Lung abscesses in children – Twenty four years of experience
A.. Oliveiraa,, , L.. Martinsa, , M.. Félixa,
a Pediatric Medical Department, Hospital Pedi??trico de Coimbra, Centro Hospitalar e Universit??rio de Coimbra, Portugal

To the Editor,

Lung abscess is uncommon in children with an estimated incidence of 0.7 per 100,000 admissions/year.1, 2 Literature concerning this topic is scarce.

The authors carried out a retrospective study of hospital admissions of children with lung abscess from January 1990 to December 2013.

Twenty admissions occurred, related to 18 children (two had recurrent secondary lung abscesses with hyper IgE syndrome and congenital cyst adenomatoid malformation as underlying conditions). Twelve admissions (60%) were male children and ages ranged from 8 months to 12 years (mean of 3 years). Eleven cases (55%) were primary lung abscesses. Congenital cystic adenomatous malformation, immunodeficiency and neurodevelopment abnormality were the underlying conditions related to the secondary lung abscesses. The most common symptoms were fever (100%), cough (60%), chest/abdominal pain (45%) and dyspnea (30%) with a mean duration of 13 days (range 3–60). The chest radiography was diagnostic in every case. A chest computerized tomography (CT) scan was done in 65% and diagnosed congenital cyst adenomatous malformations in two cases. The right lung was involved in 64%. Microbiological studies were made in 70% admissions (12 blood cultures, 8 pleural fluid cultures, 2 bronchoalveolar lavage cultures, 3 sputum cultures, 1 abscess fluid culture). Identification of an agent was possible in 21% of these cases (Streptococcus pneumoniae in two blood cultures and one bronchoalveolar lavage and Pseudomonas aeruginosa in one sputum culture). The average hospital stay was 18 days (range 5–39). In all admissions, combination IV antibiotics were administered, with an average duration of 17 days. Antibiotics included a third generation cephalosporin in 85%, an antistaphylococcal agent in 80% and an antifungal agent in 10% (in one child, the immunodeficiency diagnosis was made in follow-up and did not receive antifungal therapy for that reason). Radiologically guided needle aspiration was performed in one secondary lung abscess that failed to respond to antibiotic treatment.

There were complications in two cases (one piopneumothorax and bronchopleural fistula; one large pneumotocele). There were no deaths directly related to lung abscess.

Lung abscesses are uncommon in pediatric age.1, 2, 3, 4, 5 There was a delay in diagnosis in our study that is common given the abscess insidious evolution. The main diagnostic test was the chest radiography,1, 2, 3 but chest CT was useful for identification of predisposing/associated lung lesions and aspiration guidance.1, 2 The most frequent location was the right lung, probably a result of the anatomic position of the right main bronchus.4 Microbiologic findings were scarce which could be explained by our minimally invasive approach. P. aeruginosa sputum culture had uncertain significance. To clarify the microbiologic etiology of the lung abscess, the ideal samples are the ones that result from percutaneous aspiration of the abscess or transtracheal aspirates. The samples of the upper respiratory tract are of no value.3 In addition to cultures, rapid diagnostic tests, such polymerase chain reaction techniques, can also be helpful.

The choice and length of the antibiotic regimen was usually recommended, covering upper respiratory flora and also anaerobes in second lung abscess and fungal pathogens in immunocompromised children.2, 3, 4, 5

In conclusion, lung abscess has a low incidence in pediatric age and our series showed that a conservative approach still is an appropriate choice.

Conflicts of interest

The authors have no conflicts of interest to declare.

Corresponding author. alexandra.raquel@gmail.com

Bibliography
1
Lung abscess in children. Pediatr Infect Dis J. 2009; 4:27-35.
2
Lung abscess in children. Paediatr Respir Rev. 2007; 8:77-84.
3
Lung abscess in infants and children. Clin Pediatr. 1995; 34:2-6.
4
Pediatric lung abscess: a retrospective review of 23 cases. J Microbiol Immunol Infect. 2004; 37:45-9.
5
Clinical management and outcome of childhood lung abscess: a 16-year experience. J Microbiol Immunol Infect. 2005; 38:183-8.

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