Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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A clinical study on the etiology of parapneumonic effusion in children

소아 감염성 흉막삼출의 원인 분석

  • Yeom, Jung-Sook (Departments of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Bae, Won-Tae (Departments of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Park, Eun-Sil (Departments of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Seo, Ji-Hyun (Departments of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Lim, Jae-Young (Departments of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Park, Chan-Hoo (Departments of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Woo, Hyang-Ok (Departments of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Youn, Hee-Shang (Departments of Pediatrics, Gyeongsang National University College of Medicine)
  • 염정숙 (경상대학교 의과대학 소아과학교실) ;
  • 배원태 (경상대학교 의과대학 소아과학교실) ;
  • 박은실 (경상대학교 의과대학 소아과학교실) ;
  • 서지현 (경상대학교 의과대학 소아과학교실) ;
  • 임재영 (경상대학교 의과대학 소아과학교실) ;
  • 박찬후 (경상대학교 의과대학 소아과학교실) ;
  • 우향옥 (경상대학교 의과대학 소아과학교실) ;
  • 윤희상 (경상대학교 의과대학 소아과학교실)
  • Received : 2005.08.01
  • Accepted : 2005.10.06
  • Published : 2006.01.15
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Abstract

Purpose : This study was designed to document the etiologies and the characteristics of parapneumonic effusion in children. Methods : During a 17-year period from 1987 to 2004, parapneumonic effusion was confirmed in 86 children at Gyeongsang National University Hospital. The clinical records of these children were reviewed and radiological findings and laboratory data, especially results of thoracentesis, were analyzed retrospectively. Results : M. pneumoniae(34 subjects) was the most common pathogen at all over age, especially above 1-years-old. There were diagnosed with clinical characteristics and serologic tests. The $2^{nd}$ most common pathogen revealed non tuberculous bacteria(14 subjects). A species of bacteria at no tuberculous bacteria revealed S. aureus(5), S. pneumoniae(3), P. aeroginosa(3), other staphylococcus (2), and K. pneumoniae(1). There were confirmed with sputum culture or pleural fluid culture or blood culture. S. aureus was most common pathogen in infants. The $3^{rd}$ common pathogen was M. tuberculosis(7). There were confirmed with skin tuberculin tests and AFB stains. Another that was classified as a non bacteria was adenovirus(2). Complications of parapneumonic effusion such as pleural thickness occurred on M. tuberculosis(1). Non tuberculous bacteria, especially S. aureus revealed a serious predominance of polymorphocyte at pleural fluid, and lowest pleural pH and glucose, and highest pleural protein and LDH. Tuberculosis revealed high pleural protein and LDH. Conclusion : Age and chemistries of pleural fluid might be helpful in differentiating various etiologies of parapneumonic effusion. If there were suspicious of tuberculosis and non-tuberculous bacteria, more aggressive approaches were needed to prevent complication.

목 적 : 흉막삼출을 동반한 폐렴에서 빠른 원인병원체의 판단으로 조기진단과 적절한 치료로 후유증 발생을 최소화하는데 도움을 주는 자료를 얻기 위해 최근 경험한 감염성 흉막삼출의 원인병원체, 연도별 발생빈도 변화, 연령별 빈도 및 후유증 발생률을 알아보고자 하였다. 방 법 : 1987년부터 2004년까지 17년간 경상대학교병원 소아과에 폐렴으로 입원한 환아 중 감염성 흉막삼출을 보인 86례를 대상자로 이들의 병록기록지를 후향적으로 조사하였다. 결 과 : 총 대상자의 남녀 비율은 1.45 : 1(남 : 여=51 : 35명)로 남아가 많았으며, 평균 연령은 5.64세(${\pm}4.43$)이었다. 발생빈도의 변화를 연도별로 분류해 보았을 때 평균 발생률은 감소를 보이지만 통계학적으로 의미 있는 변화를 보이지 않았다(r=-0.25, P=0.30). 총 대상자 86례 중 원인체가 밝혀진 경우는 57례(66.3%)로 결핵 7례(8.2%), 비결핵 세균성 14례(16.3%), 미코플라스마 34례(39.5%), 기타 감염성 흉막삼출 2례(2.3%)였다. 나머지 29례(33.7%)는 원인불명 감염성 흉막삼출이었다. 비결핵 세균성 흉막삼출 14례를 병원균 별로 분류하면 황색포도알균이 5례(5.8%)로 가장 많았고, 폐렴사슬알균이 3례(3.5%), 녹농균 3례(3.5%), 기타 포도알균 2례(2.3%), 폐렴막대균 1례(1.2%)로 밝혀졌다. 미코플라스마 폐렴은 혈청검사를 통한 진단이 비교적 용이하고 후유증 동반율이 매우 낮고, 비결핵 세균성 흉막삼출에서 흉막액의 소견은 높은 백혈구수와 함께 중성구 우세를 보이며, 산도와 당이 매우 낮게 측정되고, 단백과 LDH가 매우 높게 나오는 특징을 보였다. 결핵성 흉막삼출 환자 1례에서 흉막비후의 후유증을 남겼는데, 결핵성 흉막삼출은 흉막액에 높은 백혈구수에 림프구와 중성구의 우세가 비슷하고, 단백과 LDH가 높게 나오는 특징을 보였다. 결 론 : 이에 연구자들은 폐렴의 초기에 흉막유출이 동반되었는지를 빨리 파악하고, 환아의 연령도 고려하여 병인을 추정하여, 흉막삼출액의 빠른 분석을 통한 치료적 접근이 사망률과 이환율을 줄일 수 있는 것이라 본다.

Keywords

References

  1. Amal Q, Anne HT. Pleural fluids associated with chest infection. Pediatr Respir Rev 2002;2:349-55
  2. Glenna BW. Pleurisy. In : Berhman RE, Kliegman RM, Arvin AM, editors. Nelson text book of pediatrics. 17th ed. Philadelphia : WB Saunders Co, 2000:1461-3
  3. Freij BJ, Kusmiesz H, Nelson JD. Parapneumonic effusions and empyema in hospitalized children. Pediatr Infect Dis 1984;3:578-91 https://doi.org/10.1097/00006454-198411000-00021
  4. Light RW. Pleural Diseases. 2nd ed. Philadelphia : Lea & Febiger Co, 1990:39-236
  5. Bauwens AM, de Graaff CS, Boersma WG. Pleural effusion and empyema as complication of pneumonia. Ned Tijdschr Geneeskd 2002;146:464-9
  6. Kim YK, Lee YJ, Kim KE. The etiologic disease of pleural disease in children. J Korean Allergy Respir Dis 1996;6: 103-9
  7. Light RW, Girard WM, Jenkinson SG. parapneumonic effusion. Am J Med 1980:69:507-12. https://doi.org/10.1016/0002-9343(80)90460-X
  8. Ministry of Health and Welfare, The Korean National Tuberculosis Association. Report on the 7th tuberculosis prevalence survey in Korea 1995:14-5
  9. Cassell GH, Cole BC. Mycoplasma as agent of human disease. N Engl J Med 1981;304:80-9 https://doi.org/10.1056/NEJM198101083040204
  10. Fine NR, Smith LR, Sheedy PW. Frequency of pleural effusions in mycoplasmal and viral pneumonias. N Eng J Med 1970;283:790-3 https://doi.org/10.1056/NEJM197010082831505
  11. Jung JH, Rah SY, Sun YH, Lee MH, Koh YY. A clinical study on the etiology and the characteristics of pleural effusion in children. J Korean Pediatr Soc 1998;41:62-73
  12. Hong JY, Nah SY, Nam SG, Choi EH, Park JY, Jong H. Occurrence of Mycoplasma pneumoniae pneumonia in Seoul, Korea from 1986 to 1995. J Korean Pediatr Soc 1997;40:607-12
  13. Richard E, Bryant CJS. Pleural effusion and empyema. In Gerald LM, John EB, Raphael D, editors. Principles and practice of infectious diseases. 5th ed. Philadelphia : WB Saunders Co, 2000:743-9
  14. Forbes GB. Diagnosis and management of severe infections in infants and children : a review of experiences since the introduction of sulfonamide therapy. J Pediatr 1946;29:45-67 https://doi.org/10.1016/S0022-3476(46)80240-3
  15. Buckingham SC, King MD, Miller ML. Incidence and etiologies of complicated parapneumonic effusions in children, 1996 to 2001. Pediatr Infect Dis J 2003;22:499-504 https://doi.org/10.1097/00006454-200306000-00004
  16. Richard WM. Pleural effusion. In : John FM, Jay AN, editors. Textbook of respiratory medicine, 3rd ed. Philadelphia WB Saunders Co, 2000:2014-40
  17. Potts DE, Tarlye DA, Sahn SA. The acidosis of low-glucose pleural effusions. Am Rev Respir Dis 1978;117:665-71
  18. Light RW, MacGregor MI, Ball WC, Luchsinger PC. Diagnostic significance of pleural fluid pH and pCO2. Chest 1973;64:591-6 https://doi.org/10.1378/chest.64.5.591
  19. Krogle C, Antony VB. Immunobiology of pleural inflammation : potential implications for pathogenesis, diagnosis and therapy. Eur Respire J 1997;10:1150-6. https://doi.org/10.1183/09031936.97.10051150
  20. Scharer L, Mcclement JH. Isolation of tubercle bacilli from needle biopsy specimen of parietal pleura. Am Rev Respir Dis 1968;97:466-8
  21. Agrons GA, Markowitz RI, Kramer SS. Pulmonary tuberculosis in children. Semin Roentgenol 1993;28:158-72 https://doi.org/10.1016/S0037-198X(05)80105-1
  22. Ban les JL, Pineda PR, Fitzgerald JM, Rubio H, Selman M, Lezama MS. Adenosine deaminase in the diagnosis of tuberculous pleural effusions; A report of 218 patients and review of the literature. Chest 1991;99:355-7 https://doi.org/10.1378/chest.99.2.355
  23. Abe C, Hirano K, Wada M, Kazumi Y, Takahashi M, Fukasawa Y, et al. Detection of Mycobacterium tuberculosis in clinical specimens by polymerase chain reaction and gen probe amplified Mycobacterium tuberculosis direct test. Clin Microbiol 1993;31:3270-4
  24. Hamm H, Light RW. Parapneumonic effusion and empyema. Eur Respir J 1997;10:2411-8 https://doi.org/10.1183/09031936.97.10102411