Empyema and parapneumonic effusions in children: an update
Childhood empyema is an important complication of bacterial pneumonia. The incidence of empyema is increasing worldwide. Streptococcus pneumoniae and Staphylococcus aureus are the most common aetiologies in high- and low-income countries, respectively. The diagnosis is based on clinical, radiographic and pleural fluid examination. Tuberculosis (TB) is an important cause of a pleural effusion in high TB prevalence areas. There is controversy about the optimal treatment for empyema in children. Sepsis should be controlled with antibiotics and drainage of the pleural cavity. Intrapleural fibrinolysis and videoassisted thoracoscopic surgery (VATS) are modern interventions widely used in high-income countries, but mostly unavailable in the developing world. There are however few properly conducted studies that would support one therapeutic approach over the other. Despite this, the clinical outcome of paediatric empyema is usually good regardless of therapeutic approach. This review summarises aetiology, pathogenesis and clinical presentation of childhood empyema and discusses the various treatment modalities with an emphasis on clinical practice in developing countries.