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The unwell child presenting with respiratory symptoms for a prolonged period of time - A unique case with review of the associated literature.

Debkumar Chowdhury*

Background: Bacterial infection with associated empyema is the commonest cause of pleural effusion. The likely pathogens to be associated are Streptococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus. Clinical signs of pneumonia without any signs of respiratory compromise can be treated with empirical antibiotics. However, if the infection does not settle and there is progressive worsening of clinical signs with persistent pyrexial, it is imperative that the unwell is referred to the paediatric unit for further evaluation.
Introduction: In our study we present a 2-year-old previously well girl presenting with a 2- week history of respiratory symptoms with intermittent pyrexia and loss of weight. On examination there was evidence of reduced air entry on the left lung field with increased work of breathing. Initial CXR indicated a complete whiteout of the left lung field. There was a concern of pleural effusion secondary to an empyema or a possible underlying malignancy. She subsequently underwent Ultrasound and Computed Tomogram of the thorax which confirmed left sided pleural effusion. She subsequently underwent tube thoracostomy having being intubated and ventilated and pleural fluid confirmed a diagnosis of empyema. She was treated with antibiotics with tailored sensitivities.
Discussion: Early detection of potential respiratory complications is paramount to the nonpaediatric practitioner. Awareness of the traffic light system and the associated appropriate intervention reduces both morbidity and mortality. There are limited studies in the paediatric management of empyema and the results from adult population cannot be extrapolated for use in the paediatric patients.
Conclusion: Although the vast majority of respiratory illnesses are viral in aetiology, bacterial infections when present can lead to significant complications unless detected early. It is imperative to recognise and realise that the paediatric population can compensate satisfactorily through the initial stages of significant physiological derangement. The mainstay treatment of uncomplications pleural effusion is through tube thoracostomy and systemic antibiotics.