Volume 5, Issue 4, December 2019, Page: 270-275
Parapneumonic Pleural Effusions Consist of Two Distinct Entities
Vladimir Tatochenko, National Medical Research Center of Child Health, Moscow, Russia
Received: Oct. 27, 2019;       Accepted: Nov. 22, 2019;       Published: Dec. 4, 2019
DOI: 10.11648/j.ajp.20190504.28      View  419      Downloads  85
Pleural effusions (PE) complicating pneumonia are usually considered as one entity. But some effusions collect from the start of pneumonia (“sinpneumonic”-SPE), others appear after antibiotics have been started started (“metapneumonic” – MPE). Material, methods. It is a retrospective clinical study (1980-1990s); with new therapies tested over next 20 years. Included are 2561 children with pneumonia (1 month – 14 years); 424 of them had PE, classified as SPE (173) or MPE (251 – 59%). Usual labs and immune complexes levels in blood and PE were studied. Results. Of 281 positive PE S. pneumoniae was identified in 88%, H. influenzae type b – 5%, S. pyogenes – 8%, S. aureus – 4%. MPE was mostly seen in necrotizing pneumonia in under-5 children, particularly with antibiotics started late-after 4th day. MPE starts with initial short drop of temperature that recurs to 39,5-40,5°C and lasts 5-20 days, refractory to antibiotic changes. PE are always serous or serous-fibrinous with WBC <1000/mm3, pH>7.3, glucose >3.0 mmol/l; X-ray show costal pleura fibrin deposition. Initial blood WBC, CRP, procalcitonin levels are elevated, normalizing with necrotic pneumonia resolution. From this point ESR rapidly rises to 40-80 mm/h – a landmark of MPE. We found a much higher levels jf pneumococcal antigens containing immune complexes with complement consumption in MPE, compared to SPE – in both blood and PE. This suggested an immune mechanism of MPE and justified the administration of steroids (prednisolone 1 mg/kg/d for 2-4 days) that stops fever within 1-2 days (100% cases). Full fibrin resorption occurs in 1-2 months, rarely more, making unnecessary fibrinolysis, drainage or thoracoscopy. Conclusions. MPE is an immunopathologic complication of pneumonias’ antibiotic treatment that results from microbial cells destruction by antibiotics liberating an antigen excess favoring immune complexes formation, pleura being the shock organ. Recognition of MPE is paramount for the therapy choice, particularly – steroids, and for reducing invasive procedures.
Pneumonia, Pleural Effusion, Immune-mediated Mechanism, New Treatment, Reducing Invasive Procedures
To cite this article
Vladimir Tatochenko, Parapneumonic Pleural Effusions Consist of Two Distinct Entities, American Journal of Pediatrics. Vol. 5, No. 4, 2019, pp. 270-275. doi: 10.11648/j.ajp.20190504.28
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This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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