EC Paediatrics

Objective: In this study, we aimed to report a recent significant outbreak of pneumonia with an unexpectedly high rate of parapneumonic effusion/empyema in children.

Materials and Methods: This retrospective cross-sectional study was conducted in the Children's Medical Center of Tehran, Iran from September 23, 2022, to November 23, 2022. All children with pneumonia and parapneumonic effusion hospitalized at the emergency department of a tertiary referral hospital were reviewed. Medical records of patients eligible for the study were retrieved from the archives and the following parameters were recorded: age, gender, hematologic indices, blood culture, CXR findings, sonographic parameters, pleural fluid analysis parameters, and treatments. Statistical analysis was performed with SPSS.

Results: 36 children with pneumonia and parapneumonic effusion/empyema were reported in our study (mean age = 68.41 ± 32.54 months, 55.6% females). 20 patients (55.5%) developed empyema. The mean duration of admission was 11.41 ± 6.49 days. Except for a case with a positive influenza test (2.77%), all patients tested negative for influenza types A and B, RSV, and COVID-19. Blood culture was negative in 87.5% of patients without empyema and 80% of patients with empyema. Pleural fluid smear and culture were negative in 84.2% and 73.7% of cases, respectively. No significant difference was found between patients receiving and not receiving fibrinolytic therapy in terms of any study parameters.

Conclusion: An unexplained unexpected significant rise in parapneumonic effusion and empyema has been observed in recent weeks among children with pneumonia. Bacterial cultures and viral tests were negative in the majority of cases. Searching for a probable new viral infection with a high rate of parapneumonic effusion/empyema as the underlying cause of this phenomenon should be undertaken promptly.

Keywords: Pediatric Parapneumonic Effusion; Empyema; Pneumonia

1. Light RW., et al. “Parapneumonic effusions”. The American Journal of Medicine 69 (1980): 507Y512.
2. Byington CL., et al. “An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations”. Clinical Infectious Diseases4 (2002): 434-440.
3. Bradley JS., et al. “Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of communityacquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America”. Clinical Infectious Diseases7 (2011): e25-e76.
4. Rees JHM., et al. “Increase in the incidence of childhood empyema in West Midlands, UK”. Lancet 349 (1997): 402.
5. Gupta R and Crowley S. “Increasing pediatric empyema admissions”. Thorax 61 (2006): 179-180.
6. Eastham KM., et al. “Clinical features, etiology and outcome of empyema in children in the north east of England”. Thorax 59 (2004): 522-525.
7. Roxburgh CS., et al. “Trends in pneumonia and empyema in Scottish children in the past 25 years”. Archives of Disease in Childhood 93 (2008): 316-318.
8. Hendrickson DJ., et al. “Five-fold increase in pediatric parapneumonic empyema since the introduction of the pneumococcal conjugate vaccine”. The Pediatric Infectious Disease Journal 27 (2008): 1030-1032.
9. Byington CL., et al. “An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: Risk factors and microbiological associations”. Clinical Infectious Diseases 34 (2002): 434-440.
10. Obando I., et al. “Pediatric parapneumonic empyema Spain”. Emerging Infectious Diseases 14 (2008): 1390-1397.
11. Strachan R and Jaffé A. “Assessment of the burden of pediatric empyema in Australia”. Journal of Paediatrics and Child Health 45 (2009): 431-436.
12. Muñoz-Almagro C., et al. “Influence of pneumococcal vaccine on the incidence of empyema”. Current Opinion in Pulmonary Medicine 16 (2010): 394-398.
13. Vogel AM., et al. “Impact of pneumococcal vaccine on hospital admission with lower respiratory tract infection in children resident in South Auckland, New Zealand”. The New Zealand Medical Journal 126 (2013): 26-35.
14. Thomas MF., et al. “The emergence of pneumococcal 19A empyema in UK children”. Archives of Disease in Childhood 97 (2012): 1070-1072.
15. Strachan RE., et al. “Bacterial causes of empyema in children in Australia 2007-2009”. Emerging Infectious Diseases 17 (2011): 1839-4185.
16. Buckingham SC., et al. “Incidence and etiologies of complicated parapneumonic effusions in children, 1996 to 2001”. The Pediatric Infectious Disease Journal 22 (2003): 499-504.
17. Koshy E., et al. “Impact of the seven valent pneumococcal conjugate vaccination (PCV7) program on childhood hospital admissions for bacterial pneumonia and empyema in England: National time-trends study, 1997-2008”. Thorax 65 (2010): 770-774.
18. Bilan N., et al. “Evaluation of Predictive Factors of Empyema in Children with Parapneumonic Pleural Effusion”. International Journal of Pediatrics10 (2020): 12297-12304.
19. Grisaru-Soen G., et al. “Pediatric parapneumonic empyema: risk factors, clinical characteristics, microbiology, and management”. Pediatric Emergency Care4 (2013): 425-429.
20. Eslami G., et al. “The Survey of Pediatric Pleural Empyema in North of Iran (from 2004 to 2016)”. International Journal of Pediatrics3 (2018): 7421-7432.
21. Mahon C., et al. “Incidence, etiology and outcome of pleural empyema and parapneumonic effusion from 1998 to 2012 in a population of New Zealand children”. Journal of Paediatrics and Child Health6 (2016): 662-668.
22. Deceuninck G., et al. “Pediatric Pleural Empyema in the Province of Quebec: Analysis of a 10-Fold Increase Between 1990 and 2007”. Journal of the Pediatric Infectious Diseases Society2 (2014): 119-126.
23. Francois P., et al. “Prevalence and risk factors of suppurative complications in children with pneumonia”. Acta Paediatrica 99 (2010): 861-866.