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Çocukluk Çağı Plevral Efüzyon Nedenleri, Klinik Bulguları ve Yönetimi; Retrospektif Bir Analiz

Yıl 2022, Cilt: 16 Sayı: 1, 37 - 41, 28.01.2022
https://doi.org/10.12956/tchd.839021

Öz

Amaç: Plevral efüzyon çocukluk çağında ciddi morbidite ve mortalite nedenidir. Bu çalışmada plevral efüzyon tanısı ile hastanede yatırılan çocuklarda etyolojik sınıflama yapılarak hastaların izlem ve tedavilerini araştırmak amaçlanmıştır. Ayrıca, plevral efüzyonların en sık nedeni olan parapnömonik efüzyonların yıllar içerisindeki değişimi araştırılmıştır.


Gereç ve Yöntemler:
Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Sağlık Uygulama ve Araştırma Hastanesi Pediatri Servisleri ve Yoğun Bakım Ünitesi’ne Ocak 2012- Aralık 2017 tarihleri arasında plevral efüzyon tanısı ile yatırılan çocuk hastalar değerlendirildi. Retrospektif tanımlayıcı özellikte olan bu çalışmada 0-18 yaş arası 135 hasta incelendi. Hastaların demografik ve klinik özellikleri, fizik muayene bulguları, altta yatan ek hastalık varlığı, laboratuvar verileri, görüntüleme yöntemleri, takip ve tedavileri incelendi.


Bulgular:
Plevral efüzyon tanılı 135 hastanın 74’ü (%54.8) erkek olup ortalama yaş 8.4±5.3 saptandı. Hastaların 78’i (%57.8) parapnömonik efüzyon, 14’ü (% 10.4) sepsis, 10’u (%7.4) romatolojik hastalık tanısı almıştı. En sık başvuru semptomları ateş (%62.2), öksürük (%45.9) ve nefes darlığı (%32.6)’di. Fizik muayenede en sık saptanan bulgu takipne (%39.3)’dü. Hastaların yarısından fazlasında (%59.2) kronik hastalık olduğu tespit edildi. Bu ek hastalıklar içerisinde en sık nörolojik hastalıkların olduğu görüldü. Verilerine ulaşılabilen 127 hastanın 94’üne (%74) torasentez yapılmıştı; 70’ine (%55.5) göğüs tüpü takılmıştı. Parapnömonik efüzyon tanısı alan hastaların 42’si (%53.8) basit parapnömonik efüzyon, 36’sı (%46.2) komplike parapnönomik efüzyon (ampiyem) tanısı aldı. En çok izole edilen etken Streptococcus pneumoniae’di. Ampiyem tedavisinde en çok fibrinolitik tedavinin tercih edildiği görüldü. Plevra sıvısında ‘pH ≤7.1’ ve ‘LDH ≥1000’ saptanması ampiyem tanılı hastalarda basit parapnömonik efüzyon tanılı hastalara göre anlamlı bulundu (sırasıyla p:0.003 ve p:0.001). Parapnömonik efüzyonların yıllar içindeki dağılımına bakıldığında son yıllarda ampiyem sıklığında artış görülmektedir. Pnömokok aşısı ile aşılanmanın basit parapnömonik efüzyon ve ampiyem gelişiminde fark yaratmadığı görüldü (p:0.351).


Sonuç:
Plevral efüzyon nedeniyle hastaneye yatırılan çocuk hastaların yarısından çoğunda parapnömonik efüzyon saptanmıştır. Ampiyem sıklığında son üç yılda artış görülmektedir. Bu durum aşılama ile önüne geçilemeyen invaziv suşların varlığını düşündürmektedir. Erken evrede tanı ve tedaviye yönelik daha fazla çalışmaya ihtiyaç vardır.

Kaynakça

  • 1. Hardie W, Bokulic R, Garcia VF, Reising SF, Christie CDC. Pneumococcal pleural empyemas in children. Clin Infect Dis. 1996;22(6):1057–63.
  • 2. Efrati O, Barak A. Pleural Effusions in the Pediatric Population. Pediatr Rev. 2002;23(12):417–26.
  • 3. Mocelin HT, Fischer GB. Epidemiology, presentation and treatment of pleural effusion. Paediatr Respir Rev. 2002;3(4):292–7.
  • 4. Ütine GE, Özçelik U, Kiper N, Doǧru D, Yalçin E, Çobanoǧlu N, et al. Pediatric pleural effusions: Etiological evaluation in 492 patients over 29 years. Turk J Pediatr. 2009;51:214–9.
  • 5. Liese JG, Schoen C, van der Linden M, Lehmann L, Goettler D, Keller S, et al. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study. Clin Microbiol Infect. 2018;18:1–8.
  • 6. Diaz-Guzman E, Budev MM. Accuracy of the physical examination in evaluating pleural effusion. Cleve Clin J Med. 2008;75(4):297–303.
  • 7. Mitrouska I, Klimathianaki M, Siafakas NM. Effects of pleural effusion on respiratory function. Can Respir J. 2004;11(7):499–503.
  • 8. Wernecke K. Ultrasound study of the pleura. Eur Radiol. 2000;10(10):1515–23.
  • 9. Lichtenstein DA. Ultrasound in the management of thoracic disease. Crit Care Med. 2007;35(5):250–61.
  • 10. Piette E, Daoust R, Denault A. Basic concepts in the use of thoracic and lung ultrasound. Curr Opin Anaesthesiol. 2013;26(1):20–30.
  • 11. McGrath EE, Anderson PB. Diagnosis of pleural effusion: A systematic approach. Am J Crit Care. 2011;20(2):119–28.
  • 12. Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60:1–21.
  • 13. 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.
  • 14. Gayretli-Aydın ZG, Tanır G, Bayhan Gİ, Aydın-Teke T, Öz FN, Metin-Akcan Ö, et al. Evaluation of complicated and uncomplicated parapneumonic effusion in children. Turk J Pediatr. 2017;58(6):623–31.
  • 15. Collins TR, Sahn SA. Thoracocentesis. Clinical value, complications, technical problems, and patient experience. Chest. 1987;91(6):817–22.
  • 16. Light RW. Pleural effusions. Med Clin North Am. 2011;95(6):1055–70.
  • 17. St. Peter SD, Tsao K, Harrison C, Jackson MA, Spilde TL, Keckler SJ, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009;44(1):106–11.
  • 18. Sonnappa S, Cohen G, Owens CM, Van Doorn C, Cairns J, Stanojevic S, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006;174(2):221–7.
  • 19. Alkrinawi S, Chernick V. Pleural fluid in hospitalized pediatric patients. Clin Pediatr (Phila). 1996;35(1):5–9

A Retrospective Analysis; Etiological Evaluation of Pleural Effusion in Children, Clinical Presentation and Managemet

Yıl 2022, Cilt: 16 Sayı: 1, 37 - 41, 28.01.2022
https://doi.org/10.12956/tchd.839021

Öz

Objective: Pleural effusion is a serious cause of morbidity and mortality in childhood. In this study, it was aimed to investigate the follow-up and treatment of patients by performing etiological classification of children with hospitalization with pleural effusion diagnosis.

Material and Methods: Pediatric patients who were admitted to the Pediatric Services and Intensive Care Unit of Health Sciences University Ankara Child Health and Diseases Hematology Oncology Education and Research Hospital between January 2012 and December 2017 were evaluated. In this retrospective descriptive study, 135 patients aged 0-18 years were examined. The demographic characteristics, clinical features, physical examination findings, underlying additional disease, laboratory data, imaging methods, follow-up and treatment methods of the patients were examined.


Results:
74 (54.8%) of 135 patients diagnosed with pleural effusion were male and the mean age was 8.4±5.3. 78 of the patients (57.8%) were diagnosed with parapneumonic effusion, 14 (10.4%) sepsis, 10 (7.4%) rheumatological disease. The most common presenting symptoms were fever (62.2%), cough (45.9%) and shortness of breath (32.6%). The most common finding on physical examination was tachypnea (39.3%). More than half of the patients (59.2%) had chronic disease. Among these diseases, the most common neurological diseases were found. Thoracentesis was performed in 94 (74%) of 127 patients whose data could be accessed; chest tube was inserted in 70 of them (55.5%). Of the patients diagnosed with parapneumonic effusion, 42 (53.8%) were diagnosed with simple parapneumonic effusion and 36 (46.2%) were diagnosed with complicated parapneumonic effusion (empyema). The most commonly isolated agent was Streptococcus pneumoniae. Fibrinolytic therapy was the most preferred treatment for empyema. Detection of ‘pH ≤ 7,1’ and ‘LDH ≥ 1000’ in pleural fluid was found to be significant in patients with empyema compared to patients with simple parapneumonic effusion, respectively (p:0.003) (p:0.001). Considering the distribution of parapneumonic effusions over the years, there has been an increase in the frequency of empyema in recent years. It was observed that vaccination with pneumococcal vaccine did not make any difference in the development of simple parapneumonic effusion and empyema (p: 0.351).

Conclusion: Parapneumonic effusion was detected in more than half of the pediatric patients who were hospitalized for pleural effusion. Empyema incidence has increased in the last three years. This suggests the presence of invasive strains which cannot be prevented by vaccination. Further studies are needed for diagnosis and treatment in early stage.

Kaynakça

  • 1. Hardie W, Bokulic R, Garcia VF, Reising SF, Christie CDC. Pneumococcal pleural empyemas in children. Clin Infect Dis. 1996;22(6):1057–63.
  • 2. Efrati O, Barak A. Pleural Effusions in the Pediatric Population. Pediatr Rev. 2002;23(12):417–26.
  • 3. Mocelin HT, Fischer GB. Epidemiology, presentation and treatment of pleural effusion. Paediatr Respir Rev. 2002;3(4):292–7.
  • 4. Ütine GE, Özçelik U, Kiper N, Doǧru D, Yalçin E, Çobanoǧlu N, et al. Pediatric pleural effusions: Etiological evaluation in 492 patients over 29 years. Turk J Pediatr. 2009;51:214–9.
  • 5. Liese JG, Schoen C, van der Linden M, Lehmann L, Goettler D, Keller S, et al. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study. Clin Microbiol Infect. 2018;18:1–8.
  • 6. Diaz-Guzman E, Budev MM. Accuracy of the physical examination in evaluating pleural effusion. Cleve Clin J Med. 2008;75(4):297–303.
  • 7. Mitrouska I, Klimathianaki M, Siafakas NM. Effects of pleural effusion on respiratory function. Can Respir J. 2004;11(7):499–503.
  • 8. Wernecke K. Ultrasound study of the pleura. Eur Radiol. 2000;10(10):1515–23.
  • 9. Lichtenstein DA. Ultrasound in the management of thoracic disease. Crit Care Med. 2007;35(5):250–61.
  • 10. Piette E, Daoust R, Denault A. Basic concepts in the use of thoracic and lung ultrasound. Curr Opin Anaesthesiol. 2013;26(1):20–30.
  • 11. McGrath EE, Anderson PB. Diagnosis of pleural effusion: A systematic approach. Am J Crit Care. 2011;20(2):119–28.
  • 12. Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60:1–21.
  • 13. 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.
  • 14. Gayretli-Aydın ZG, Tanır G, Bayhan Gİ, Aydın-Teke T, Öz FN, Metin-Akcan Ö, et al. Evaluation of complicated and uncomplicated parapneumonic effusion in children. Turk J Pediatr. 2017;58(6):623–31.
  • 15. Collins TR, Sahn SA. Thoracocentesis. Clinical value, complications, technical problems, and patient experience. Chest. 1987;91(6):817–22.
  • 16. Light RW. Pleural effusions. Med Clin North Am. 2011;95(6):1055–70.
  • 17. St. Peter SD, Tsao K, Harrison C, Jackson MA, Spilde TL, Keckler SJ, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009;44(1):106–11.
  • 18. Sonnappa S, Cohen G, Owens CM, Van Doorn C, Cairns J, Stanojevic S, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006;174(2):221–7.
  • 19. Alkrinawi S, Chernick V. Pleural fluid in hospitalized pediatric patients. Clin Pediatr (Phila). 1996;35(1):5–9
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm ORIGINAL ARTICLES
Yazarlar

Günay Kaplan 0000-0001-7752-445X

Halil İbrahim Yakut 0000-0001-6946-4995

Güzin Cinel 0000-0002-6209-196X

Yayımlanma Tarihi 28 Ocak 2022
Gönderilme Tarihi 10 Aralık 2020
Yayımlandığı Sayı Yıl 2022 Cilt: 16 Sayı: 1

Kaynak Göster

Vancouver Kaplan G, Yakut Hİ, Cinel G. Çocukluk Çağı Plevral Efüzyon Nedenleri, Klinik Bulguları ve Yönetimi; Retrospektif Bir Analiz. Türkiye Çocuk Hast Derg. 2022;16(1):37-41.

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