Clinical Features Of Parapneumonic Effusion In Children With Pneumonia And The Effects Of Early Local Intervention Therapy

Objective:To summarize the clinical features and pathogen spectrum of parapneumonic effusion(PPE)in hospitalized children in Hunan Provincial People's Hospital for nearly 8 years(January 2011~December2018),and analyze the related risk factors for complex parapneumonic effusion(CPPE)and parapneumonic empyema(PE)in children.Methods:1.Retrospective analysis of clinical,imaging and laboratory data of 149 clinically diagnosed PPE hospitalized children from January 2011 to December 2018 in the Children's Medical Center of Hunan Provincial People's Hospital.To explore the common pathogen composition of children with PPE,and to analyze the clinical differences of children with different pathogens infected with PPE.In addition,48 patients with PPE who underwent pleural effusion in our hospital were compared with the pleural fluid laboratory results of 23 hospitalized children with clinical diagnosis of tuberculous pleurisy.2.149 children with PPE were divided into CPPE+PE group(n=53)and uncomplexed parapneum effusion(UPPE)group.The clinical characteristics of the two groups were compared.The risk factors of CPPE and PE in children were analyzed..3.All patients with CPPE and PE underwent thoracic puncture or drainage or thoracoscopic treatment within 3 days after admission.The patients were classified as early local intervention group.Only antibiotics and symptomatic treatment were classified into the conventional treatment group.The clinical efficacy of the two groups was compared.Results:1.Clinical features:1)General Information:Of the 149 children with PPE,80 were male and 69 were female.The age of onset is from 7 months to 13 years old,with the majority of children aged 3-7 years old;the onset season is mainly in spring and summer.2)Clinical manifestations:Clinical symptoms: 143 cases(95.9%)with cough,136 cases(91.3%)with fever and 30 cases(20.1%)with shortness of breath,9 cases(6.0%)with wheezing,5 cases(3.4%)with dyspnea,chest pain 12 cases(8.1%)and 10 cases of abdominal pain(6.7%).Pulmonary signs: 90 cases(60.4%)of lungs and wet voices,low respiratory auscultation in the affected side,32 cases(21.5%)with voiced percussion,15 cases(10.1%)with whistles and pleural friction In 5patients(3.4%),vocal fibrillation was reduced by 10(6.7%).2.Laboratory examination: The percentage of neutrophils increased in106 cases(71.4%),with 127 cases of C-reactive protein(85.2%)and 92 cases of procalcitonin(61.7%).3.Pathogen analysis:There were 130 cases(87.2%)with positive pathogen detection,including 72 cases(48.3%)of mycoplasma infection,25 cases(16.8%)with bacterial infection and 22 cases(14.8%)with viral infection.Among them,8 cases of bacterial infection were Streptococcus pneumoniae.(5.4%),Staphylococcus aureus 5 cases(3.4%),Klebsiella pneumoniae,Pseudomonas aeruginosa and A-type hemolytic streptococcus 3 cases(2.0%),Streptococcus pyogenes,Escherichia coli 1case(0.7%)of L.ornithololyticum;11 cases(7.4%)with mixed infection,and 19 cases with unknown pathogens.Children with PPE infected with different pathogens also have certain clinical differences;the white blood cell count of children with bacterial infection is higher,the neutrophil increased significantly,and the CRP and PCT are also significantly increased.There was no significant difference in gender and age between PPE infected with mycoplasma,bacteria and virus.4.Imaging performance:Examination of one or more of X-ray chest X-ray,chest CT or chest color Doppler ultrasound showed pleural effusion.According to the specific manifestations of imaging,96 children with UPPE,38 cases with CPPE and 15 cases with PE.There were 32 cases of pulmonary consolidation combined with pleural effusion,and 7cases of encapsulated pleural effusion.5.Identification of PPE and tuberculous pleurisy:Compared with the tuberculous pleurisy group,the pleural neutrophils,LDH and ADA in the PPE group were significantly increased,while the glucose was significantly reduced.The chest consolidation was performed on the lung consolidation and pleural effusion area,which suggesting that the lungs were solid.Patients with lung consolidation area larger than pleural effusion area should consider mycoplasma and common bacterial infection,pleural effusion area larger than lung consolidation area should mainly consider tuberculosis infection.6.Possible factors for forming CPPE and PE:The results of single factor analysis showed that the fever time,fiber separation and WBC,CRP and PCT levels in the CPPE+PE group were significantly higher than those in the UPPE group,while the HGB level was lower than that in the UPPE group.Logitic regression analysis showed that fiber separation and CRP elevation were independent risk factors for CPPE+PE formation.7.Treatment:1)Treatment options based on pathogenic results:149 children with PPE,including 72 cases of mycoplasma infection,58 cases of routine treatment(macrolide antibiotics or combination of third-generation cephalosporin anti-infective and symptomatic treatment),of which only14 were based on antibiotics Invasive interventional therapy(thoracic puncture/drainage,thoracoscopy);25 cases of bacterial infection,20 cases of invasive intervention,and 13 cases of intrathoracic injection of urokinase;22 cases of viral infection,Only 7 patients underwent invasive intervention.2)Comparison of curative effects:CPPE and PE children in the early intervention group,the CRP level decreased rapidly,pleural effusion can be absorbed in a short time,can improve the clinical efficacy,the difference between the two groups was statistically significant(P<0.05);There was no significant difference in the time of heat withdrawal,total hospital stay,and pleural adhesion thickening(P>0.05).Conclusion:1.The age of onset of PPE in children in Hunan is 3-7 years old.It is caused by spring and summer.The main clinical manifestations are cough,fever and shortness of breath.The pathogens are mainly mycoplasma and bacterial infection,and different pathogen infections are different.2.The area of pleural effusion and pneumonia consolidation on chest CT may be helpful in distinguishing between tuberculosis and mycoplasma and common bacterial infections.3.the formation of fiber separation,CRP significantly increased may suggest that the disease progresses to complex PPE and empyema.4.Children with CPPE and PE who have invasive interventions in the early stage of the disease can improve the clinical efficacy and improve the prognosis of children to some extent.