Staphylococcal lung pleura

 

Pneumonia, staphylococcus aureus, specific to infants, often in poor general condition (malnutrition, skin infection, etc).

The Staphylococcal pneumonia is a classic complication of measles.

Clinical signs:

– General signs marked: deterioration of general condition, grunting, pallor, high temperature or hypothermia, frequently signs of shock (see Shock, page 17) and the presence of skin lesions (front door).

– Digestive signs: nausea, vomiting, diarrhea, painful abdominal bloating.

– Respiratory signs: dry cough, tachypnoea, signs of a struggle (nasal flaring, draw).

– Pulmonary examination: often normal. Sometimes dullness indicating pleural effusion.

If possible, take a chest X-ray: the presence of bubbles confirms the diagnosis. You can also see liquid levels or often unilateral pleural effusion.

Treatment:

Urgent because rapidly worsening: hospital

– Antibiotic:

cloxacillin IV: 200 mg / kg / day in 3 injections + gentamicin IM or IV: 7.5 mg / day in one injection. Take over with cloxacillin PO as soon as the child’s condition improves to complete 10 to 14 days of treatment.

or

chloramphenicol IV (children over 2 months): 100 mg / kg / day in 3 divided injections.

Take over with chloramphenicol PO as soon as the child’s condition improves to complete 10 to 14 days of treatment.

– Hydration orally (or by nasogastric tube) or infusion.

– Oxygen nasal probe at a rate of 1 liter / min.

– Local disinfection of skin lesions (see Bacterial skin infections, page 105).

– If significant pleural effusion: pleural tap with drainage (for pyopneumothorax: put two drains, one anterior and posterior) or without drainage (empyema, make repetitive taps with an IV catheter).

Evolution:

– Serious risk of decompensation from pneumothorax or suppurative pleurisy or pyopneumothorax.

– In a pediatric service, provide the opportunity to ask anytime pleural drain emergency.

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