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Source: http://www.nationalpost.com/news/story.html?id=411239
Little-known lung infection soars among children: study
'Huge' Burden On System
Tom Blackwell, National Post Published: Monday, March 31, 2008
Rates of a little-known but potentially fatal lung infection have soared among young children and climbed significantly in all age groups in recent years, putting a "huge" burden on the health care system, a new Canadian study indicates.
No one is sure what is behind the worrisome trend, or why children have been hit so hard, but drug resistance among some bacteria linked to the ailment --called empyema--may be at least partly to blame, say respiratory specialists. In the meantime, patients spend an average of three weeks in hospital with the illness, where pus forms in the "pleural" cavity around the lung and sometimes has to be removed with chest surgery.
The study by B.C. researchers found more than 11,000 reported empyema cases across Canada between 1995 and 2003, with rates jumping more than 450% among children aged one to four over that period. "We didn't expect it to be that much," said Dr. Christian Finley, the senior surgical resident at the University of British Columbia who headed the research. "It's pretty dramatic."
Empyema occurs when an infection takes hold in the pleural cavity, usually after spreading from the lung. The most common cause is bacterial pneumonia, though infections can also occur after chest surgery and injury to the chest.
As much as a pint of pus can build up, putting pressure on the lungs that causes shortness of breath and pain.
Before the advent of antibiotics, half the people who contracted empyema died, though the mortality rate is still about 5%,Dr. Finley said.
His findings came as no surprise to Dr. Ian Maclusky, head of respiratory medicine at the Children's Hospital of Eastern Ontario in Ottawa. "Everybody's been saying, 'Whoa, we're seeing a lot more of this stuff,' " he said.
The hospital has had six empyema cases in just the past two weeks.
The B.C. study, published in the latest Canadian Respiratory Journal issue, analyzed hospital data from the Canadian Institute for Health Information, finding that the rate of empyema had increased 30% overall between 1995 and 2003. As the disease primarily afflicts the elderly, the figures partly reflect the ageing population. But even when that demographic factor was filtered out, there was still a jump of 12%. One "distressing" finding was that the numbers had doubled in patients under 19, and quadrupled in the one-to-four-years age group, suggesting that children are a "high-risk" group for empyema that needs attention, the paper says.
"Because significant length of hospital stays and resources are required to manage these patients, a huge increase in the burden of this disease occurred," the researchers said.
It urges greater awareness of the disease among family physicians, as catching empyema earlier makes treatment faster and more effective.
It is unclear why children are being affected disproportionately. One reason might be the pneumococcal vaccines children receive to prevent meningitis, pneumonia and other illnesses. Although they have saved thousands of lives, the vaccines might also have resulted in greater incidence of one serotype of the streptococcus pneumoniae bacteria not covered by the shot, which in turn is the main trigger of empyema in children, Dr. Finley said. Adding that strain to the vaccine might help, he said.
Dr. Maclusky is skeptical of the theory, though, and points the finger more at pneumonia cases that are "under-treated" with antibiotics, allowing the infection to spread. That might be partly a result of antibiotic-resistance in some microbes, he said.
"We're getting bugs that used to be no problem, but are coming back because they are drug resistant," Dr. Maclusky said. "If you have a resistant bacteria, now you're getting the natural history of untreated pneumonia as of 100 years ago. And empyemas were not terribly uncommon then."
tblackwell@nationalpost.com
Little-known lung infection soars among children: study
'Huge' Burden On System
Tom Blackwell, National Post Published: Monday, March 31, 2008
Rates of a little-known but potentially fatal lung infection have soared among young children and climbed significantly in all age groups in recent years, putting a "huge" burden on the health care system, a new Canadian study indicates.
No one is sure what is behind the worrisome trend, or why children have been hit so hard, but drug resistance among some bacteria linked to the ailment --called empyema--may be at least partly to blame, say respiratory specialists. In the meantime, patients spend an average of three weeks in hospital with the illness, where pus forms in the "pleural" cavity around the lung and sometimes has to be removed with chest surgery.
The study by B.C. researchers found more than 11,000 reported empyema cases across Canada between 1995 and 2003, with rates jumping more than 450% among children aged one to four over that period. "We didn't expect it to be that much," said Dr. Christian Finley, the senior surgical resident at the University of British Columbia who headed the research. "It's pretty dramatic."
Empyema occurs when an infection takes hold in the pleural cavity, usually after spreading from the lung. The most common cause is bacterial pneumonia, though infections can also occur after chest surgery and injury to the chest.
As much as a pint of pus can build up, putting pressure on the lungs that causes shortness of breath and pain.
Before the advent of antibiotics, half the people who contracted empyema died, though the mortality rate is still about 5%,Dr. Finley said.
His findings came as no surprise to Dr. Ian Maclusky, head of respiratory medicine at the Children's Hospital of Eastern Ontario in Ottawa. "Everybody's been saying, 'Whoa, we're seeing a lot more of this stuff,' " he said.
The hospital has had six empyema cases in just the past two weeks.
The B.C. study, published in the latest Canadian Respiratory Journal issue, analyzed hospital data from the Canadian Institute for Health Information, finding that the rate of empyema had increased 30% overall between 1995 and 2003. As the disease primarily afflicts the elderly, the figures partly reflect the ageing population. But even when that demographic factor was filtered out, there was still a jump of 12%. One "distressing" finding was that the numbers had doubled in patients under 19, and quadrupled in the one-to-four-years age group, suggesting that children are a "high-risk" group for empyema that needs attention, the paper says.
"Because significant length of hospital stays and resources are required to manage these patients, a huge increase in the burden of this disease occurred," the researchers said.
It urges greater awareness of the disease among family physicians, as catching empyema earlier makes treatment faster and more effective.
It is unclear why children are being affected disproportionately. One reason might be the pneumococcal vaccines children receive to prevent meningitis, pneumonia and other illnesses. Although they have saved thousands of lives, the vaccines might also have resulted in greater incidence of one serotype of the streptococcus pneumoniae bacteria not covered by the shot, which in turn is the main trigger of empyema in children, Dr. Finley said. Adding that strain to the vaccine might help, he said.
Dr. Maclusky is skeptical of the theory, though, and points the finger more at pneumonia cases that are "under-treated" with antibiotics, allowing the infection to spread. That might be partly a result of antibiotic-resistance in some microbes, he said.
"We're getting bugs that used to be no problem, but are coming back because they are drug resistant," Dr. Maclusky said. "If you have a resistant bacteria, now you're getting the natural history of untreated pneumonia as of 100 years ago. And empyemas were not terribly uncommon then."
tblackwell@nationalpost.com