Yasin BULUT, Barlas ETENSEL, Semiha TERLEMEZ, Yavuz TOKGÖZ

A Rare Cause of Empyema in Children: Streptococcus pyogenes

Empyema is the presence of purulent material in the pleural cavity, and it is a well-known and frequent complication of pneumonia in children. Despite the new antimicrobial treatment options and the different drainage techniques, parapneumonic pleural empyema still represents a significant cause of morbidity and mortality. Streptococcus pyogenes is an infrequent cause of empyema. In this article, we will present a four-teen years old girl with empyema who presented with severe additional clinical symptoms including hypotension and hypoxia. Streptokinase is five times table fibrinolytic therapy improved after implementation of broad-spectrum antibiotics, has been used up to six weeks. We wanted to present this case because of the challenges that we faced in the management of the disease.

Çocuklarda Nadir Bir Ampiyem Etkeni: Streptococcus pyogenes

Ampiyem, plevral boşlukta pürülan sıvı varlığı olup çocuklarda pnömoninin bilinen ve sık rastlanan bir komplikasyonudur. Plevral ampiyemler, antimikrobiyal tedavi olanaklarının ve plevral boşluk drenaj seçeneklerinin artmasına rağmen çocuk hastalarda da yüksek oranda morbidite ve mortaliteye neden olmaktadır. Streptococcus pyogenes ampiyemin nadir görülen nedenlerindendir. Bu makalede hipotansiyon ve hipoksinin eşlik ettiği ağır bir klinik tabloda başvurmuş olan ve torakas tüpü ile kapalı sualtı drenajına rağmen düzelmeyen ampiyemli on dört yaşında bir kız olgu sunulmuştur. Beş defa fibrinolitik streptokinaz tedavisi uygulandıktan sonra tablosu düzelmiş olup, altı hafta kadar geniş spektrumlu ikili antibiyotik kullanılmıştır. Streptococcus pyogenes’in neden olduğu bu ampiyem tablosunu yönetimindeki güçlükler nedeniyle sunmayı amaçladık.

PDF

___

Wheeler JG, Jacobs RF. Pleural effusions and empyema. In: Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. Textbook of Pediatric Infectious Diseases, 6th ed. Philadelphia: Saunders Elsevier, 2009: 325-35.

Cameron RJ. Management of complicated parapneumonic effusions and thoracic empyema. Intern Med J 2002; 32: 408-14.

Mocelin HT, Fischer GB. Epidemiology, presentation and treatment of pleural effusion. Paediatr Respir Rev 2002; 3: 292-7.

Gerber MA. Group A streptococci. In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics,17th Edition. 2008: 870-3.

Celayir AC, İnalhan M, Etker Ş, İnan S. Çocuklarda infeksiyona sekonder plevral efüzyonlara yaklaşım:6 yıllık deneyim. Cerrahpaşa Tıp dergisi Ekim-Aralık 2000; 31: 191-5.

Ertuğrul M, Somer A, Törün SH, Salman N, Gürler N, Salman T, ve ark. Çocuklarda Plevral Ampiyem: Seksen Beş Vakanın Değerlendirilmesi. Çocuk Dergisi 2013; 13: 16-28.

Sakran W, Ababseh Z, Miron D, Koren A. Thoracic empyema in children: Clinical presentation, microbiology analysis and therapeutic options. J Infect Chemother 2014; 20: 262-5.

Chen K, Chen H, Lin J, Tseng Y, Kuo S, Huang P, et al. Acute thoracic empyema: Clinical characteristics and outcome analysis of video-assisted thoracoscopic surgery. J Formos Med Assoc 2014; 113: 210-8.

Burgos J, Falco V, Pahissa A. The increasing incidence of empyema. Curr Opin Pulm Med 2013: 19: 350-6.

Walker W, Wheeler R, Legg J. Update on the causes, investigation and man-agement of empyema in childhood. Arch Dis Child 2011; 96: 482-8.

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(Suppl 1): 11-21.

Jaffe A, Balfour-Lynn IM. Management of empyema in children. Pediatr Pulmonol 2005; 40: 148-56.

Walker W, Wheeler R, Legg J. Update on the causes, investigation and man-agement of empyema in childhood. Arch Dis Child 2011; 96: 482-8.

. Islam S, Calkins CM, Goldin AB, Chen C, Downard CD, Huang EY, et al., APSA Outcomes and Clinical Trials Committee, 2011e2012. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg 2012; 47: 2101-10.

St Peter SD, Tsao K, Splide TL, Keckler SJ, Harrison C, Jackson MA, et al. Thoracoscopic decortication vs tube thoracostomy withfibrinolysis for em-pyema in children, 2009 thoracoscopic decortication vs tube thoracostomy withfibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg 2009; 44: 106-11.