Original article
Diagnosis of parapneumonic pleural effusion by polymerase chain reaction in children

https://doi.org/10.1016/j.jpedsurg.2005.03.057Get rights and content

Abstract

Purpose

Most pleural effusions are associated with bacterial pneumonia, and the identification of the pathogen will assist the therapeutic decision. A specific method that is not affected by previous antibiotic therapy is sought to detect the main causative agents of pneumonia in infants and children (Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus). The aim of the present study was to compare the polymerase chain reaction (PCR) technique with standard culture methods in identifying bacterial infections in infants' and children's pleural effusion.

Methods

Samples obtained from pediatric patients (n = 37) with a diagnosis of pneumonia associated to pleural effusion, submitted to thoracentesis, were analyzed by PCR with specific primers.

Results

The PCR technique identified the presence of bacterial infection in a larger proportion (95.2%) than the standard culture method (33.3%) on complicated pleural effusion samples. The microorganism detection on uncomplicated pleural effusion samples was positive only by the PCR method (31.3%). The frequencies of microorganisms identified on complicated pleural effusion were 57.1% of all patients for methicillin-resistant Staphylococcus; 52.4%, S pneumoniae; 28.6%, S aureus; and 23.8%, H influenzae. The previous use of antibiotics interferes with standard culture method, but it did not interfere with the PCR results.

Conclusions

The molecular diagnosis by PCR method could improve the etiologic diagnosis and might help to guide the treatment of parapneumonic effusion in children.

Section snippets

Materials and methods

A cross-sectional study was performed at the Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. Samples were obtained from pediatric patients with a clinical and radiological diagnosis of pneumonia associated with pleural effusion, admitted and submitted to thoracentesis for 25 consecutive months. Parents gave consent for their children's participation. The research and ethics committee approved the study.

Results

Samples from 37 patients ages 1 month to 12 years, who attended to the emergency department of Hospital São Lucas da PUCRS, with bacterial pneumonia associated with parapneumonic pleural effusion were analyzed.

Twenty-three patients (62%) were girls. Infection in the right hemithorax was detected in 53% of patients. Bilateral infections were present in 6% of patients. Lobar pneumonia was observed in 30% of patients. According to the criteria by Light, 21 patients (57%) presented CPE.

Molecular

Discussion

The etiologic diagnosis of pneumonia with pleural effusion in infants and children has been widely studied. In general, there is a clear tendency to consider viral agents as the main cause of children's pneumonia in developed countries, whereas bacterial agents are common in developing nations. Moreover, the collection of appropriate material and the great variability between standard culture and immunologic methods are the major drawbacks.

Molecular diagnosis, particularly PCR, is a powerful

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