Clinical management and outcome of childhood lung abscess: A 16-year experience
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
38
Journal Issue
3
Pages
183-188
Date Issued
2005
Author(s)
Chan P.-C.
Wu P.-S.
Chang P.-Y.
Yang T.-T.
Abstract
In order to evaluate the clinical manifestations, management and outcome of childhood lung abscess, a retrospective chart review of 27 pediatric patients with International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9 CM) code of 503.1 (lung abscess) from August 1987 to August 2003 was conducted. Among the 27 patients (14 males and 13 females), 30% (8/27) were primary lung abscess and 70% (19/27) had underlying chronic diseases (secondary lung abscess). The predisposing factors of the primary group (n = 8) included 6 cases of respiratory tract infection, 1 with choking during swimming, and 1 with laceration wound. The underlying diseases in the secondary group (n = 19) included 10 cases of hematologic disorder (52%), 3 of congenital heart disease, 2 of central nervous system anomalies, and 1 each of hyperimmunoglobulin E syndrome, chronic lung disease, liver cirrhosis with fistula formation, and Swyer-James syndrome. Eleven patients (41%) underwent diagnostic tapping, including echo-guided aspiration (10 cases) and computed tomography-guided percutaneous needle aspiration (1 case). Positive yield rate from aspiration of lung abscess was 63.6% (7/11). Surgical intervention was performed in 8 (42%) of the secondary group and in 1 patient from the primary group. The pathogens were identified in 11 patients (41%): 5 with oral flora, 2 with Staphylococcus aureus plus other pathogens, 1 with S. aureus alone, 1 with Pseudomonas aeruginosa plus Proteus mirabilis, 1 with P. aeruginosa alone, and 1 with Aspergillus. The average duration of parenteral antibiotic use was 40 days. Five cases (18.5%) died due to poor control of the underlying diseases, and 4 of the patients (15%) had sequelae (2 with branchiectasis and 2 with lung fibrosis). Seventy percent of lung abscess occurred in children with underlying medical conditions. Early percutaneous aspiration has an important role in identification of pathogens. Oral anaerobes and S. aureus are the core pathogens in primary lung abscess and Gram-negative pathogens should also be considered in secondary lung abscess.
SDGs
Other Subjects
antibiotic agent; adolescent; airway obstruction; anaerobic bacterium; antibiotic therapy; Aspergillus; bronchiectasis; cause of death; central nervous system disease; chronic disease; chronic lung disease; clinical article; clinical feature; computer assisted tomography; congenital heart disease; disease predisposition; female; fistula; Gram negative bacterium; hematologic disease; human; hyperimmunoglobulinemia E; hypertranslucent lung; laceration; liver cirrhosis; lung abscess; lung aspiration; lung fibrosis; male; mouth flora; needle biopsy; preschool child; Proteus mirabilis; Pseudomonas aeruginosa; respiratory tract infection; retrospective study; review; school child; Staphylococcus aureus; swimming; treatment outcome; Adolescent; Bacteria, Anaerobic; Bacterial Infections; Child; Child, Preschool; Female; Gram-Negative Bacteria; Humans; Infant; Lung; Lung Abscess; Male; Retrospective Studies; Risk Factors; Staphylococcus aureus; Treatment Outcome
Type
review