Incidence of parapneumonic pleural effusions (PPE) in children. A twenty year experience from a tertiary paediatric department

Background: Various reports have demonstrated increased incidence of PPEs in children. Aim: To investigate the incidence of PPEs in our area. Methods: Retrospective review of the records of children ≤ 14yrs hospitalized for PPE from 1-1994 to 12-2013. The annual rate and its change trend was evaluated. Culture, PCR results and PCV history were collected. Serotyping of Streptococcus pneumoniae isolates for 1, 3, 4, 6, 14, 18C, 19A, 19F, 23F was conducted routinely after 2006. Results: 132 children 0.33-14 years old (mean age 4.85 years) with PPE were admitted. During this 20 years period, a continuously increasing annual rate was recorded (mean 3.1%, p=0.006 ). Isolations either by culture or PCR were as follows: Streptococcus pneumoniae in 23 patients (3 belonged to serotype 1, 7 to serotype 3, 2 to serotype 19A and 1 to serotype 19F while, 10 were non-typable), Streptococcus pyogenes in 5 , Streptococcus agalactiae in 1 , Streptococcus spp. 3 , MRSA in 1, coagulase-negative Staphylococci 2, Haemophilus non-typable 1. The mean hospital stay was 16.0 days. 86/132 (65.1%) patients needed drainage and 40/132(30.3%) given urokinase intrapleural infusion. 6/132 needed lung decortication. In 3 pts PPE complicated with sepsis, in 2 with ARDS, in 1 with uremic-hemolytic syndrome. 13 patients had pneumothorax, 21 bullae and 6 bronchial-pleural fistula. Conclusion: PPE incidence with severe complications in children is increasing.