Intrapleural injection of urokinase in the treatment of acute Haemophilus influenza empyema in children: A case report and literature review

Abstract

Objective: The purpose of this study is to analyze the clinical data of a child with acute empyema caused by Haemophilus influenzae, and to investigate the diagnosis and treatment of this disease through literature review to improve the clinical understanding of this kind of disease.

Methods: A 6-year-old female with acute H. influenzae empyema was treated at the Department of Pediatrics of The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China. The pleural puncture fluid turned out to be yellow turbid pus, and the pleural effusion was diagnosed as empyema according to the classification of pleural effusions. High-throughput sequencing revealed the presence of H. influenzae. After comprehensive treatment, including antibiotics, closed pleural drainage, and intrapleural injection of urokinase, the pleural effusion was absorbed and discharged. A systematic literature search in Pubmed, Embase, Scopus, CNKI, Wanfang, and VIP Chinese databases revealed no cases of acute empyema in children caused by H. influenza and treated with urokinase.

Results: There was no bronchopleural fistula and tension pneumothorax during the treatment. One month after discharge, chest computed tomography (CT) revealed no pleural thickening and normal pulmonary function.

Conclusion: Pneumonia in the child worsened after an initial improvement of symptoms, which is an issue that requires further medical attention. High-throughput sequencing of pathogens in pleural effusion can improve the detection rate. This study indicated that closed pleural drainage combined with intrapleural injection of urokinase is an effective treatment for H. influenzae empyema in children.

Keywords: Haemophilus influenzae; empyema; high-throughput; infection; urokinase.

Figure 1

High confidence pathogen genome coverage map: gene coverage map of H. influenzae. The total number of bases in the genome of this species is 1,890,645 (bp) and the total length of the measured sequence coverage of this species is 64,657 (bp), with a coverage of 3.42% and an average depth of 1.07553706481897X.

Figure 2

(A) Pre-admission outpatient chest X-ray showed inflammation in both lungs. (B) On admission, chest CT showed inflammation in both lungs, partial atelectasis in the left lower lobe, and left pleural effusion. (C) Three days after closed chest drainage, a chest CT showed localized progression of inflammation in both lungs, partial atelectasis in the left lower lobe, and resorption of left pleural effusion. (D) Eighteen days after antibiotic treatment, chest CT showed improvement of the inflammation in both lungs, and a small amount of pleural effusion on the left side.