Abstract
SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: 1. To study the tuberculous and non-tuberculous patterns in the etiology of Empyema. 2. To compare the age, sex distribution among tuberculous and non-tubercluous groups. 3. To know the effect of early intervention, prognosis, treatment modalities and outcomes in tuberculous and non-tuberculous empyema. METHODS: A prospective study of empyema thoracis was conducted on 52 consecutive patients with empyema thoracis admitted to the tuberculosis and chest diseases ward of a teaching hospital over one-and-a-half-year period with the objective of comparing the etiology, clinical profiles and outcomes of patients. The demographic data, clinical presentation, microbiological findings, etiology, the clinical course and management were recorded as per a planned pro forma and analyzed. RESULTS: Out of 52 cases, 30 (57.7%) cases were of non TB etiology where as TB constitute 42.3%. Gram negative organisms 28.8% cases, Gm+ve 15.3%. In TB empyema mean age of presentation was 35.8 years & 44.46 yrs in non TB. Average duration of symptom presentation in TB & non TB empyema are 40.35 & 21.13 days respectively. Mean duration of intercostal tube drainage in TB was 33.55 days vs 18.36 days in non TB empyema. Bronchopleural fistula present in 54.54% of tuberculous versus 20% of non-tuberculous empyema. Good lung expansion with minimal pleural thickening seen in 25(83.33%) cases of non TB cases but only 59% cases of TB empyema had good resolution. CONCLUSIONS: Empyema continues to be prevalent in our country particularly in the lower socioeconomic strata due to the delay in seeking medical care, inappropriate antibiotics and dosages and duration of antibiotic treatment. Pleural fluid biochemical parameters would also vary depending on the stage of empyema, severity and previous antibiotic therapy. Management of primary empyema continues to be controversial in terms of duration of antibiotic therapy and the indications for and timing of surgery. There is a need for randomized controlled trials for strict guidelines on the management of empyema Tuberculous empyema differs from non-tuberculous empyema in the age profile, Clinical presentation, management issues, and has a significantly poorer outcome. All cases of empyema with bronchopleural fistula should be managed by intercostal drainage tube connected to water seal. It was also observed that all cases of empyema complicated by bronchopleural fistula were difficult to manage and needed major surgery. CLINICAL IMPLICATIONS: Tuberculous empyema remains a significant cause of empyema thoracis in India. Further studies are needed to evaluate the role of rapid diagnostic tools like CBNAAT with reliable sensitivity and specificity in the diagnostic algorithm for the early diagnosis of tuberculous empyema which would help in planning the treatment of empyema. DISCLOSURES: No relevant relationships by PRAPULLA CHANDRA DAVULURI, source=Web Response
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