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Turk Gogus Kalp Damar Cerrahisi Dergisi Jan 2024Empyema is the infection of the fluid in the pleural space due to different causes. The most common cause of empyema in children is parapneumonic effusion. Although its... (Review)
Review
Empyema is the infection of the fluid in the pleural space due to different causes. The most common cause of empyema in children is parapneumonic effusion. Although its frequency has decreased significantly with the use of antibiotics, it is still a significant cause of morbidity and mortality worldwide. The main aim in the treatment of empyema is to drain the pleural cavity to provide reexpansion of the compressed lung, to treat the parenchymal infection with appropriate antibiotic therapy, and to prevent complications that may develop in the acute and chronic periods. Treatment options for this disease vary depending on the stage of the disease. Treatment success in childhood empyema detected at an early stage is high. The diagnosis and treatment of empyema in children differs from adults. Due to rapid tissue regeneration in childhood, healing can occur without the need for aggressive treatment options.
PubMed: 38584781
DOI: 10.5606/tgkdc.dergisi.2024.25759 -
Frontiers in Endocrinology 2023No existing comprehensive Mendelian randomization studies have focused on how obesity affects respiratory diseases.
BACKGROUND
No existing comprehensive Mendelian randomization studies have focused on how obesity affects respiratory diseases.
METHODS
BMI and waist circumference, mainly from the UK Biobank, and 35 respiratory diseases from the FinnGen Biobank were subjected to Mendelian randomization analyses. In this study, the inverse variance weighting method was used as the predominant analysis method and was complemented by MR-Egger and weighted median methods. Horizontal pleiotropy and potential outliers were detected by employing the MR-PRESSO method.
RESULTS
This study indicated that obesity rises the possibility of acute upper respiratory infections (BMI: OR=1.131, p<0.0001; WC: OR=1.097, p=0.00406), acute sinusitis (BMI: OR=1.161, p=0.000262; WC: OR=1.209, p=0.000263), acute pharyngitis (WC: OR=1.238, p=0.0258), acute laryngitis and tracheitis (BMI: OR=1.202, p=0.0288; WC: OR=1.381, p=0.00192), all influenza (BMI: OR=1.243, p=0.000235; WC: OR=1.206, p=0.0119), viral pneumonia (WC: OR=1.446, p=0.000870), all pneumoniae (BMI: OR=1.174, p <0.0001; WC: OR=1.272, p <0.0001), bacterial pneumoniae (BMI: OR=1.183, p=0.000290; WC: OR=1.274, p<0.0001), acute bronchitis (BMI: OR=1.252, p <0.0001; WC: OR=1.237, p=0.000268), acute unspecified lower respiratory infection (BMI: OR=1.303, p=0.000403), chronic tonsils and adenoids diseases (BMI: OR=1.236, p <0.0001; WC: OR=1.178, p=0.000157), chronic laryngotracheitis and laryngitis (WC: OR=1.300, p=0.00785), COPD (BMI: OR=1.429, p <0.0001; WC: OR=1.591, p <0.0001), asthma (BMI: OR=1.358, p <0.0001; WC: OR=1.515, p <0.0001), necrotic and suppurative conditions of lower respiratory tract (WC: OR=1.405, p=0.0427), pleural effusion (BMI: OR=1.277, p=0.00225; WC: OR=1.561, p<0.0001), pleural plaque (BMI: OR=1.245, p=0.0312), other diseases of the respiratory system (BMI: OR=1.448, p <0.0001; WC: OR=1.590, p <0.0001), and non-small cell lung cancer (BMI: OR=1.262, p=0.00576; WC: OR=1.398, p=0.00181). This study also indicated that obesity decreases the possibility of bronchiectasis (BMI: OR=0.705; p=0.00200).
CONCLUSION
This study revealed that obesity increases the risk of the majority of respiratory diseases (including 20 of all 35 respiratory diseases) and that obesity decreases the risk of bronchiectasis.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Laryngitis; Mendelian Randomization Analysis; Lung Neoplasms; Respiratory Tract Infections; Bronchiectasis
PubMed: 37711902
DOI: 10.3389/fendo.2023.1197730 -
BMJ Case Reports Sep 2023, are gram-positive, non-spore forming anaerobic or microaerophilic species. Empyema due to actinomycosis is relatively rare and can be difficult to diagnose as the...
, are gram-positive, non-spore forming anaerobic or microaerophilic species. Empyema due to actinomycosis is relatively rare and can be difficult to diagnose as the presenting symptoms may be indolent and the micro-organism may be difficult to culture. This case report describes a patient presenting with dyspnoea, weight loss and lethargy. The chest radiograph, CT and thoracic ultrasound revealed a left-sided pleural effusion. A chest drain was inserted under ultrasound guidance. The pleural fluid was macroscopically consistent with pus and microbiology showed growth of gram-positive bacilli, as well as the species. The patient was treated with a drainage of the pleural fluid, a prolonged course of antibiotics and made a good recovery. The awareness that the species and the species through their synergistic interaction may cause empyema, may lead to a timely diagnosis and treatment.
Topics: Humans; Actinomycosis; Anti-Bacterial Agents; Chest Tubes; Empyema; Fusobacterium
PubMed: 37714555
DOI: 10.1136/bcr-2022-252867 -
Seminars in Respiratory and Critical... Jun 2024Connective tissue diseases (CTD) are heterogeneous, immune-mediated inflammatory disorders often presenting with multiorgan involvement. With the advent of... (Review)
Review
Connective tissue diseases (CTD) are heterogeneous, immune-mediated inflammatory disorders often presenting with multiorgan involvement. With the advent of high-resolution computed tomography, CTD-related pleuritis-pleural thickening and effusion-is now increasingly recognized early in the disease trajectory. The natural history of CTD-related pleural effusions varies from spontaneous resolution to progressive fibrothorax with ventilatory impairment. Treatment of the underlying CTD is necessary to manage the pleural disease. Depending on the degree of symptom burden and physiological insult, specific treatment of pleural disease can include monitoring, repeated aspirations, systemic anti-inflammatory medication, and surgical decortication.
Topics: Humans; Connective Tissue Diseases; Pleural Diseases; Tomography, X-Ray Computed; Pleural Effusion; Pleurisy; Anti-Inflammatory Agents; Disease Progression
PubMed: 38547917
DOI: 10.1055/s-0044-1782612 -
Minerva Surgery Apr 2024Infections in the pleural space have been a significant problem since ancient times and continue to be so today, with an incidence of 52% in patients with post-pneumonia... (Review)
Review
Infections in the pleural space have been a significant problem since ancient times and continue to be so today, with an incidence of 52% in patients with post-pneumonia syndrome. Typically, these effusions require a combination of medical treatment and surgical drainage, including debridement and decortication. Researchers have been studying the use of intrapleural fibrinolytics in managing complicated pleural effusions and empyema, but there is still ongoing debate and controversy among clinicians. Empyema has traditionally been considered a surgical disease, with antibiotics and chest tube drainage being the initial treatment modality. However, with advances in minimally invasive procedures such as video-assisted thoracoscopic surgery (VATS) and the use of intrapleural fibrinolytics, medical management is now preferred over surgery for many cases of empyema. Surgical options, such as open thoracotomy, are reserved for patients who fail conservative management and have complicated or chronic empyema. This comprehensive review aims to explore the evolution of various management strategies for pleural space infections from ancient times to the present day and how the shift from treating empyema as a surgical condition to a medical disease continues.
Topics: Humans; Empyema, Pleural; Thoracic Surgery, Video-Assisted; Drainage; Pleural Effusion; Thoracotomy
PubMed: 38264874
DOI: 10.23736/S2724-5691.23.09992-6 -
Clinical Infectious Diseases : An... Nov 2023Many community-acquired pleural infections are caused by facultative and anaerobic bacteria from the human oral microbiota. The epidemiology, clinical characteristics,...
BACKGROUND
Many community-acquired pleural infections are caused by facultative and anaerobic bacteria from the human oral microbiota. The epidemiology, clinical characteristics, pathogenesis, and etiology of such infections are little studied. The aim of the present prospective multicenter cohort study was to provide a thorough microbiological and clinical characterization of such oral-type pleural infections and to improve our understanding of the underlying etiology and associated risk factors.
METHODS
Over a 2-year period, we included 77 patients with community-acquired pleural infection, whereof 63 (82%) represented oral-type pleural infections. Clinical and anamnestic data were systematically collected, and patients were offered a dental assessment by an oral surgeon. Microbial characterizations were done using next-generation sequencing. Obtained bacterial profiles were compared with microbiology data from previous investigations on odontogenic infections, bacteremia after extraction of infected teeth, and community-acquired brain abscesses.
RESULTS
From the oral-type pleural infections, we made 267 bacterial identifications representing 89 different species. Streptococcus intermedius and/or Fusobacterium nucleatum were identified as a dominant component in all infections. We found a high prevalence of dental infections among patients with oral-type pleural infection and demonstrate substantial similarities between the microbiology of such pleural infections and that of odontogenic infections, odontogenic bacteremia, and community-acquired brain abscesses.
CONCLUSIONS
Oral-type pleural infection is the most common type of community-acquired pleural infection. Current evidence supports hematogenous seeding of bacteria from a dental focus as the most important underlying etiology. Streptococcus intermedius and Fusobacterium nucleatum most likely represent key pathogens necessary for establishing the infection.
Topics: Humans; Fusobacterium nucleatum; Streptococcus intermedius; Cohort Studies; Prospective Studies; Empyema, Pleural; Bacteria; Communicable Diseases; Brain Abscess; Bacteremia
PubMed: 37348872
DOI: 10.1093/cid/ciad378 -
Thorax Nov 2023
Topics: Humans; Pleural Diseases; Empyema, Pleural
PubMed: 37848216
DOI: 10.1136/thorax-2022-219630 -
Breathe (Sheffield, England) Dec 2023The data about the optimal duration of antibiotics and the usefulness of corticosteroids in the management of parapneumonic effusion and pleural infection are scarce....
UNLABELLED
The data about the optimal duration of antibiotics and the usefulness of corticosteroids in the management of parapneumonic effusion and pleural infection are scarce. Two randomised controlled trials evaluating short antibiotic courses (ODAPE and SLIM) and another trial assessing the benefit from corticosteroid use (STOPPE) in this setting were recently published. The aim of this journal club is to present these trials and discuss their significance and limitations. ODAPE compared the efficacy and safety of a short (2 weeks) an extended (3 weeks) course of amoxicillin-clavulanate in community-acquired complicated parapneumonic effusions, while SLIM compared the efficacy and safety of short (14-21 days) longer (28-42 days) antibiotic courses in patients with community- or hospital-acquired pleural infection. STOPPE assessed the benefit from dexamethasone use in patients with community-acquired pneumonia and concomitant pleural effusion. Both ODAPE and SLIM found that shorter antibiotic courses produce less adverse events while being equally efficacious to the longer courses in a subgroup of patients, such as those with pleural infection that is stabilised with only medical treatment and does not require surgery. In contrast, STOPPE found no benefit from the use of dexamethasone in unselected patients with pneumonia and pleural effusion. Due to the significant limitations of these trials, further studies are required to confirm these findings.
COMMENTARY ON
Hassan M, . The Short Long Antibiotic Course for Pleural Infection Management (SLIM) randomised controlled open-label trial. 2023; 9: 00635-2022.Porcel JM, . Two . three weeks of treatment with amoxicillin-clavulanate for stabilized community-acquired complicated parapneumonic effusions. A preliminary non-inferiority, double-blind, randomized, controlled trial. 2020; 5: 20190027.Fitzgerald DB, . Steroid Therapy and Outcome of Parapneumonic Pleural Effusions (STOPPE): a pilot randomized clinical trial. 2022; 205: 1093-1101.
PubMed: 38125804
DOI: 10.1183/20734735.0134-2023