Diagnosis and Treatment of Acute Community-Acquired Destructive Pneumonia in Children

Background. Acute destructive pneumonia is the most severe form of purulent-inflammatory lung lesions in children and accounts for up to 10% of the total number of pneumonias in childhood. In the Republic of Belarus over the past 5 years the incidence of destructive pneumonia with purulent complications has increased by 2,5 times. The objective of this research was to study the characteristics of the course of acute community-acquired destructive pneumonia in childhood, to analyze the methods of diagnosis and treatment of pleural complications of the disease. Material and methods. In the period from 2015 to 2022, 70 patients with pulmonary and pleural complications of acute destructive pneumonia were treated at the Republican Scientific and Practical Center for Pediatric Surgery. The average age of patients was 3.4 (1.4-7.1) years. Results. More than 70% were admitted to the clinic in a severe but stable condition with manifestations of respiratory failure of 0-1 degree. Unilateral damage was diagnosed in 46 (66%) patients, bilateral pneumonia - in 24 (34%). Lung tissue destruction was combined with pleural empyema in all patients, with bronchopleural fistula in 14 (37%). In 30 (43%) patients, pneumonia proceeded without predominance of lung parenchyma destruction and was mainly accompanied by the development of pleural empyema. Thoracoscopic sanitation of the pleural cavity was the main method of treating patients with Stage II-III pleural empyema. According to the results of microbiological research, Streptococcus pneumoniae was the most common causative agent of the disease. All patients in our study recovered avoiding chronic form of this disease. Conclusions. Timely diagnostics of pulmonary-pleural complications of acute pneumonia allows to determine indications for the choice of the optimal method of surgical treatment. Thoracoscopic sanitation of the pleural cavity is an effective method of surgical treatment of pleural empyema and allows to perform adequate sanitation of encapsulated purulent cavities and foci of pulmonary destruction.