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European Journal of Clinical... Jan 2024The aim of this study was to assess the reliability of rapid antigen detection tests (RADT) for Streptococcus pyogenes (GAS) and Streptococcus pneumoniae on pleural...
The aim of this study was to assess the reliability of rapid antigen detection tests (RADT) for Streptococcus pyogenes (GAS) and Streptococcus pneumoniae on pleural fluid samples for diagnosis of parapneumonic effusion/empyema (PPE) and their potential for improving pathogen identification rates. Sixty-three pleural samples were included from 54 patients on which GAS and S. pneumoniae RADT (BinaxNOW), culture, 16S rRNA PCR, and S. pneumoniae-specific PCR were performed. GAS RADT showed a sensitivity of 95.2% and a specificity of 100%. Pneumococcal RADT showed a sensitivity of 100% and specificity of 88.6%. Both RADT increased the pathogen identification rate in PPE compared to culture.
Topics: Humans; Streptococcus pneumoniae; Streptococcus pyogenes; RNA, Ribosomal, 16S; Reproducibility of Results; Empyema; Pleural Effusion; Empyema, Pleural
PubMed: 37981632
DOI: 10.1007/s10096-023-04710-w -
Journal of Thoracic Disease Nov 2023Pleural infection is associated with significant mortality and morbidity worldwide, with a steadily increasing incidence. We sought to investigate whether video-assisted... (Review)
Review
BACKGROUND AND OBJECTIVE
Pleural infection is associated with significant mortality and morbidity worldwide, with a steadily increasing incidence. We sought to investigate whether video-assisted thoracic surgery (VATS) or thoracotomy provides the best outcomes in the treatment of stage II and III pleural infection as indications remain controversial.
METHODS
Systematic review of relevant articles from the PubMed database.
KEY CONTENT AND FINDINGS
Nine non-randomized retrospective studies published between 1996 and 2020 with a total of 2,121 patients were included. Results varied between studies, but overall shorter operative and recovery times and greater patient satisfaction were demonstrated using VATS compared with thoracotomy.
CONCLUSIONS
Although VATS and thoracotomy are viable treatment options for stage II and III pleural infection, VATS has potential advantages in terms of decreased operation time, fewer days with tube drainage, shorter postoperative hospital stay, reduced postoperative pain, increased patient satisfaction with the procedure, and wound appearance. VATS has limitations in the treatment of patients with stage III pleural infection, where delayed surgical referral has been shown to increase the risk of intraoperative conversion to thoracotomy. The data to date implies that debridement by VATS should be proposed as soon as possible in stage II pleural infection and considered in cases of stage III pleural infection.
PubMed: 38090316
DOI: 10.21037/jtd-23-928 -
Peritoneal Dialysis International :... May 2024A 65-year-old woman on peritoneal dialysis (PD) was admitted due to abdominal pain with cloudy PD effluent. The white blood cell count in PD effluent was 5860/µL with...
A 65-year-old woman on peritoneal dialysis (PD) was admitted due to abdominal pain with cloudy PD effluent. The white blood cell count in PD effluent was 5860/µL with 85% polymorphonuclear neutrophils. Therefore, she was clinically diagnosed with peritonitis. The cultures of PD effluent were negative. Initial abdominal computed tomography did not find suggest any intraabdominal pathology. The patient was treated with empirical intraperitoneal antibiotics. Because abdominal pain with cloudy PD effluent persisted, the PD catheter was removed eventually. The culture of the removed PD catheter grew . However, intermittent fever was noted over the following days and empyema developed approximately 2 weeks after PD catheter removal. The culture of pleural fluid also grew . Another computed tomography revealed multiple intraabdominal abscesses that was assumed to come from a complication of PD-associated peritonitis. We postulate that the empyema might be caused by transdiaphragmatic extension of the intraabdominal abscesses into the pleural space.
PubMed: 38807441
DOI: 10.1177/08968608241241180 -
Internal Medicine Journal Dec 2023Pleural infection is life-threatening and increasingly prevalent. In addition to usual care, twice-daily, separate administration of tissue plasminogen activator and...
BACKGROUND
Pleural infection is life-threatening and increasingly prevalent. In addition to usual care, twice-daily, separate administration of tissue plasminogen activator and deoxyribonuclease (tPA-DNase) reduces radiological pleural opacity with lower surgical referral rates.
AIMS
This retrospective cohort study examines the use of once-daily, concurrent administration of tPA-DNase for complex parapneumonic pleural effusion and empyema.
METHODS
Patients with pleural infection who received intrapleural tPA-DNase between October 2014 and July 2020 at Logan Hospital, where it is given concurrently and once-daily as salvage therapy, were retrospectively identified. Radiographic opacification, inflammatory markers, clinical response and complications were examined.
RESULTS
Thirty-one patients were identified. Mean age was 48.8 years (standard deviation [SD], 17.2). Median tPA-DNase administration was 3 (interquartile range [IQR], 2-3). Chest x-ray pleural opacity decreased significantly (P = 0.047) from a median of 39.6% (IQR, 28.8-65.7%) to 9.7% (IQR, 2.5-23.2%), a median relative reduction of 75.5% (IQR, 47.7-93.9%). White cell count and C-reactive protein improved significantly (P = 0.002 and P = 0.032, respectively) from a median of 16.3 × 10 /L (IQR, 11.8-20.6 × 10 /L) to 9.9 × 10 /L (IQR, 8.0-12.3 × 10 /L) and 311.0 mg/L (IQR, 218.8-374.0 mg/L) to 69.0 mg/L (IQR, 36.0-118.0 mg/L), respectively. No patients experienced significant bleeding or died. Five patients (16.1%) were referred for surgery.
CONCLUSION
This is pilot evidence that a practical regimen of concurrent, once-daily intrapleural tPA-DNase improved pleural opacification and inflammatory markers without bleeding or mortality. The surgical referral rate was higher than in studies assessing twice-daily administration, though the validity of this outcome as a measure of treatment success is limited, and further studies are needed to assess the optimal dose and frequency of intrapleural therapy and indications for surgical referral.
Topics: Humans; Middle Aged; Tissue Plasminogen Activator; Fibrinolytic Agents; Retrospective Studies; Deoxyribonucleases; Pleural Effusion; Pleural Diseases; Empyema; Hemorrhage
PubMed: 37029951
DOI: 10.1111/imj.16084 -
Seminars in Respiratory and Critical... Aug 2023Parapneumonic effusion and empyema are rising in incidence worldwide, particularly in association with comorbidities in an aging population. Also driving this change is...
Parapneumonic effusion and empyema are rising in incidence worldwide, particularly in association with comorbidities in an aging population. Also driving this change is the widespread uptake of pneumococcal vaccines, leading to the emergence of nonvaccine-type pneumococci and other bacteria. Early treatment with systemic antibiotics is essential but should be guided by local microbial guidelines and antimicrobial resistance patterns due to significant geographical variation. Thoracic ultrasound has emerged as a leading imaging technique in parapneumonic effusion, enabling physicians to characterize effusions, assess the underlying parenchyma, and safely guide pleural procedures. Drainage decisions remain based on longstanding criteria including the size of the effusion and fluid gram stain and biochemistry results. Small-bore chest drains appear to be as effective as large bore and are adequate for the delivery of intrapleural enzyme therapy (IET), which is now supported by a large body of evidence. The IET dosing regimen used in the UK Multicenter Sepsis Trial -2 has the most evidence available but data surrounding alternative dosing, concurrent and once-daily instillations, and novel fibrinolytic agents are promising. Prognostic scores used in pneumonia (e.g., CURB-65) tend to underestimate mortality in parapneumonic effusion/empyema. Scores specifically based on pleural infection have been developed but require validation in prospective cohorts.
Topics: Humans; Aged; Prospective Studies; Pleural Effusion; Fibrinolytic Agents; Empyema; Exudates and Transudates; Pneumonia
PubMed: 37429296
DOI: 10.1055/s-0043-1769095 -
IDCases 2024TB is a well-recognized cause of pulmonary infection. Empyema Necessitans is a rare complication of untreated empyema, mainly caused by mycobacterium tuberculosis. It...
INTRODUCTION
TB is a well-recognized cause of pulmonary infection. Empyema Necessitans is a rare complication of untreated empyema, mainly caused by mycobacterium tuberculosis. It mainly affects immunocompromised individuals.
CASE PRESENTATION
We present a case of 28 years old gentleman, Sudanese, with intermittent fever, non-productive cough, weight loss and night sweats. Chest X-ray then CT chest revealed a large right pleural collection invading the chest wall. Chest tube was inserted, fluid analysis was taken, and a bronchoscopy was done. A diagnosis of Empyema Necessitans was confirmed and patient was started on anti-TB regimen with clinical improvement.
CONCLUSION
Empyema Necessitans is a severe disease, complicating pulmonary tuberculosis. Diagnosis can be a challenge. Surgical and medical approaches are both crucial in the treatment of EN. This case highlights the importance of early recognition and diagnosis of this rare but aggressive condition particularly in TB endemic area.
PubMed: 38601432
DOI: 10.1016/j.idcr.2024.e01939 -
Journal of Cardiothoracic and Vascular... Sep 2023Surgery for pleural empyema carries a high burden of morbidity and mortality. The authors investigated the incidence of postoperative pulmonary complications (PPCs) and... (Observational Study)
Observational Study
OBJECTIVES
Surgery for pleural empyema carries a high burden of morbidity and mortality. The authors investigated the incidence of postoperative pulmonary complications (PPCs) and their effects on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs were analyzed.
DESIGN
Retrospective observational study.
SETTING
A single, large university hospital.
PARTICIPANTS
A total of 250 adult patients were included who underwent thoracic surgery for pleural empyema between January 2017 and December 2021.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
A total of 250 patients with pleural empyema underwent thoracic surgery by video-assisted thoracoscopic surgery (49%; n = 122) or open thoracotomy (51%; n = 128). A proportion (42% [105]) of patients had ≥1 PPCs; 28% (n = 70) had to undergo resurgery; and 10% (n = 25) were re-admitted unexpectedly to the ICU. Preoperative respiratory failure (odds ratio [OR]: 5.8, 95% CI: 2.4-13.1), general anesthesia without regional analgesia techniques (OR: 2.9, 95% CI: 1.4-5.8), open thoracotomy and subsequent resurgery (OR: 3.9, 95% CI 1.5-9.9), surgery outside the regular working hours (OR: 3.1, 95% CI 1.2-8.2), and postoperative sepsis (OR: 2.6, 95% CI 1.1-6.8) were identified as independent risk factors for PPCs. Postoperative pulmonary complications were independent factors for unplanned intensive care unit admission (OR: 10.5, 95% CI 2.1-51 for >1 PPC), death within 360 days (OR: 4.5, 95% CI 2.2-12.3 for ≥2 PPCs), and death within 30 days for ≥1 PPCs (OR: 1.2, 95% CI 1.1-1.3).
CONCLUSIONS
The incidence of PPCs is a significant risk factor for morbidity and mortality after surgery for pleural empyema. Targeting the risk factors identified in this study could improve patient outcomes.
Topics: Adult; Humans; Thoracic Surgery; Empyema, Pleural; Risk Factors; Respiratory Insufficiency; Incidence; Retrospective Studies; Postoperative Complications
PubMed: 37236839
DOI: 10.1053/j.jvca.2023.04.017 -
Respirology Case Reports Nov 2023Biliothorax is a rare but serious condition, as the presence of bile is damaging and can lead to empyema. Here, we report a case of a 51-year-old man recently diagnosed...
Biliothorax is a rare but serious condition, as the presence of bile is damaging and can lead to empyema. Here, we report a case of a 51-year-old man recently diagnosed with unresectable cholangiocarcinoma, admitted to the hospital for malignant obstructive jaundice. After interventional management of biliary obstruction, the patient developed a significant right pleural effusion compatible with biliothorax, successfully managed with pleural drainage and antibiotic therapy. Resolution was possible with a conservative approach: biliary decompression, chest tube drainage and antibiotics.
PubMed: 37881506
DOI: 10.1002/rcr2.1239 -
Clinical Transplantation Oct 2023The safety and efficacy of indwelling pleural catheters (IPCs) in lung allograft recipients is under-reported.
INTRODUCTION
The safety and efficacy of indwelling pleural catheters (IPCs) in lung allograft recipients is under-reported.
METHODS
We performed a multicenter, retrospective analysis between 1/1/2010 and 6/1/2022 of consecutive IPCs placed in lung transplant recipients. Outcomes included incidence of infectious and non-infectious complications and rate of auto-pleurodesis.
RESULTS
Seventy-one IPCs placed in 61 lung transplant patients at eight centers were included. The most common indication for IPC placement was recurrent post-operative effusion. IPCs were placed at a median of 59 days (IQR 40-203) post-transplant and remained for 43 days (IQR 25-88). There was a total of eight (11%) complications. Infection occurred in five patients (7%); four had empyema and one had a catheter tract infection. IPCs did not cause death or critical illness in our cohort. Auto-pleurodesis leading to the removal of the IPC occurred in 63 (89%) instances. None of the patients in this cohort required subsequent surgical decortication.
CONCLUSIONS
The use of IPCs in lung transplant patients was associated with an infectious complication rate comparable to other populations previously studied. A high rate of auto-pleurodesis was observed. This work suggests that IPCs may be considered for the management of recurrent pleural effusions in lung allograft recipients.
Topics: Humans; Pleural Effusion, Malignant; Retrospective Studies; Transplant Recipients; Catheters, Indwelling; Lung
PubMed: 37354125
DOI: 10.1111/ctr.15056 -
Radiology Feb 2024An 81-year-old man living in South Korea was referred to the pulmonology clinic because of abnormal findings at routine surveillance CT. His past medical history...
An 81-year-old man living in South Korea was referred to the pulmonology clinic because of abnormal findings at routine surveillance CT. His past medical history included right radical nephroureterectomy for ureteral cancer in 2016, transurethral resection of a bladder tumor in 2015, and tuberculous pleurisy in his third decade of life that was complicated by a chronic calcified empyema. He had been doing well clinically until 6 months prior, when he presented to an outside hospital with progressive right-sided chest pain and dyspnea and was found to have active tuberculosis. During that hospitalization, he underwent chest CT and CT-guided biopsy of an incidentally found thoracic lesion, which revealed chronic active inflammation. His symptoms improved after initiation of antituberculous medication, and he was discharged home to complete treatment. Because of interval growth of this lesion noted on a subsequent surveillance CT scan, he was referred to pulmonology for further evaluation. Laboratory tests obtained during his visit revealed mild leukocytosis (1258 cells × 10/L; normal range, 4000-10 000 cells × 10/L) with neutrophilic predominance (82% neutrophils; normal range, 50%-75% neutrophils), and a mildly elevated C-reactive protein level (3.17 mg/dL; normal range, 0-0.5 mg/dL). A sputum culture was negative for tuberculosis. The patient reported mild chest discomfort and dyspnea. Liver MRI was performed to further evaluate an abnormal lesion seen at CT. Given the patient's recent nonspecific biopsy results and tuberculosis treatment, no further work-up was pursued. Contrast-enhanced chest CT was performed 6 months later because the patient developed worsening chest pain and dyspnea. He remained afebrile, with persistent leukocytosis (1485 cells × 10/L) and an elevated C-reactive protein level (3.56 mg/dL). On the basis of the imaging findings, repeat CT-guided biopsy and PET/CT were performed, thereby enabling confirmation of the diagnosis, and appropriate treatment was initiated.
Topics: Male; Humans; Aged, 80 and over; C-Reactive Protein; Leukocytosis; Positron Emission Tomography Computed Tomography; Lymphoma, Large B-Cell, Diffuse; Pleural Neoplasms; Chest Pain; Dyspnea; Image-Guided Biopsy; Tuberculosis; Empyema, Pleural
PubMed: 38411510
DOI: 10.1148/radiol.223090