Case Of Empyema Research Articles

Current morbimortality and one-year survival after pneumonectomy for infectious diseases

ObjectiveIdentify the one-year survival rate and major complications in patients submitted to pneumonectomy for infectious disease. MethodsRetrospective data from all cases of infectious disease pneumonectomy over the past 10 years were collected from two reference centers. The authors analyzed: patient demographics, etiology, laterality, bronchial stump treatment, presence of previous pulmonary resection, postoperative complications in the first 30 days, the treatment used in pleural complications, and one-year survival rate. Results56 procedures were performed. The average age was 44 years, with female predominance (55%). 29 cases were operated on the left side (51%) and the most frequent etiology was post-tuberculosis (51.8%). The overall incidence of complications was 28.6% and the most common was empyema (19.2%). Among empyema cases, 36.3% required pleurostomy, 27.3% required pleuroscopy and 36.3% underwent thoracoplasty for treatment. Bronchial stump fistula was observed in 10.7% of cases. From all cases, 16.1% were completion pneumonectomies and 62.5% of these had some complication, a significantly higher incidence than patients without previous surgery (p = 0.0187). 30-day in-hospital mortality was (7.1%) with 52 cases (92.9%) and 1-year survival. The causes of death were massive postoperative bleeding (1 case) and sepsis (3 cases). ConclusionsPneumonectomy for benign disease is a high-risk procedure performed for a variety of indications. While morbidity is often significant, once the perioperative risk has passed, the one-year survival rate can be very satisfying in selected patients with benign disease.

Which Surgery for Stage II-III Empyema Patients? Observational Single-Center Cohort Study of 719 Consecutive Patients.

Recent guidelines support the use of thoracoscopic surgery in stage II-III empyema; however, there is still debate regarding the best surgical approach. The aim of our study is to compare postoperative outcomes of VATS and open surgical approaches for the treatment of post-pneumonic empyema. Observational cohort study on prospectively collected cases of post-pneumonic empyema surgically treated in a single center (2000-2020). Patients were divided into an open group (OT, posterolateral muscle sparing thoracotomy) and VATS group (VT, 2 or 3 port ± utility incision). The primary outcome of the study was empyema resolution, assessed by the recurrence rate. Secondary outcomes were mortality, complications, pain and return to daily life. All patients were followed up at 1, 3 and 6 months after surgery in the outpatient clinic with a chest radiograph/CT scan. In total, 719 consecutive patients were surgically treated for stage II-III empyema, with 644 belonging to the VT group and 75 to the OT group. All patients had a clinical history of pneumonia lasting no more than 6 months before surgery, and 553 (76.9%) had stage II empyema. Operative time was 92.7 ± 6.8 min for the OT group and 112.2 ± 7.4 for the VT group. The conversion rate was 8.4% (46/545) for stage II and 19.2% (19/99) for stage III. Twelve patients (1.86%) in the VT group and four patients (5.3%) in the OT group underwent additional surgery for bleeding. Postoperative mortality was 1.25% (9/719): 5.3% (4/75) in OT and 0.77% (5/644) in VT. Postoperative stay was 10 ± 6.5 days in OT and 8 ± 2.4 in VT. Overall morbidity was 14.7% (106/719): 21.3% (16/75) in OT and 13.9% (90/644) in VT. In VT, six patients (0.93%) showed recurrent empyema: five were treated with chest drainage and one with additional open surgery. Our findings suggest that the VATS approach, showing a 99% success rate, shorter length of stay and lower postoperative morbidity, should be considered the treatment of choice for thoracic empyema.

Massive subdural empyema secondary to infectious parotitis: a case report

Background: Subdural empyema is an intracranial focal collection of purulent material between the dura and arachnoid mater. The most common causes are purulent meningitis in infants and sinusitis and otitis media in older children through a direct extension of the infection. Although it is very rare, parotitis may also cause subdural empyema. This report presents our case of subdural empyema due to infectious parotitis in a pediatric patient. Case report: A 1-year-old boy was referred from other hospitals for multiple seizure episodes. He also had a complaint of vomit and fever 3 weeks ago. On the neurological examination, we found that he had a GCS of 8, no meningeal sign was found, and with dilated pupil on the right side. A contrast-enhanced head computed tomography (CT) scan revealed multiple hypodense masses with ring enhancement over the right hemisphere, and a severe midline shift suggested as subdural empyema. We then performed a craniotomy to evacuate the empyema. Two weeks after surgery, he was fully alert without any surgical morbidity. Conclusion: Although parotitis is the less likely disease that can cause subdural empyema, we should also include the disease as the possible cause before we examine the patient more thoroughly and exclude them as the disease that can cause subdural empyema.

Outcome of Intermittent Thoracentesis versus Pigtail Catheter Drainage for Hepatic Hydrothorax.

Background/Aims: The management of hepatic hydrothorax (HH) remains a challenging clinical scenario with suboptimal options. We investigated the effect and safety of pigtail catheter drainage compared to intermittent thoracentesis. Methods: This multicenter, retrospective study included 164 cirrhotic patients with recurrent pleural effusion from March 2012 to June 2017. Patients with neoplasms, cardiopulmonary disease, and infectious conditions were excluded. We compared the clinical outcomes of pigtail catheter drainage versus thoracentesis for variables including complications related to procedures, overall survival, and re-admission rates. Results: A total of 164 patients were divided into pigtail catheter (n = 115) and thoracentesis (n = 49) groups. During the follow-up period of 6.93 months after discharge, 98 patients died (pigtail; n = 47 vs. thoracentesis; n = 51). The overall survival (p = 0.61) and 30-day mortality (p = 0.77) rates were similar between the pigtail catheter and thoracentesis groups. Only MELD scores were associated with overall survival (adjusted HR, 1.08; p < 0.01) in patients with HH. Spontaneous pleurodesis occurred in 59 patients (51.3%) in the pigtail catheter group. Re-admission rates did not differ between the pigtail catheter and thoracentesis groups (13.2% vs 19.6% p = 0.7). A total of five complications occurred, including four total cases of bleeding (one patient in the pigtail catheter group and three in the thoracentesis group) and one case of empyema in the pigtail catheter group. Conclusions: Pigtail catheter drainage is not inferior to that of intermittent thoracentesis for the management of HH, proving it may be an effective and safe clinical option.

Pneumococcal empyema: Resistance patterns, fitness cost and serotype distribution.

Streptococcus pneumoniae is a recognized etiology of invasive infections including parapneumonic empyema, and its resistance to antibiotics is evolving worldwide, raising concerns of encountering untreatable strains. This study measured the serotype distribution, antimicrobial susceptibility and biological cost incurred by resistance of pneumococci from pleural samples. The serotype profiles, susceptibility results and growth rates were phenotypically determined for a panel of clinical strains of S. pneumoniae from cases of empyema between 2011 and 2019. Of 24 empyema cases, the isolated strains belonged to seven serotypes in the following descending order; 19A, 11A/D, 19F, 3, 7F, 1/6B while two strains remained non-typable. Penicillin susceptibility was shown in <80% of the isolates, while parenteral cephalosporins (cefuroxime and ceftriaxone) demonstrated activity in 83.3 and 95.8% respectively. High resistance frequency was noted for macrolides and sulfonamides, but the strains were uniformly sensitive to respiratory fluroquinolones, vancomycin and linezolid. The macrolide-resistant strain exhibited a high growth rate, suggesting a possible beneficial effect. Phenotypes with mono-resistance to sulfonamides and clindamycin were equally fit as the susceptible counterpart strains. Resistance to multiple antimicrobial agents resulted in a high degree of fitness deficit, while other resistant phenotypes were less fit. The pneumococcal conjugate vaccine PCV13 serotypes still circulate in the community. The data indicate that resistance to certain antimicrobials incurs an apparent fitness cost in pneumococci which may limit the dissemination of such strains while low fitness cost, seen in case of resistance to macrolides, may contribute to the spread of resistant clones.

An Unusual Case of Spontaneous Bacterial Empyema Caused by Aeromonas hydrophila

An Unusual Case of Spontaneous Bacterial Empyema Caused by Aeromonas hydrophila

A Five-Year Study of Intrapleural Fibrinolytic Therapy in Loculated Pleural Collections

Pleural fluid loculations due to complicated parapneumonic effusion (CPE), empyema, tubercular effusion and traumatic hemothorax can be managed either by video-assisted thoracoscopic surgery (VATS) or intrapleural ibrinolytic therapy (IPFT). The former is more invasive, not easily available and is also more expensive. On the other hand, IPFT is less invasive, cheaper, easily accessible and if used early, in loculated pleural collections, break loculations and early pleural peel, thereby facilitating pleural space drainage. To study the efficacy of IPFT in facilitating pleural space drainage in loculated pleural collections of diverse aetiologies. A five-year retrospective, observational study of 200 patients, with loculated pleural collections and failed tube drainage and managed with IPFT was carried out. Responders were defined as those with significant volume of fluid drained and significant radiological resolution. There were 106 (53%) cases of CPE, 59 (29.5%) cases of tubercular effusion, 23 (11.5%) cases of empyema and 12 (6%) cases of hemothorax. Responders were 148 (74%) in number. The distribution of responders as per type of loculated pleural collection was as follows: CPE 88 (83%), tubercular 37 (62.7%), empyema 14 (60.8%) and traumatic hemothorax 11 (91.6%). The adverse effects were mild and included chest pain in six patients and low-grade transient fewer in three cases. Intrapleural fibrinolytic therapy is a safe and cost-effective option in the management of selected patients with loculated pleural effusions.

PLEURITIS AND EMPYEMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

PLEURITIS AND EMPYEMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

PET PEEVE: DYSPNEA FROM UNDIAGNOSED PASTEURELLA MULTOCIDA EMPYEMA

PET PEEVE: DYSPNEA FROM UNDIAGNOSED PASTEURELLA MULTOCIDA EMPYEMA

A CASE OF CHRONIC EMPYEMA REQUIRING ELOESSER FLAP SURGERY

A CASE OF CHRONIC EMPYEMA REQUIRING ELOESSER FLAP SURGERY

CASE OF EMPYEMA CAUSED BY CLOSTRIDIUM BIFERMENTANS INFECTION

CASE OF EMPYEMA CAUSED BY CLOSTRIDIUM BIFERMENTANS INFECTION

Guttural pouch empyema in a Mangalarga Marchador filly: Case report

Guttural pouch empyema is usually a consequence of upper respiratory tract infections, especially those caused by Streptococcus equi. In adult horses, empyema is a common disease, whereas considered rare in foals. The aim of this work was to report a case of unilateral guttural pouch empyema in a filly, with a focus on diagnostic and treatment approaches. A 1-month-old filly, 68 kg, Mangalarga Marchador, was admitted because of respiratory distress and enlargement caudally in the head. Clinical examination revealed dyspnea, dysphagia, lymphadenopathy, unilateral enlargement in the retropharyngeal area, and mucopurulent nasal discharge. Further, endoscopic examination confirmed the presence of purulent material inside the left guttural pouch and a diagnosis of empyema was arrived at. Drainage was performed surgically, a catheter was inserted for guttural pouch lavage. The animal received bromexin, dexamethasone, flunixin meglumine, ceftiofur, probiotics, vitamin complexes, and ringer lactate solution. Hematological evaluation performed every 24-72h, showed a decrease in total leukocytes, fibrinogen, platelets, total plasma protein, hematocrit, hemoglobin, and erythrocytes. Eleven days after drainage, the filly’s clinical condition was stable and the wound has healing. The animal was discharged following a good prognosis. Differential diagnoses can include other respiratory diseases, such as guttural pouch timpanism, strangles, and Rhodococcus, which are excluded due to the clinical signs and complementary examinations. In the present case early diagnosis, based on physical examination, hematological parameters, and radiography, combined with adequate treatment methods, including surgical procedures, lavages, antibiotics, and anti-non-steroidal inflammatory therapy, contributed to resolving the guttural pouch empyema in the filly.

Cholecystitis secondary to Salmonella typhi: a rare pathology with an unreported management option—a case report and literature review

BackgroundThis report describes the presentation and course of treatment for one of the youngest reported cases of empyema of the gallbladder. Given the rare occurrence of this disease process, we elected to proceed with a systematic review of the literature. This is only the 7th case series discussing pediatric empyema of the gallbladder due to Salmonella typhi in the literature, and the second case ever reported in the USA.Case presentationWe report a case of a previously healthy 13-month-old girl who presented with diffuse peritonitis and equivocal imaging studies. Diagnostic laparoscopy revealed purulent peritonitis. The gallbladder was distended with intraluminal pus. Laparoscopy was converted to laparotomy to facilitate exposure, and a cholecystostomy tube was placed. Cultures from the fluid were positive for Salmonella typhi. The patient received a 14-day course of intravenous Ceftriaxone followed by 14 days of oral amoxicillin and clavulanate. A cholangiogram performed 8 weeks after surgery confirmed normal biliary anatomy. The cholecystostomy tube was removed. The patient recovered uneventfully and is doing well over 9 months later.ConclusionThere is no consensus on treatment with options reported ranging from medical management with antibiotic therapy to more invasive procedures such as cholecystostomy tube or cholecystectomy. Less invasive management options are an alternative for Salmonella cholecystitis.

Thoracic spinal epidural empyema in a cat

A 2-month-old male domestic shorthair cat was referred to a private veterinary clinic with a history of dyspnea and inappetence. At the clinical examination, the cat was in poor body condition, with hyperthermia and abdominal distension. No major abnormalities were observed in the thoracic radiographs or abdominal ultrasound. A complete blood count revealed leukocytosis with neutrophilia. Although no clinical diagnosis was made, the cat received support therapy, but went into cardiac arrest and died. The cat was submitted for necropsy and the main gross finding was two white nodules on the ventral surface of the thoracic vertebrae (from T1 to T4). At the cut surface, the nodules were friable and filled with yellow exudate. The epidural space of the thoracic region was filled with yellowish viscous material. Histologically, the vertebrae were partially replaced by abscess formation characterized by a necrotic center with degenerate neutrophils, surrounded by fibrous connective tissue. The epidural space was filled with degenerate neutrophils, necrotic debris, fibrin, and intralesional colonies of gram-negative short rod-shaped to coccobacillary bacteria. Bacteriologic culture yielded Pasteurella multocida. This paper describes the gross, histological, and bacteriological features of a rare case of spinal epidural empyema caused by Pasteurella multocida in a cat.

Clinical relevance of molecular testing methods in the diagnosis and guidance of therapy in patients with staphylococcal empyema: a systematic review and meta-analysis.

BackgroundEfficient detection tools for determining staphylococcal pleural infection are critical for its eradication. The objective of this meta-analysis was to assess the diagnostic utility of nucleic acid amplification tests (NAAT) in suspected empyema cases to identify staphylococcal strains and avoid unnecessary empiric methicillin-resistant Staphylococcus aureus (MRSA) therapy.MethodsFrom inception to July 24, 2021, relevant records were retrieved from PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. The quality of studies was determined using the QUADAS-2 tool. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and hierarchical summary receiver operating characteristic (HSROC) curve for NAAT’s diagnostic performance were evaluated using an HSROC model.ResultsEight studies comprising 424 samples evaluated NAAT accuracy for Staphylococcus aureus (SA) identification, while four studies comprising 317 samples evaluated methicillin-resistant Staphylococcus aureus (MRSA) identification. The pooled NAAT summary estimates for detection of both SA (sensitivity: 0.35 (95% CI 0.19–0.55), specificity: 0.95 (95% CI 0.92–0.97), PLR: 7.92 (95% CI 4.98–12.59), NLR: 0.44 (95% CI 0.14–1.46), and DOR: 24.0 (95% CI 6.59–87.61) ) and MRSA (sensitivity: 0.45 (95% CI 0.15–0.78), specificity: 0.93 (95% CI 0.89–0.95), PLR: 10.06 (95% CI 1.49–67.69), NLR: 0.69 (95% CI 0.41–1.15), and DOR: 27.18 (95% CI 2.97–248.6) ) were comparable. The I 2 statistical scores for MRSA and SA identification sensitivity were 13.7% and 74.9%, respectively, indicating mild to substantial heterogeneity. PCR was frequently used among NAA tests, and its diagnostic accuracy coincided well with the overall summary estimates. A meta-regression and subgroup analysis of country, setting, study design, patient selection, and sample condition could not explain the heterogeneity (meta-regression P = 0.66, P = 0.46, P = 0.98, P = 0.68, and P = 0.79, respectively) in diagnostic effectiveness.ConclusionsOur study suggested that the diagnostic accuracy of NAA tests is currently inadequate to substitute culture as a principal screening test. NAAT could be used in conjunction with microbiological culture due to the advantage of faster results and in situations where culture tests are not doable.

Postoperative empyema complicated with descending necrotizing fasciitis: a case report

BackgroundEmpyema is a serious complication of lung surgery.Case presentationWe report a case of Streptococcus anginosus empyema complicated by descending necrotizing fasciitis after surgery. Ten days after the initial surgery, the patient presented with arrhythmia and hypotension with septic shock. Pleural fluid analysis led to the diagnosis of empyema, and surgical debridement (second surgery) was performed. One week after the emergency surgery, a palpable pink erythematous skin change was observed on the ipsilateral iliac crest. Hence, the second emergency surgery (third surgery) was performed to debride the subcutaneous and intramuscular abscesses.ConclusionsThe possibility of descending abscess and necrotizing fasciitis should be considered when Streptococcus anginosus is detected.

Medical Thoracoscopy for Undiagnosed Pleural Effusions: Experience from a Tertiary Care Hospital in North India

Medical thoracoscopy, also called pleuroscopy, has received renewed interest in the recent past for diagnostic as well as therapeutic uses. In this study, we describe our experience with thoracoscopy for undiagnosed pleural effusions. In a retrospective analysis of thoracoscopic procedures we performed between January 2007 and December 2008, yield of thoracoscopic pleural biopsy for achieving a diagnosis in undiagnosed pleural effusions, defined as pleural effusions with adenosine deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy on three occasions was evaluated. Complications of thoracoscopy were also analysed. Overall diagnostic yield of thoracoscopic pleural biopsy was 74.3% in patients with undiagnosed pleural effusions. Pleural malignancy was diagnosed in 48.6% of patients. There was only one case of mesothelioma and the rest were due to pleural metastasis. Lung cancer and breast cancer were the most common sites of primary malignancy. Tuberculosis was diagnosed with pleural biopsy in 22.8% of patients. We had low complication rate after thoracoscopy. Only two cases of empyema were observed. Medical thoracoscopy is a safe procedure and has good diagnostic yield in patients with undiagnosed pleural effusions.

Pleural empyema caused by dropped gallstones after laparoscopic cholecystectomy for acute cholecystitis: a case report

BackgroundDropped gallstones during laparoscopic cholecystectomy (LC) sometimes induce postoperative infectious complications. However, pleural empyema rarely occurs as a complication of LC.Case presentationWe present the case of a 66-year-old woman with right pleural empyema. She previously underwent LC for acute gangrenous cholecystitis 11 months ago. The operative report revealed iatrogenic gallbladder perforation and stone spillage. The bacterial culture of the gallbladder bile was positive for Escherichia coli. Chest and abdominal computed tomography revealed right pleural effusion, perihepatic fluid collection, and multiple small radiopaque density masses. Although ultrasound-guided transthoracic drainage was performed, the drainage was incomplete, and systemic inflammatory reaction persisted. Consequently, thoracotomy and laparotomy with gallstone retrieval were performed, and the patient recovered completely. The patient has remained well without complications after 14 months of follow-up.ConclusionsWe report a rare case of pleural empyema caused by dropped gallstones after LC. This case emphasized the importance of completely retrieving the dropped gallstones to prevent late infectious complications after LC.

Pleural Peels Tissue Culture plus Pleural Fluid Culture Help to Improve Culture Rate for Empyema.

Background: Empyema is known as a serious infection, and outcomes of empyema cases remain poor. Pleural fluid culture and blood culture have been reported to give unsatisfactory results. We introduce a novel pleural peels tissue culture during surgery and aim to improve the culture results of empyema. Methods: This was a retrospective study and was obtained from our institute. Patients with stage II or III empyema undergoing video-assisted thoracic surgery decortication from January 2019 to June 2021 were included in the study. Results: There were 239 patients that received a pleural peels tissue culture, a pleural fluid culture, and a blood culture concurrently during the perioperative period. Of these, 153 patients had at least one positive culture and 86 patients showed triple negative culture results. The positive culture rates were 46.9% for pleural peels tissue cultures, 46.0% for pleural fluid cultures, and 10% for blood cultures. The combination of pleural peels tissue culture and pleural fluid culture increased the positive rate to 62.7%. Streptococcus species and Staphylococcus species were the most common pathogens. Conclusion: The combination of pleural peels tissue culture and pleural fluid culture is an effective method to improve the positive culture rate in empyema.

An unusual case of empyema with septicaemia secondary to eggerthella lenta

Eggerthella lenta is an anaerobic, non-spore-forming, nonmotile, gram-positive bacillus commensal in human intestine. It causes genitourinary tract infection, abscess, and wound infection but can lead to disseminated life-threatening septicemia. Risk factors to develop infection secondary to E. Lenta are immunocompromised and elderly patients with pre-existing co-morbidities such as cancer and diabetes mellitus.