Primary staphylococcal pneumonia in young children: a review of 100 cases

Pediatric Lower Respiratory Tract Infections: Imaging Guidelines and Recommendations

Lower respiratory tract infection (LRTI) remains a major cause of morbidity and mortality in children. Various organisms cause LRTI, including viruses, bacteria, fungi, and parasites, among others. Infections caused by 2 or more organisms also occur, sometimes enhancing the severity of the infection. Medical imaging helps confirm a diagnosis but also plays a role in the evaluation of acute and chronic sequelae. Medical imaging tests help evaluate underlying pathology in pediatric patients with recurrent or long-standing symptoms as well as the immunocompromised.

Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review

Background: Neonates and infants comprise the majority of the 6 million annual deaths under 5 years of age around the world. Most of these deaths occur in low/middle income countries (LMICs) and are preventable. However, the clinical identification of neonates and infants at imminent risk of death is challenging in developing countries. Objective: To systematically review the literature on clinical risk factors for mortality in infants under 12 months of age hospitalized for sepsis or serious infections in LMICs. Methods: MEDLINE and EMBASE were systematically searched using MeSH terms through April 2017. Abstracts were independently screened by two reviewers. Subsequently, full-text articles were selected by two independent reviewers based on PICOS criteria for inclusion in the final analysis. Study data were qualitatively synthesized without quantitative pooling of data due to heterogeneity in study populations and methodology. Results: A total of 1,139 abstracts were screened, and 169 full-text articles were selected for text review. Of these, 45 articles were included in the analysis, with 21 articles featuring neonatal populations (under 28 days of age) exclusively. Most studies were from Sub-Saharan Africa and South Asia. Risk factors for mortality varied significantly according to study populations. For neonatal deaths, prematurity, low birth-weight and young age at presentation were most frequently associated with mortality. For infant deaths, malnutrition, lack of breastfeeding and low oxygen saturation were associated with mortality in the highest number of studies. Conclusions: Risk factors for mortality differ between the neonatal and young infant age groups and were also dependant on the study population. These data can serve as a starting point for the development of individualized predictive models for in-hospital and post-discharge mortality and for the development of interventions to improve outcomes among these high-risk groups.

Secondary spontaneous pneumothorax: which associated conditions benefit from pigtail catheter treatment?

OBJECTIVE

The study aimed to assess the clinical efficacy of pigtail catheter drainage for patients with a first episode of secondary spontaneous pneumothorax (SSP) and different associated conditions.

METHODS

We retrospectively reviewed the records of patients with SSP who received pigtail catheter drainage as their initial management between July 2002 and October 2009. A total of 168 patients were included in the analysis; 144 (86%) males and 24 (14%) females with a mean age of 60.3 ± 18.3 years (range, 17-91 years). Data regarding demographic characteristics, pneumothorax size, complications, treatments, length of hospital stay, and associated conditions were analyzed.

RESULTS

In total, 118 (70%) patients were successfully treated with pigtail catheter drainage, and 50 (30%) patients required further management. Chronic obstructive lung disease was the most common underlying disease (57% of cases). Secondary spontaneous pneumothorax associated with infectious diseases had a higher rate of treatment failure than SSP associated with obstructive lung conditions (19/38 [50%] successful vs 78/104 [75%] successful, P = .004) and malignancy (19/38 [50%] successful vs 13/16 [81%] successful, P = .021). Moreover, patients with SSP associated with infectious diseases had a longer length of hospital stay than those with obstructive lung conditions (23.8 vs 14.5 days, P = .003) and malignancy (23.8 vs 12.1 days, P = .017). No complications were associated with pigtail catheter drainage.

CONCLUSIONS

A higher rate of treatment failure was noted in SSP patients with infectious diseases; thus, pigtail catheter drainage is appropriate as an initial management for patients with SSPs associated with obstructive lung conditions and malignancy.

Community-acquired Staphylococcus aureus pneumonia among hospitalized children in Hawaii

SUMMARY BACKGROUND

Invasive community acquired (CA) Staphylococcus aureus (SA) disease has been endemically observed in Hawaiian children. We wanted to evaluate the clinical, laboratory findings, and outcomes of methicillin-resistant SA (MRSA) and methicillin-susceptible SA (MSSA) associated pneumonia admissions.

METHODS

We performed retrospective chart reviews of 38 culture proven SA pneumonia patients admitted to a pediatric tertiary medical center in Hawaii between January 1996 to December 2007.

RESULTS

Twenty-six patients (68%) had MRSA and 12 patients (32%) had MSSA infection. The mean age of MRSA patients was 2.8 and 6.7 years for MSSA patients (P < 0.05). Pacific Islander and Native Hawaiian patients were affected disproportionately compared to non-Pacific Islander and Hawaiian groups (P < 0.0001). Demographic data, days of fever, tachypnea, hypoxia, and length of stay (LOS) were not significantly different between MRSA and MSSA infected patients. The mean LOS was 26.2 days (range 6-138 days); mean length of fever was 12.4 days. Seventy five percent (15 of 20) of patients who required intubation had MRSA. Twenty-one of the 29 (72%) total patients with pleural effusions had MRSA infection and all required chest tube placements. Two (5%) patients died; both had MRSA infection.

CONCLUSIONS

Younger Pacific Islander/Native Hawaiian children were affected disproportionately and had MRSA infection more frequently. MRSA infected patients appeared to have severe disease with frequent chest tube placement, intubation, and fatality. Overall, both MRSA and MSSA pneumonia resulted in prolonged hospitalization, multiple complications, and significant healthcare costs.

Effect of biomass smoke on pulmonary host defence mechanisms

In the developing world, the burning of biomass fuels in and around homes results in very high levels of inhalable particles and gases. Several epidemiological studies have reported an association between indoor air pollution from biomass smoke and increased vulnerability to lower respiratory tract infection in children. This review assesses whether a plausible mechanism for this association can be found in studies using animal models and airway cells.

A 5-year PICU experience of disseminated staphylococcal disease, part 1: clinical and microbial profile

Staphylococcus aureus causes an impressive spectrum of disease in tropics and subtropics. Scanty data are available regarding disseminated staphylococcal disease (DSD) in children, especially on their critical care needs. It is important to recognize and prioritize patients who may benefit most from Pediatric Critical Care. The objective of this article is to review the demographic, clinical and microbial features, critical care needs, management and outcome of patients with DSD to identify clinical indicators for need of critical care. The study setting is a Pediatric Intensive Care Unit (PICU) of an urban tertiary care teaching hospital in a developing economy. The subjects were fifty-three patients (age, 1 month-12 years) with DSD admitted to PICU during June 1994-June 1999. DSD was defined as involvement of at least two distant organs with presence of Gram-positive cocci in clusters and/or growth of S. aureus from at least one normally sterile body fluid. Data regarding demographic and clinical picture, microbiological profile, indication for PICU admission, monitoring needs, medical and surgical management and outcome was retrieved from the case records. Patients had mean age of 5.1 years (+/- 3.4) (range, 1.5 months-12 years). Majority (34/53, 64%) were malnourished, however, none had history of recurrent infections. Two-thirds presented during hot and humid months (P < 0.001). Predisposing conditions were pustules (26%), blunt trauma (15%) and injections (8%). Fever (98%) and respiratory distress (81%) were commonest presentation followed by restriction of limb mobility and altered sensorium (21/53, 40% each). On an average, 3.25 sites were involved per patient (total, 171 sites). Twelve (9%) sites were detected after 7 days of hospitalization. Disease spectrum included necrotizing soft tissue disease (61%), pleuro-pulmonary disease (89%), pericardial effusion (40%), osteo-articular disease (30%) and meningitis (17%). Forty patients (76%) developed growth of methicillin sensitive S. aureus (MSSA) and four grew methicillin resistant S. aureus (MRSA). Hematological spread from benign skin lesions may lead to fulminant disseminated disease. Identifying metastatic foci by thorough clinical evaluation, appropriate and frequent imaging studies form an integral part of management.

Pneumatocele formation in adult Escherichia coli pneumonia revealed by pneumothorax

Pulmonary pneumatoceles are a rare complication of nosocomial pneumonia. They occur most often in staphylococcal infections and are hence more frequent in children. We report the case of an immunocompromised adult who shortly after digestive surgery developed Escherichia coli pneumonia which evolved rapidly towards pneumatocele formation revealed by pneumothorax.

Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia

AIMS

To study the clinical and microbial profile of childhood empyema in South Asia and to identify the changes over the past three decades.

METHODS

A total of 265 children (aged 1 month to 12 years) with empyema admitted to the Advanced Pediatric Center, PGIMER, Chandigarh, India in 1989-98, were reviewed retrospectively.

RESULTS AND CONCLUSIONS

One third of children were under 5. Culture positivity had decreased significantly (48% v 75%) over the years. Staphylococcus aureus continues to be the commonest (77%) aetiological agent; clustering was seen during hot and humid months (46%). Culture positive Streptococcus pneumoniae cases also decreased (9% v 27%); all were seen during the winter and spring season. Gram negative rods grew in more patients (11% v 7%). Community acquired methicillin resistant S aureus (MRSA) was isolated in three patients. Most children (93%) were treated with parenteral cloxacillin and an aminoglycoside. Tube drainage (TD) was used in 92% of fibropurulent cases, and was successful in 79%. Of 48 patients with failed TD, 12 needed decortication; limited thoracotomy was sufficient in the remaining 36. Surgery was mainly required by children with persistent pleural sepsis after 10 days of TD. Delaying surgery until 14 days had a significantly higher potential of requiring decortication. Early change to oral antibiotics (after 1-2 weeks of parenteral therapy) reduced the hospital stay significantly (17+7 v 23+7 days) without compromising long term outcome. Twenty two patients presenting late in the chronic stage underwent decortication at admission.

Minor [correction of Mi1nor] burns and pneumatocoeles: a case report

Minor burns in children need to be cautiously managed as they may manifest with life threatening complications especially in the presence of staphylococcal infection. A one and a half year old child with minor burns (12% TBSA), who developed large pneumatocoeles and peumomediastinum following Staphylococcus aureus pneumonia causing severe respiratory distress and needing ventilatory support is presented. Most of the pneumatocoeles were spontaneously absorbed over a period of 10 days while surgical interference was being contemplated. A conservative approach to pneumatocoeles as in non-burn patients may help prevent unnecessary surgery. An extensive English literature search (since 1966) did not reveal any report of pneumatocoeles in association with burns and therefore we believe this to be the first report of its kind.