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Empyema is defined as the presence of pus in the pleural cavity and represents an effusion containing great numbers of polymorphonuclear leukocytes and fibrin. Acute empyema is generally secondary to infection at another site, most commonly a pulmonary infection. Empyema generally is an internal extension of pneumonia or lung abscess; oral, retropharyngeal, or skin abscess (3); and mediastinal lymph nodes or paravertebral abscess or external introduction of organisms related to trauma or surgery. Predisposing conditions unique to children are cerebral palsy, hypogammaglobulinemia, Down's syndrome, congenital heart disease, and prematurity (4).

TABLE 1 Factors Predisposing Individuals to Develop Lower Respiratory Tract Infections Due to Endogenous Anaerobic Bacterial Flora

Impaired mechanical defenses due to Neurologic injury (i.e., depressed cough reflex, altered consciousness, seizures) Intubation or tracheostomy Debilitation Dysphagia Alcoholism Nasogastric tube Feeding malformations Constant recumbent position Change in oropharyngeal flora Repeated administration of antibiotics Gingivitis due to anticonvulsion therapy Poor oral hygiene, gingivitis, periodontitis Long-term hospitalization and response to hospital flora Impaired immunological defenses in some genetic disorders (i.e., Down's syndrome) Delay in recognition of acute illness because of the patient's inability to complain

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