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

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.