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Respiratory Medicine Jul 2016An increasing incidence of parapneumonic effusion and pleural empyema (PPE/PE) has been reported in recent studies. As only few data on etiology of PPE/PE in Central... (Observational Study)
Observational Study
BACKGROUND
An increasing incidence of parapneumonic effusion and pleural empyema (PPE/PE) has been reported in recent studies. As only few data on etiology of PPE/PE in Central Europe have been reported, we undertook a study on the etiology of PPE/PE in children, using both standard culture and molecular techniques.
METHODS
This prospective study was conducted between June 2011 and December 2013. Consecutive children with PPE/PE complicating community acquired pneumonia, who required diagnostic/therapeutic thoracentesis were included. Blood and pleural fluid samples for microbiological cultures were collected. Molecular methods were applied to identify Streptococcus pneumonia, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes, Mycoplasma pneumoniae, Chlamydophila pneumoniae, and respiratory viruses in pleural fluid.
RESULTS
The study group included 64 children, median age 4 (1-15). Seven of 64 (10.9%) blood cultures and 11 of 64 (17.2%) pleural fluid cultures revealed bacterial growth. The most common bacteria detected was S. pneumoniae (13 blood and pleural fluid samples from 11/64 (17.2%) children). DNA sequences of typical bacteria were found in 29/64 (45.3%) pleural fluid samples. S. pneumoniae was identified in 90% of these samples. The most common serotypes were: serotype 6B in 9/26 (36.6%), 19A in 6/26 (23%), serotype 3 in 3/26 (11.5%), 6A and 23F (both in 2/26 i.e. 7.7%) patients. Molecular methods identified atypical bacteria in 8/58 (13.8%) and respiratory viruses in 12/58 (20.7%) pleural fluid samples.
CONCLUSIONS
S. pneumoniae, in particular serotype 6B and 19A, is the most common etiologic agent of PPE/PE in Polish children. The use of PCR significantly improves pathogen identification in pleural fluid.
Topics: Administration, Intravenous; Adolescent; Anti-Infective Agents; Bacteriological Techniques; Child; Child, Preschool; Chlamydophila pneumoniae; Community-Acquired Infections; Empyema, Pleural; Europe; Female; Haemophilus influenzae; Humans; Incidence; Infant; Male; Molecular Diagnostic Techniques; Mycoplasma pneumoniae; Pleura; Pleural Effusion; Poland; Polymerase Chain Reaction; Prospective Studies; Serotyping; Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus pyogenes; Thoracentesis
PubMed: 27296817
DOI: 10.1016/j.rmed.2016.05.009 -
Internal Medicine (Tokyo, Japan) May 2022Campylobacter rectus is a campylobacterium considered to be a primary periodontal pathogen. Thus, C. rectus has rarely been isolated from extraoral specimens, especially...
Campylobacter rectus is a campylobacterium considered to be a primary periodontal pathogen. Thus, C. rectus has rarely been isolated from extraoral specimens, especially in the thoracic region. We herein report a case of thoracic empyema in which Campylobacter infection was suspected after Gram staining of the pleural effusion, and C. rectus was isolated using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Fusobacterium nucleatum was also detected. Molecular identification was performed using polymerase chain reaction amplification and a sequencing analysis of the 16S rRNA gene. Estimation of the causative bacteria using Gram staining led to the proper culture and identification of the causative bacteria.
Topics: Campylobacter Infections; Campylobacter rectus; Empyema, Pleural; Humans; RNA, Ribosomal, 16S; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
PubMed: 34645758
DOI: 10.2169/internalmedicine.7704-21 -
Prilozi (Makedonska Akademija Na... Sep 2017Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced...
UNLABELLED
Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery - decortications or thoracoplasty. Early recognition of the parapneumonic effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally invasive, is possible not to prograde the process and not to become empyema.
AIM
To analyze the results of the surgical treatment in patients with empyema treated at Clinic for thoracic surgery.
MATERIAL AND METHODS
In the retrospective study we analyzed 234 patients with empyema which were treated at the Clinic for Thoracic Surgery in 5 year period (2011-2015). The mean age of the patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty.
RESULTS
With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total of 108/234 (46.15%) were treated with decortications from which, primary decortications were indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty - 3 of the patients with decortications and 2 with primary indicated thoracoplasty according to the local findings, long term untreated empyema and bad general condition. The Mean hospitalization was 17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and 2/5 (40%) in the group with thoracoplasty.
CONCLUSION
Early detection of the parapneumonic effusion and the adequate treatment will prevent the appearance of empyema. If the empyema is detected it is necessary as early as possible to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to use less invasive decortications, using VATS than the open thoracotomy decortication which is more extensive surgical intervention.
Topics: Drainage; Empyema, Pleural; Female; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications; Republic of North Macedonia; Retrospective Studies; Risk Factors; Thoracoplasty; Time Factors; Treatment Outcome
PubMed: 28991771
DOI: 10.1515/prilozi-2017-0027 -
BMJ Case Reports May 2018We report the case of a 41-year-old woman who presented with a unilateral exudative effusion with prominent eosinophils on pleural cytology. Carbimazole had been started...
We report the case of a 41-year-old woman who presented with a unilateral exudative effusion with prominent eosinophils on pleural cytology. Carbimazole had been started 4 weeks prior to presentation. No immediate cause was identified on imaging or laboratory testing. The effusion persisted at 2-month follow-up. Further investigation at this time, including autoimmune serology was negative. At 2-month follow-up, the effusion was loculated on ultrasound imaging and had a low fluid pH on diagnostic aspiration, in keeping with an empyema. The patient received treatment for pleural empyema, including antibiotics, intercostal drain insertion and video-assisted thoracoscopic pleural biopsy. Carbimazole was stopped, and following treatment for the empyema, the effusion did not reaccumulate.This case illustrates the diagnostic difficulties that pleural effusions may present. It demonstrates that drug reactions should be considered in the differential diagnosis following thorough investigation for other potential causes and also describes the complications that may occur.
Topics: Adult; Anti-Bacterial Agents; Antithyroid Agents; Carbimazole; Diagnosis, Differential; Empyema, Pleural; Eosinophils; Exudates and Transudates; Female; Humans; Pleura; Pleural Effusion; Streptococcus oralis; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
PubMed: 29735508
DOI: 10.1136/bcr-2018-224701 -
Pharmacotherapy May 2014Intrapleural fibrinolysis has been investigated for the treatment of pleural effusion for several decades. Fibrinolytics have the ability to break up fibrin and... (Review)
Review
Intrapleural fibrinolysis has been investigated for the treatment of pleural effusion for several decades. Fibrinolytics have the ability to break up fibrin and loculations that characterize complicated pleural effusions, facilitating drainage. Older fibrinolytics such as urokinase and streptokinase have been replaced by tissue plasminogen activator (tPA) for this indication due to product availability and a more favorable safety profile. The literature supports tPA as a treatment approach for this indication in adult patients, and the use of tPA has become a standard management approach in this population. Over the past decade, data on the efficacy of intrapleural fibrinolytic therapy in children have also been generated, which now support the use of fibrinolysis as a treatment alternative to more invasive therapeutic options such as surgical intervention. In this review, we discuss the pathophysiology, diagnosis, and treatment of parapneumonic effusion and empyema, with a focus on intrapleural fibrinolysis, specifically tissue plasminogen activator, in the pediatric population. Recent articles provide sufficient evidence to support the use of this drug in pediatric patients for the management of pleural effusions; however, due to study heterogeneity, questions remain that may be addressed in future studies.
Topics: Child; Empyema, Pleural; Fibrinolytic Agents; Humans; Pleural Effusion; Pneumonia; Tissue Plasminogen Activator; Treatment Outcome
PubMed: 24390857
DOI: 10.1002/phar.1392 -
Updates in Surgery Apr 2023Common complications of coronavirus disease 2019 (COVID-19) related ARDS and ventilation are barotrauma-induced pneumothorax, pneumatocele and/or empyema. We analysed...
Common complications of coronavirus disease 2019 (COVID-19) related ARDS and ventilation are barotrauma-induced pneumothorax, pneumatocele and/or empyema. We analysed indications and results of video-assisted thoracoscopic surgery (VATS) in complicated COVID-19 patients. This is a retrospective single-institution study analysing a case series of patients treated by VATS for secondary spontaneous pneumothorax (SSP), pneumatocele and empyema complicating COVID-19, not responding to drainage in Lodi Maggiore Hospital between February 2020 and May 2021. Out of 2076 patients hospitalized in Lodi Maggiore Hospital with COVID-19, nine Males (0,43%; mean age 58,1-33-81) were treated by VATS for complications of pneumonia (6 SSP and 3 empyema; 1 case complicated by haemothorax). 7 patients (77%) had CPAP before surgery for 21.3 days mean (4-38). Mean Operative time was 80.9 min (38-154). Conversion rate was 0%. 3 (33%) patients were admitted to ICU before VATS. Treatments were: bullectomy in six patients (66%), drainage of the pleural space in all patients, pleural decortication and fluid aspiration in five cases (55%). two patients (22%) needed surgery interruption and bilateral ventilation to restore adequate oxygenation. Mortality was 1/9 (11%) due to respiratory failure for persistent pneumonia. In one patient (11%) redo surgery was performed for bleeding. Mean postop Length of Stay (LOS) was 37.9 days (10-77). Our report shows that VATS can be considered an extreme, but effective treatment for COVID-19 patients with SSP, pneumatocele or empyema, for patients who can tolerate general anaesthesia. Attention must be paid to the aerosol-generation of infected droplets.
Topics: Male; Humans; Thoracic Surgery, Video-Assisted; Retrospective Studies; Empyema, Pleural; COVID-19; Pneumonia; Length of Stay
PubMed: 36385609
DOI: 10.1007/s13304-022-01420-4 -
Journal of Veterinary Internal Medicine 2023Pyothorax, an accumulation of inflammatory fluid in the pleural space, is often caused by foreign body inhalation in dogs, whereas the etiology in cats can be more...
BACKGROUND
Pyothorax, an accumulation of inflammatory fluid in the pleural space, is often caused by foreign body inhalation in dogs, whereas the etiology in cats can be more difficult to discern.
OBJECTIVE
Compare clinical, microbiologic findings, and etiology in cats and dogs with pyothorax.
ANIMALS
Twenty-nine cats and 60 dogs.
METHODS
Medical records of cats and dogs diagnosed with pyothorax from 2010 to 2020 were reviewed. Clinical findings, fluid analysis, and microbiologic results were retrieved.
RESULTS
Antimicrobials had been administered to equal proportions of cats and dogs before fluid sampling (45% and 47%). Groups did not differ in age or total protein concentration or percentage neutrophils in pleural fluid, but effusion cell count was significantly higher in cats than in dogs (P = .01). Neutrophils containing intracellular bacteria were identified in more cats (27/29, 93%) than dogs (44/60, 73%; P = .05). Penetrating damage to the thorax was implicated as the cause of pyothorax in equal percentages of cats (76%) and dogs (75%). Etiology could not be determined in 2 cats and 1 dog. Cats had higher numbers of bacterial isolates per patient (median, 3) than dogs (median, 1; P = .01) and anaerobes were isolated more often in cats (23/29, 73%) than in dogs (27/60, 45%; P = .003).
CONCLUSIONS AND CLINICAL IMPORTANCE
Pyothorax had similar etiologies in cats and dogs. Cats had higher fluid cell counts, higher numbers of bacterial isolates identified per patient, and intracellular bacteria detected more commonly than did dogs.
Topics: Cats; Dogs; Animals; Dog Diseases; Empyema, Pleural; Anti-Bacterial Agents; Retrospective Studies; Cat Diseases; Pleural Effusion
PubMed: 37098692
DOI: 10.1111/jvim.16699 -
Der Chirurg; Zeitschrift Fur Alle... Feb 2021Parapneumonic pleural effusion is a common complication of pneumonia and can progress to empyema. Pleural empyema is a life-threatening infection, which can be treated... (Review)
Review
Parapneumonic pleural effusion is a common complication of pneumonia and can progress to empyema. Pleural empyema is a life-threatening infection, which can be treated with antibiotics and interventional drainage but in later stages often requires surgery. Here we describe the first case of pleural empyema following a COVID-19 infection with no respiratory failure in a previously healthy and athletic patient. The patient was initially treated with antibiotics and interventional drainage but was readmitted to hospital with symptom deterioration. He was then referred for surgery and underwent an uneventful thoracoscopic washout with partial decortication. The preoperative SARS-CoV‑2 swab was negative. The patient recovered fully and could be discharged.
Topics: COVID-19; Empyema, Pleural; Humans; Male; Pleural Effusion; Pneumonia; SARS-CoV-2
PubMed: 33512559
DOI: 10.1007/s00104-021-01362-4 -
The Cochrane Database of Systematic... Oct 2009Pleural empyema is a collection of pus between the lungs and the chest wall. There is debate about treatment options with the advent of both fibrinolytic enzymes to... (Review)
Review
BACKGROUND
Pleural empyema is a collection of pus between the lungs and the chest wall. There is debate about treatment options with the advent of both fibrinolytic enzymes to facilitate tube drainage and less invasive video-assisted thoracoscopic surgery (VATS).
OBJECTIVES
To determine which was more effective: surgical (using thoracoscopy or thoracotomy) or non-surgical techniques (thoracocentesis, chest tube drainage); and to establish whether there was an optimum time for intervention.
SEARCH STRATEGY
In this updated review we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, issue 3) which contains the Acute Respiratory Infections Group's specialized register; MEDLINE (January 2002 to July Week 4, 2005); and EMBASE (January 2001 to 3rd Quarter 2005). Bibliographies, reference lists of identified studies and review articles were handsearched. Personal communication with authors is ongoing. There were no language restrictions.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of surgical techniques versus non-surgical approaches for treatment of pus in the pleural cavity in children and adults but not neonates. Studies of empyema associated with tuberculosis or malignancy were excluded.
DATA COLLECTION AND ANALYSIS
Trial quality was assessed using Jadad criteria (Jadad 1996). Authors were contacted for missing information. The primary outcomes were death or resolution of the empyema. Secondary outcomes addressed the length of time chest tubes were required, pain, hospital stay and any complications.
MAIN RESULTS
Only one small randomised study was identified. Some methodological quality considerations cast doubt on the validity of the study with regard to patient selection, unclear allocation concealment and outcome assessor blinding and it scored 'B' overall (Jadad score 3). When compared with chest tube drainage combined with streptokinase, video-assisted thoracoscopic surgery (VATS) had a significantly higher primary treatment success and patients spent less time in hospital. Each treatment group suffered one mortality. The latest search revealed no further published randomised studies but communication with authors revealed two ongoing studies comparing conventional chest tube drainage plus antibiotics with and without fibrinolytics with video-assisted thorascopic surgery (VATS). A small unpublished study is awaiting assessment that compared chest tube drainage and antibiotics with thoracoscopy or thoracotomy plus antibiotics.
AUTHORS' CONCLUSIONS
It seems that for large, loculated pleural empyemas VATS is superior to chest tube drainage in terms of duration of chest tubes in situ and length of hospital stay. However, there are questions about validity in the one study which met the inclusion criteria and the study has too few participants to draw conclusions. There are risks of complications (associated with all treatments) which may not be apparent with small numbers. Larger studies are needed.
Topics: Chest Tubes; Drainage; Empyema, Pleural; Humans; Paracentesis; Randomized Controlled Trials as Topic; Thoracic Surgery, Video-Assisted; Thoracoscopy; Thoracotomy
PubMed: 19821285
DOI: 10.1002/14651858.CD001956.pub3 -
Respirology (Carlton, Vic.) Jul 2022
Topics: Empyema, Pleural; Fibrinolytic Agents; Humans; Pleural Effusion; Suppuration; Thrombolytic Therapy
PubMed: 35560748
DOI: 10.1111/resp.14293