Community-Acquired Pseudomonas Aeruginosa Pneumonia Complicated with Loculated Empyema in an Infant with Selective IgA Deficiency

選擇性免疫球蛋白A缺乏症之一嬰兒併發社區綠膿桿菌肺炎及分房性膿胸

陳善銘(Shan-Ming Chen) ； 許績男(Ji-Nan Shen) ； 陳榮賓(Jung-Pin Chen) ； 楊旻憲(Ming-Hsien Yang)

《Acta Paediatrica Taiwanica》 43卷3期 (2002/06) Pp. 157-161

https://doi.org/10.7097/APT.200206.0157

摘要

Pseudomonas aeruginosa is widely prevalent in the hospital environment, especially in intensive care units. Selective IgA deficiency is characterized by a serum IgA level less than 5 mg/dl with no deficiency of other immunoglobulins. The occurrence of community-acquired P aeruginosa pneumonia with empyema is rare in pediatric patients. We present a 10-month-old male infant who was referred due to persistent fever and progressive respiratory distress for 1 week. A chest radiograph revealed a right lobar pneumonia with pleural effusion. P aeruginosa that was subsequently isolated from both blood and pleural effusion cultures. The patient received treatment with ceftazidime and intrapleural instillation of urokinase to promote drainage of empyema. Subsequent immunological screening revealed a very low serum IgA level (＜5 mg/dl). We present our experience in successfully treating a loculated empyema with intrapleural instillation of urokinase in an infant. It is also important for pediatricians to be aware that they should be alert for the patient who present with respiratory infections due to unusual organisms. An advanced immunological study to investigate the underlying disorders in these patients is mandatory.

關鍵字

綠膿桿菌 ； 社區肺炎 ； 分房膿性胸 ； 選擇性免疫球蛋白A缺乏症 ； 尿激酶

並列摘要

Pseudomonas aeruginosa is widely prevalent in the hospital environment, especially in intensive care units. Selective IgA deficiency is characterized by a serum IgA level less than 5 mg/dl with no deficiency of other immunoglobulins. The occurrence of community-acquired P aeruginosa pneumonia with empyema is rare in pediatric patients. We present a 10-month-old male infant who was referred due to persistent fever and progressive respiratory distress for 1 week. A chest radiograph revealed a right lobar pneumonia with pleural effusion. P aeruginosa that was subsequently isolated from both blood and pleural effusion cultures. The patient received treatment with ceftazidime and intrapleural instillation of urokinase to promote drainage of empyema. Subsequent immunological screening revealed a very low serum IgA level (＜5 mg/dl). We present our experience in successfully treating a loculated empyema with intrapleural instillation of urokinase in an infant. It is also important for pediatricians to be aware that they should be alert for the patient who present with respiratory infections due to unusual organisms. An advanced immunological study to investigate the underlying disorders in these patients is mandatory.

並列關鍵字

pseudomonas aeruginosa ； community-acquired pneumonia ； loculated empyema ； selective IgA deficiency ； urokinase