hyperinflation. We did not find a restrictive disorder in any of the children. There were no deaths in our study. Lung abscess is a rare but severe complication of pneumonia in children. Most children recover uneventfully with no significant long-term pulmonary sequelae.

Management of Complicated Pneumonia in Childhood: A Review of Recent Literature.

Despite declining rates of community acquired pneumonia (CAP) in children, complicated pneumonia has been on the rise in the last two decades. The management of complicated pneumonia is challenging and continues to be an area of investigation. Despite recently published guidelines, many gaps exist and recent studies attempt to answer challenging questions. The aim was to review recently published literature to inform the clinician about the most up to date management of complicated pneumonia in children. Using Medline, a search of the medical literature was conducted in order to find relevant clinical trials and review articles published in the last 5 years. Narrow spectrum antibiotics including ampicillin and azithromycin remain important first line agents, but directed therapy towards causative pathogens is the ideal standard practice. Novel DNA isolation technologies hold promise for raising the diagnostic yield of pleural fluid. Surgical interventions are often required and new literature further supports the use of fibrinolytics and minimally invasive chest tube thoracostomy. Not to be overlooked is the importance of supportive measures including oxygen therapy and adequate fluid, electrolyte and nutrition support. The use of other adjunctive therapies such as steroids in pediatric complicated pneumonia remains controversial. Recent studies have shown promise in establishing best practices for evaluation and management of complicated pneumonia in children. Despite these robust efforts however, many areas are in need of future inquiry and prospective studies could help to better understand the optimal therapeutic and diagnostic options for children with this common and persistent childhood illness.

Predictive value of Thomsen-Friedenreich antigen activation for Streptococcus pneumoniae infection and severity in pediatric lobar pneumonia.

Most cases of complicated pneumonia in children are caused by pneumococcal infections. Thomsen-Friedenreich antigen (TA) is present on erythrocytes, platelets and glomeruli, and it can be activated during pneumococcal infection. The aim of this study was to investigate the predictive value of TA activation for pneumococcal infection and association with the severity of complicated pneumonia. Patients with lobar pneumonia were routinely tested for TA at the Department of Pediatrics, Mackay Memorial Hospital from January 2010 to December 2015. We retrospectively reviewed and analyzed their charts and data including age, sex, etiology of infection, chest tube insertion or video-assisted thoracoscopic surgery, length of hospital stay, TA activation, white blood cell count and level of C reactive protein. A total of 142 children with lobar pneumonia were enrolled, including 35 with empyema, 31 with effusion, 11 with necrotizing pneumonia and four with lung abscess. Streptococcus pneumoniae was the most commonly identified pathogen. Twenty-two patients (15.4%) had activated TA, all of whom were infected with S. pneumoniae. TA activation had 100% specificity and 100% positive predictive value for pneumococcal infection. In the multivariate analysis in lobar pneumonia, TA activation (OR, 15.8; 95% CI, 3.0-83.5; p=0.001), duration of fever before admission (OR, 1.2; 95% CI, 1.1-1.5; p=0.013) and initial CRP level (OR, 1.1; 95% CI, 1.0-1.1; p=0.004) were independent predictors of empyema. TA activation is a specific marker for pneumococcal pneumonia and might indicate higher risk for complicated pneumonia.