Focus
Empiema pleurico in pediatria
l’empiema pleurico nel bambino: un approccio a più voci
PLEURAL EMPYEMA IN CHILDREN
MARIO CANCIANI1, MASSIMILIANO DON2, BARBARA DEL PIN1, LOLITA FASOLI1, TIZIANA GUERRERA1, ALESSANDRO DE CANDIA3, ANGELO MORELLI4
1Servizio di Allergo-Pneumologia, Clinica Pediatrica, DPMSC, Università di Udine
2UOC di Pediatria, Ospedale S. Antonio, San Daniele del Friuli (Udine)
3Istituto di Radiologia, Università di Udine
4UOS di Chirurgia Toracica, Azienda Ospedaliera, Udine
Febbraio 2007 - pagg. 89 -102
Abstract
Parapneumonic effusion and empyema (the presence of pus in the pleural space) have an
incidence of 3.3 per 100,000. An empyema could be suspected if a child remains pyrexial
or unwell 48 hours after adequate antibiotic treatment; examination should include assessment
of hydration, high respiratory frequence, the presence of a scoliosis and any underlying
disorders. Investigation may include chest radiography, chest ultrasonography to
assess the amount of fluid and differentiate free from loculated pleural fluid, diagnostic
analysis of pleural fluid and eventually CT scan. Chest drain, intrapleural fibrinolytics and
video-assisted thoracoscopic surgery (VATS) are the options for management of stages II-III
of empyema, whereas stage I requires only antibiotic therapy.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
of nontuberculous empyema. Surg Clin
North Am 1961;41:681-93.
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-i21.
3. Canciani M, Pettarin R, Guglia E, Crevatin E, Dal Molin G, Busetti M. Acute Respiratory Infections in a Children’s Hospital. Eur Respir J 1995;8,S19,45s.
4. Jones ME, Karlowsky JA, Draghi DC, Thornsberry C, Sahm DF, Bradley JS. Rates of antimicrobial resistance among common bacterial pathogens causing respiratory, blood, urine, and skin and soft tissue infections in pediatric patients. Eur J Clin Microbiol Infect Dis 2004;23(6):445-55.
5. Busetti M, Longo B, Campello C. Low rates of antimicrobial resistance in respiratory pathogens from a pediatric population in north-eastern Italy. Pediatr Med Chir 2003;25(2):131-4.
6. Schultz KD, Fan LL, Pinsky J, et al. The changing face of pleural empyemas in children: epidemiology and management. Pediatrics 2004;113:1735-40.
7. Pinotti KF, Ribeiro SM, Cataneo AJ. Thorax ultrasound in the management of pediatric pneumonias complicated with empyema. Pediatr Surg Int 2006;22(10): 775-8.
8. Chiu CY, Wong KS, Huang YC, Lai SH, Lin TY. Echo-guided management of complicated parapneumonic effusion in children. Pediatr Pulmonol 2006;41(12):1226- 32.
9. Wurnig PN, Wittmer V, Pridun NS, Hollaus PH. Video-assisted thoracic surgery for pleural empyema. Ann Thorac Surg 2006;81(1):309-13.
10. Kurt BA, Winterhalter KM, Connors RH, Betz BW, Winters JW. Therapy of parapneumonic effusions in children: videoassisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics 2006;118:547-53.
11. Tillet WS, Sherry S. The effect in patients of streptococcal fibrinolysis (streptokinase) and streptococcal deoxyribonuclease on fibrinous, purulent, and sanguinous pleural exudations. J Clin Invest 1949; 28:173-90.
12. Bouros D, Schiza S, Patsourakis G, et al. Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions. Am J Respir Crit Care Med 1997;155:291-95.
13. Davies RJ, Traill ZC, Gleeson FV. Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection. Thorax 1997;52:416-21.
14. Chin NK, Lim TK. Controlled trial of intrapleural streptokinase in the treatment of pleural empyema and complicated parapneumonic effusions. Chest 1997;111:275-9.
15. Thomson AH, Hull J, Kumar MR, et al. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 2002;57:343-7.
16. Singh M, Mathew JL, Chandra S, Katariya S, Kumar L. Randomised controlled trial of intrapleural streptokinase in empyema thoracis in children. Acta Paediatr 2004;93:1443-5.
17. Rosen H, Nadkarni V, Theroux M, et al. Intrapleural streptokinase as adjunctive treatment for persistent empyema in pediatric patients. Chest 1993;103:1190-3.
18. Stringel G, Hartman AR. Intrapleural instillation of urokinase in the treatment of loculated pleural effusion in children. J Pediatr Surg 1994;29:1539-40.
19. Kornecki S, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg 1997; 32:1473-5.
20. Krishnan S, Amin N, Dozor AJ, Stringel G. Urokinase in the management of complicated parapneumonic effusions in children. Chest 1997;112:1579-83.
21. De Benedictis FM, De Giorgi G, Niccoli A, et al. Treatment of complicated pleural effusion with intracavitary urokinase in children. Pediatr Pulmonol 2000;29:438-42.
22. Kilic N, Celebi S, Gurpinar A, et al. Management of thoracic empyema in children. Pediatr Surg Int 2002;18:21-3.
23. Barbato A, Panizzolo C, Monciotti C, et al. Use of urokinase in childhood pleural empyema. Pediatr Pulmonol 2003;35:50-5.
24. Wells RG, Havens PL. Intrapleural fibrinolysis for parapneumonic effusion and empyema in children. Radiology 2003;228: 370-8.
25. Yao CT, Wu JM, Liu CC, et al. Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children. Chest 2004;125:566-71.
26. Barnes NP, Hull J, Thomson AH. Medical management of parapneumonic pleural disease. Pediatr Pulmonol 2005;39:127-34.
27. Maskell NA, Davies CWH, Nunn AJ, et al. UK controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352:865-74.
28. Diacon AH, Theron J, Schuurmans MM, et al. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Crit Care Med 2004; 170:49-53.
29. Weinstein M, Restrepo R, Chait PG, et al. Effectiveness and safety of tissue plasminogen activator in the management of complicated parapneumonic effusions. Pediatrics 2004;113:e182-e185.
30. Bilaceroglu S, Colerici U, Cokan A. Management of complicated parapneumonic pleural effusions with image-guided drainage and intrapleural urokinase or streptokinase: a controlled randomized trial (abstract). Eur Respir J 1997;10:325S.
31. Laisaar T, Pullerits T. Effect of intrapleural streptokinase administration on antistreptokinase antibody level in patients with loculated pleural effusions. Chest 2003;123:432-5.
32. Alfageme I, Vazquez R. Ventricular fibrillation after intrapleural urokinase. Intensive Care Med 1997;23:352.
33. Balci AE, Eren S, Ulku R, et al. Management of multiloculated empyema thoracis in children: thoracotomy versus fibrinolytic treatment. Eur J Cardiothor Surg 2002;22: 595-8.
34. Blom D, van Aaldren WM, Alders JM, Hoekstra MO. Life-threatening hemothorax in a child following intrapleural administration of urokinase. Pediatr Pulmonol 2000;30:493.
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-i21.
3. Canciani M, Pettarin R, Guglia E, Crevatin E, Dal Molin G, Busetti M. Acute Respiratory Infections in a Children’s Hospital. Eur Respir J 1995;8,S19,45s.
4. Jones ME, Karlowsky JA, Draghi DC, Thornsberry C, Sahm DF, Bradley JS. Rates of antimicrobial resistance among common bacterial pathogens causing respiratory, blood, urine, and skin and soft tissue infections in pediatric patients. Eur J Clin Microbiol Infect Dis 2004;23(6):445-55.
5. Busetti M, Longo B, Campello C. Low rates of antimicrobial resistance in respiratory pathogens from a pediatric population in north-eastern Italy. Pediatr Med Chir 2003;25(2):131-4.
6. Schultz KD, Fan LL, Pinsky J, et al. The changing face of pleural empyemas in children: epidemiology and management. Pediatrics 2004;113:1735-40.
7. Pinotti KF, Ribeiro SM, Cataneo AJ. Thorax ultrasound in the management of pediatric pneumonias complicated with empyema. Pediatr Surg Int 2006;22(10): 775-8.
8. Chiu CY, Wong KS, Huang YC, Lai SH, Lin TY. Echo-guided management of complicated parapneumonic effusion in children. Pediatr Pulmonol 2006;41(12):1226- 32.
9. Wurnig PN, Wittmer V, Pridun NS, Hollaus PH. Video-assisted thoracic surgery for pleural empyema. Ann Thorac Surg 2006;81(1):309-13.
10. Kurt BA, Winterhalter KM, Connors RH, Betz BW, Winters JW. Therapy of parapneumonic effusions in children: videoassisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics 2006;118:547-53.
11. Tillet WS, Sherry S. The effect in patients of streptococcal fibrinolysis (streptokinase) and streptococcal deoxyribonuclease on fibrinous, purulent, and sanguinous pleural exudations. J Clin Invest 1949; 28:173-90.
12. Bouros D, Schiza S, Patsourakis G, et al. Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions. Am J Respir Crit Care Med 1997;155:291-95.
13. Davies RJ, Traill ZC, Gleeson FV. Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection. Thorax 1997;52:416-21.
14. Chin NK, Lim TK. Controlled trial of intrapleural streptokinase in the treatment of pleural empyema and complicated parapneumonic effusions. Chest 1997;111:275-9.
15. Thomson AH, Hull J, Kumar MR, et al. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 2002;57:343-7.
16. Singh M, Mathew JL, Chandra S, Katariya S, Kumar L. Randomised controlled trial of intrapleural streptokinase in empyema thoracis in children. Acta Paediatr 2004;93:1443-5.
17. Rosen H, Nadkarni V, Theroux M, et al. Intrapleural streptokinase as adjunctive treatment for persistent empyema in pediatric patients. Chest 1993;103:1190-3.
18. Stringel G, Hartman AR. Intrapleural instillation of urokinase in the treatment of loculated pleural effusion in children. J Pediatr Surg 1994;29:1539-40.
19. Kornecki S, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg 1997; 32:1473-5.
20. Krishnan S, Amin N, Dozor AJ, Stringel G. Urokinase in the management of complicated parapneumonic effusions in children. Chest 1997;112:1579-83.
21. De Benedictis FM, De Giorgi G, Niccoli A, et al. Treatment of complicated pleural effusion with intracavitary urokinase in children. Pediatr Pulmonol 2000;29:438-42.
22. Kilic N, Celebi S, Gurpinar A, et al. Management of thoracic empyema in children. Pediatr Surg Int 2002;18:21-3.
23. Barbato A, Panizzolo C, Monciotti C, et al. Use of urokinase in childhood pleural empyema. Pediatr Pulmonol 2003;35:50-5.
24. Wells RG, Havens PL. Intrapleural fibrinolysis for parapneumonic effusion and empyema in children. Radiology 2003;228: 370-8.
25. Yao CT, Wu JM, Liu CC, et al. Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children. Chest 2004;125:566-71.
26. Barnes NP, Hull J, Thomson AH. Medical management of parapneumonic pleural disease. Pediatr Pulmonol 2005;39:127-34.
27. Maskell NA, Davies CWH, Nunn AJ, et al. UK controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352:865-74.
28. Diacon AH, Theron J, Schuurmans MM, et al. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Crit Care Med 2004; 170:49-53.
29. Weinstein M, Restrepo R, Chait PG, et al. Effectiveness and safety of tissue plasminogen activator in the management of complicated parapneumonic effusions. Pediatrics 2004;113:e182-e185.
30. Bilaceroglu S, Colerici U, Cokan A. Management of complicated parapneumonic pleural effusions with image-guided drainage and intrapleural urokinase or streptokinase: a controlled randomized trial (abstract). Eur Respir J 1997;10:325S.
31. Laisaar T, Pullerits T. Effect of intrapleural streptokinase administration on antistreptokinase antibody level in patients with loculated pleural effusions. Chest 2003;123:432-5.
32. Alfageme I, Vazquez R. Ventricular fibrillation after intrapleural urokinase. Intensive Care Med 1997;23:352.
33. Balci AE, Eren S, Ulku R, et al. Management of multiloculated empyema thoracis in children: thoracotomy versus fibrinolytic treatment. Eur J Cardiothor Surg 2002;22: 595-8.
34. Blom D, van Aaldren WM, Alders JM, Hoekstra MO. Life-threatening hemothorax in a child following intrapleural administration of urokinase. Pediatr Pulmonol 2000;30:493.
Corrispondenza: mario.kanzian@med.uniud.it