Investigation of patients that were treated with the diagnosis of parapnomonic effusion in the pediatric infectious diseases clinic: Ten years of retrospective evaluation

In this thesis study, it was aimed to retrospectively evaluate the clinical, laboratory, radiological and risk factors as well as the prognostic data of 77 patients who were hospitalized in the Pediatric Infectious Diseases Clinic with the diagnosis of parapneumonic effusion for a period of ten years (2008-2017). Seventy percent of the cases were male, the median age was 5.4 years. The most common presenting symptoms were fever and cough. The median duration of symptoms before admission was 6 days. Sixty percent of the cases had chronic disease. Seventy five percent of the cases had used antibiotics before admission. Pleural fluid examination was performed in 42% of the cases. In nine cases (12%), 11 microorganisms could be shown as causative agents and these are Streptococcus pneumoniae (n=2), Mycoplasma pneumoniae (n=3), Staphylococcus aureus (n=1), Staphylococcus epidermidis (n=1), Chlamydophila psittaci (n=1), Corynebacterium propinquum (n=1). Fifty six percent of effusions were in acute exudative, 27% were in fibrinopurulent, and 17% were in chronic organized stage. Necrotizing pneumonia was detected in 14% of the cases. Empirical parenteral antibiotics were initiated in all cases and only antibiotic treatment was sufficient in 62% of the cases. Tube thoracostomy (37%) success rate was 68%, intrapleural fibrinolytic therapy (9%) success rate was 88%, surgical treatment (5%) success rate was 100%. Median total length of stay in the hospital was 13 days. During the treatment, 2 cases (3%) with immune system defects and chronic diseases died. In the cluster analysis made to determine the risk factors and significant features in prognosis; three different groups that defined 1) Patients who initially presented with a severe clinic and developed necrotizing pneumonia had a worse prognosis (need for invasive treatment, late clinical response, long hospitalization), but low mortality, 2) Patients with young age (1-36 months) and chronic disease have a more mortal course, 3) Even if there is a chronic disease, cases presenting early show a more favorable course with all the results were identified. Keywords: Parapneumonic effusion, necrotizing pneumonia, cluster analysis.