Abstract

Forty-eight children with empyema thoracis were seen over a seven-year period (December, 1982 to November 1989) in the University of Calabar Teaching Hospital, Calabar, Nigeria. This number accounted for 0.2% of all paediatric admissions during the period. The peak age incidence was 2 years and under. Pneumonia was the antecedent illness in about all cases, but surprisingly, measles played an insignificant role. Late consultation and severe morbidity were constant feature with anaemia and cardiac failure as frequent complications of the disease. Staphylococcus aureus, the predominant causative organism was resistant to penicillin and ampicillin but sensitive to gentamicin, cloxacillin and erythromycin. The initial use of the parenteral gentamicin or cloxacillin in treating children with empyema is therefore recommended. This study demonstrates the rarity and low fatality (6%) of childhood empyema in Calabar, but protracted hospitalisation and exorbitant medication involved make it an important disease. Perhaps, it can be completely eliminated if parents are educated enough to avoid late reporting of childhood respiratory disease.

PIP:

Physicians analyzed December 1982-November 1989 data on 48 2-60 month old children with empyema thoracis at the University of Calabar Teaching Hospital in southeastern Nigeria to determine the incidence and etiology of empyema thoracis in this region. The incidence rate stood at 2/1000 pediatric admissions. 3 children died (6.3%), all of heart failure. 47 children suffered from fever, cough, and breathlessness, the symptoms for pneumonia. Even though bronchopneumonia is a common complication of measles which occurs frequently in Calabar, only 3 children (6.25%) also had measles. The most frequent complication of this accumulation of pus in the thoracic cavity was congestive heart failure (16 cases). 47 patients suffered from anemia (hemoglobin levels 11 gm/dl). Hemoglobin levels of 54% of all patients decreased over time to 8 gm/dl. In fact, 2 children had hemoglobin levels of 4.4 gm/dl and they experienced cardiac failure. Laboratory personnel were only able to examine pleural aspirates from 37 patients. They did not detect any organisms in 27% of these aspirates. This may have been due to parent's widespread practice of giving medication to all the children before coming to the hospital. 45.9% of the aspirates only grew Staphylococcus aureus while another 8.1% grew it and other pathogens. About 90% of the pathogens were resistant to ampicillin and penicillin and almost 90% were sensitive to cloxacillin, gentamicin, and erythromycin. Cloxacillin was very expensive and parenteral erythromycin was unavailable. Nevertheless the pediatricians used parenteral gentamicin and cloxacillin. The parents were responsible for buying the antibiotics which tended to be costly. All the patients required emergency closed tube thoracostomy drainage within 24 hours of admission. 83.3% remained in the hospital for 2 weeks and 33.3% for 1 month. Despite the rarity of empyema, long hospitalization and expensive drugs make it an important disease in Calabar.