RESUMEN
OBJECTIVE: Empyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention. DESIGN/SETTING/PATIENTS: Retrospective cohort of paediatric empyema cases requiring drainage or surgical intervention, 2011-2018, admitted to a large Australian tertiary children's hospital. RESULTS: During the study, the incidence of empyema increased from 1.7/1000 to 7.1/1000 admissions (p<0.001). We describe 192 cases (174 CDF and 18 VATS), median age 3.0 years (IQR 1-5), mean fever duration prior to intervention 6.2 days (SD ±3.3 days) and 50 (26%) cases admitted to PICU. PICU admission increased during the study from 18% to 34% (p<0.001). Bacteraemia occurred in 23/192 (12%) cases. A pathogen was detected in 131/192 (68%); Streptococcus pneumoniae 75/192 (39%), S. aureus 25/192 (13%) and group A streptococcus 13/192 (7%). Reintervention occurred in 49/174 (28%) and 1/18 (6%) following primary CDF and VATS. Comparing repeat intervention with single intervention cases, a continued fever postintervention increased the likelihood for a repeat intervention (OR 1.3 per day febrile; 95% CI 1.2 to 1.4, p<0.0001). Younger age, prolonged fever preintervention and previous antibiotic treatment were not associated with initial treatment failure (all p>0.05). CONCLUSION: We report increasing incidence and severity of empyema in a large tertiary hospital. One in four patients required a repeat intervention after CDF. Neither clinical variables at presentation nor early investigations were able to predict initial treatment failure.
Asunto(s)
Empiema/etiología , Preescolar , Empiema/epidemiología , Empiema/patología , Empiema/terapia , Femenino , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria/estadística & datos numéricos , Cirugía Torácica Asistida por Video , Terapia Trombolítica/métodos , Resultado del TratamientoAsunto(s)
Empiema/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Absceso Pulmonar/microbiología , Micrococcaceae/aislamiento & purificación , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/patología , Anciano , Antibacterianos/uso terapéutico , Empiema/tratamiento farmacológico , Empiema/patología , Infecciones por Bacterias Grampositivas/patología , Humanos , Inmunocompetencia , Absceso Pulmonar/tratamiento farmacológico , Absceso Pulmonar/patología , Masculino , Neumonía Bacteriana/tratamiento farmacológicoAsunto(s)
ADN Helicasas/genética , Empiema/diagnóstico por imagen , Proteínas Nucleares/genética , Sarcoma/diagnóstico por imagen , Neoplasias Torácicas/diagnóstico por imagen , Factores de Transcripción/genética , Empiema/complicaciones , Empiema/patología , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Sarcoma/complicaciones , Sarcoma/patología , Neoplasias Torácicas/complicaciones , Neoplasias Torácicas/patología , Pared Torácica/diagnóstico por imagen , Pared Torácica/patologíaRESUMEN
Tuberculosis (TB) is the leading infectious cause of death worldwide, and the commonest cause of death in people living with HIV. Globally, pleural TB remains one of the most frequent causes of pleural exudates, particularly in TB-endemic areas and in the HIV positive population. Most TB pleural effusions are exudates with high adenosine deaminase (ADA), lymphocyte-rich, straw-coloured and free flowing, with a low yield on mycobacterial culture. TB pleurisy can also present as loculated neutrophil-predominant effusions which mimic parapneumonic effusions. Rarely, they can present as frank TB empyema, containing an abundance of mycobacteria. Up to 80% of patients have parenchymal involvement on chest imaging. The diagnosis is simple if M. tuberculosis is detected in sputum, pleural fluid or biopsy specimens, and the recent advent of liquid medium culture techniques has increased the microbiological yield dramatically. Where the prevalence of TB is high the presence of a lymphocyte-predominant exudate with a high ADA has a positive predictive value of 98%. In low prevalence areas, the absence of an elevated ADA and lymphocyte predominance makes TB very unlikely, and pleural biopsy should be performed to confirm the diagnosis. Pleural biopsy for liquid culture and susceptibility testing must also be considered where the prevalence of drug resistant TB is high. Treatment regimens are identical to those administered for pulmonary TB. Initial pleural drainage may have a role in symptom relief and in hastening the resolution of the effusion. Surgical intervention may be required in loculated effusions and empyemas.
Asunto(s)
Derrame Pleural/etiología , Tuberculosis Pleural/epidemiología , Tuberculosis Pleural/patología , Tuberculosis Pulmonar/epidemiología , Adenosina Desaminasa/metabolismo , Biopsia/métodos , Drenaje/métodos , Empiema/tratamiento farmacológico , Empiema/microbiología , Empiema/patología , Empiema/cirugía , Exudados y Transudados/enzimología , Exudados y Transudados/microbiología , Femenino , Humanos , Linfocitos/patología , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Neutrófilos/patología , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/microbiología , Derrame Pleural/patología , Prevalencia , Esputo/microbiología , Tuberculosis Pleural/tratamiento farmacológico , Tuberculosis Pleural/microbiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/patologíaRESUMEN
Slackia exigua (S. exigua) is an obligatory anaerobic coccobacillus under the family of Coriobacteriaceae. It is a rare cause of pyogenic extraoral infections. We report a 58-year-old lady with good past health presented with fulminant community-acquired pneumonia causing acute respiratory distress syndrome caused by S. exigua requiring veno-venous extra-corporeal membrane oxygenation (VV-ECMO). Bacterial identification can be challenging and often require 16 S rRNA and MALDI-TOF MS. The patient was treated with amoxicillin-clavulanic acid according to sensitivity and made significant recovery.
Asunto(s)
Actinobacteria/patogenicidad , Infecciones Comunitarias Adquiridas/patología , Empiema/microbiología , Infecciones por Bacterias Grampositivas/patología , Neumonía/patología , Síndrome de Dificultad Respiratoria/microbiología , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Infecciones Comunitarias Adquiridas/microbiología , Empiema/patología , Empiema/terapia , Oxigenación por Membrana Extracorpórea , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Persona de Mediana Edad , Neumonía/microbiología , Síndrome de Dificultad Respiratoria/patología , Síndrome de Dificultad Respiratoria/terapia , Resultado del TratamientoRESUMEN
In this case report we described a Bahraini male patient of twenty years of age, a smoker and diagnosed with stage IV B Hodgkin lymphoma. He presented with fever, nonproductive cough, upper back pain and shortness of breath due to right upper lobe pneumonia with right encysted pleural effusion. Salmonella enterica serotype Enteritidis was isolated from the sputum. He was successfully treated with 2 weeks of ceftriaxone followed by 2 weeks of oral cefixime. This was the first case of encysted empyema caused by Salmonella enterica serotype Enteritidis reported in the Kingdom of Bahrain. The different aspects of pulmonary Salmonella infections were discussed and the literature was reviewed.
Asunto(s)
Empiema/diagnóstico , Empiema/patología , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/diagnóstico , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/patología , Salmonella enteritidis/aislamiento & purificación , Antibacterianos/administración & dosificación , Bahrein , Cefixima/administración & dosificación , Ceftriaxona/administración & dosificación , Empiema/tratamiento farmacológico , Empiema/microbiología , Enfermedad de Hodgkin/complicaciones , Humanos , Masculino , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/patología , Infecciones por Salmonella/tratamiento farmacológico , Infecciones por Salmonella/microbiología , Salmonella enteritidis/clasificación , Esputo/microbiología , Adulto JovenAsunto(s)
Actinomicosis/patología , Aggregatibacter actinomycetemcomitans/aislamiento & purificación , Empiema/patología , Infecciones por Pasteurellaceae/patología , Derrame Pleural/etiología , Pared Torácica/patología , Traqueostomía/efectos adversos , Actinomyces/aislamiento & purificación , Actinomicosis/complicaciones , Niño , Diagnóstico Diferencial , Empiema/complicaciones , Empiema/diagnóstico por imagen , Femenino , Humanos , Inflamación/diagnóstico , Neoplasias/diagnóstico , Infecciones por Pasteurellaceae/complicaciones , Derrame Pleural/diagnóstico por imagen , Pared Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Tráquea/lesiones , Traqueítis/complicacionesRESUMEN
OBJECTIVES: We report on the incidence, clinical characteristics, and bacterial genotype of group A streptococcal (GAS) meningitis in the Netherlands. METHODS: We assessed the incidence, clinical characteristics, and outcome of patients with GAS meningitis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2013. RESULTS: GAS was identified in 26 of 1322 patients with community-acquired bacterial meningitis (2%); 9 cases (35%) occurred in the first four months of 2013. GAS meningitis was often preceded by otitis or sinusitis (24 of 26 [92%]) and a high proportion of patients developed complications during clinical course (19 of 26 [73%]). Subdural empyema occurred in 8 of 26 patients (35%). Nine patients underwent mastoidectomy and in 5 patients neurosurgical evacuation of the subdural empyema was performed. Five of 26 patients (19%) died and 11 of 21 surviving patient had neurologic sequelae (52%). Infection with the emm1 and cc28 GAS genotype was associated with subdural empyema (both 4 of 6 [67%] vs. 2 of 14 [14%]; P = 0.037). CONCLUSIONS: GAS meningitis is an uncommon but severe disease. Patients are at risk for empyema, which is associated with infection with the emm1 and cc28 genotype.
Asunto(s)
Infecciones Comunitarias Adquiridas/epidemiología , Meningitis Bacterianas/epidemiología , Infecciones Estreptocócicas/epidemiología , Streptococcus pyogenes/aislamiento & purificación , Adulto , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/patología , Empiema/epidemiología , Empiema/microbiología , Empiema/patología , Femenino , Genotipo , Humanos , Incidencia , Masculino , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/patología , Persona de Mediana Edad , Países Bajos/epidemiología , Estudios Prospectivos , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/patología , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/genética , Resultado del TratamientoAsunto(s)
Empiema/etiología , Empiema/patología , Mediastinitis/diagnóstico , Mediastinitis/patología , Cuello/patología , Necrosis/diagnóstico , Necrosis/patología , Femenino , Humanos , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: To evaluate the efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE). DESIGN: Case series with chart review. SETTING: Academic tertiary center. PATIENTS: The study included 26 consecutive patients who underwent Endo-DCR for ADLSE between August 2005 and December 2013. MAIN OUTCOME MEASURES: The success of the procedure was defined as complete complaint relief and DCR patency. Data on the time from referral to surgery, postoperative complications, and revision surgery are also reported. RESULTS: The present patient series included 4 males (15.4%) and 22 females (84.6%) (mean age, 66 years). The mean time between referral and surgery was 0.88 days and the mean follow-up time was 29 months. All patients showed immediate relief from symptoms, with no ADLSE recurrences. Complete success was achieved in 25 (96.2%) cases; the only failure was in a patient who had previously undergone radioiodine treatment. In this case, revision Endo-DCR was not successful. The only perioperative complication (3.8%) was epistaxis in a patient who required revision surgery under general anesthesia. The definitive success rate was 96.2% after primary and revision surgery. CONCLUSIONS: Endo-DCR enables rapid resolution of ADLSE with a very high success rate. Immediate surgery may reduce the risk of skin fistulization and/or orbital complications. DCR shrinkage and lacrimal obstruction are unlikely with Endo-DCR since the procedure is performed on an enlarged sac. The main advantage of Endo-DCR, compared with external DCR, is the absence of a skin incision in an inflamed and infected field.
Asunto(s)
Dacriocistitis/cirugía , Dacriocistorrinostomía , Empiema/cirugía , Endoscopía , Conducto Nasolagrimal , Enfermedad Aguda , Adulto , Anciano , Dacriocistitis/complicaciones , Dacriocistitis/patología , Empiema/complicaciones , Empiema/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Reoperación , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Spontaneous chylothorax is rare in adults. We present an unusual case that was complicated by Prevotella bivia empyema. Full recovery was achieved with chest tube drainage and prompt treatment with intravenous clindamycin.
Asunto(s)
Infecciones por Bacteroidaceae/diagnóstico , Quilotórax/complicaciones , Quilotórax/diagnóstico , Empiema/diagnóstico , Prevotella/aislamiento & purificación , Administración Intravenosa , Anciano , Antibacterianos/uso terapéutico , Infecciones por Bacteroidaceae/microbiología , Infecciones por Bacteroidaceae/patología , Infecciones por Bacteroidaceae/terapia , Quilotórax/patología , Quilotórax/terapia , Clindamicina/uso terapéutico , Drenaje , Empiema/microbiología , Empiema/patología , Empiema/terapia , Humanos , Masculino , Radiografía Torácica , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The number of cases of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia has increased since the late 1990s, with skin and soft tissue infections predominant among neonates. Herein, we present a rare case of CA-MRSA necrotizing pneumonia with empyema following respiratory syncytial virus (RSV) infection in a healthy neonate. Despite prompt vancomycin treatment, the disease worsened and finally we had to perform pneumonectomy. This case highlights the possibility of emerging CA-MRSA-related invasive disease among neonates.
Asunto(s)
Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Pulmón/patología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Necrosis/patología , Neumonía Estafilocócica/diagnóstico , Neumonía Estafilocócica/microbiología , Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/patología , Infecciones Comunitarias Adquiridas/terapia , Empiema/diagnóstico , Empiema/etiología , Empiema/patología , Femenino , Humanos , Recién Nacido , Neumonectomía , Neumonía Estafilocócica/complicaciones , Neumonía Estafilocócica/patología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/patología , Vancomicina/uso terapéuticoRESUMEN
Trichomonad is a type of flagellate that parasitizes the human oral cavity, intestine, or vagina. However, respiratory infection is rare. We report a patient with pyothorax related to Tetratrichomonas species, which is the first reported case in Japan. The patient was a 66-year-old female. She consulted the Emergency Outpatient Unit of our hospital with fever, dyspnea, and the retention of pleural effusion. The appearance of the pleural effusion collected by thoracic drainage was brown, fetid pus. On microscopy, Trichomonad was detected in the pleural effusion. On a gene test, Tetratrichomonas sp. was identified. Based on this experience, we propose that non-stained specimens should be examined to detect Trichomonad on a puncture fluid test. (Case report).
Asunto(s)
Empiema Pleural/patología , Empiema/patología , Derrame Pleural/patología , Infecciones por Protozoos/patología , Trichomonadida/aislamiento & purificación , Anciano , Diagnóstico Diferencial , Empiema/diagnóstico , Empiema Pleural/diagnóstico , Femenino , Humanos , Japón , Derrame Pleural/diagnóstico , Infecciones por Protozoos/diagnósticoRESUMEN
If in clinical practice definitive diagnostic criteria had been established, after death sepsis is often difficult to diagnose, especially if a site of origin is not found or if no clinical data are available. This article will analyze the etiology of sepsis in a medical-legal service with emphasis on the differences in diagnosing it in clinical and forensic environments. A total of 78 cases of sepsis cases diagnosed or confirmed at the autopsy were selected. The etiological agent was determined either during the hospitalization or by postmortem bacteriology. A high prevalence of Gram-negative sepsis was found, especially multidrug-resistant micro-organisms. Most frequent etiological agents were Acinetobacter baumannii, Escherichia coli, Enterobacter, Enterococcus, Pseudomonas, and Klebsiella. Polymicrobial sepsis is much more frequent than in nonforensic cases. In legal medicine, the prevalence of Gram-negative sepsis is much higher than in nonforensic autopsies, and the point of origin is shifted toward the skin and the gastrointestinal system.
Asunto(s)
Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Sepsis/microbiología , Absceso/patología , Adolescente , Glándulas Suprarrenales/patología , Adulto , Encéfalo/patología , Causas de Muerte , Niño , Preescolar , Coagulación Intravascular Diseminada/patología , Farmacorresistencia Bacteriana Múltiple , Edema/patología , Empiema/patología , Encefalitis/patología , Femenino , Patologia Forense , Ventrículos Cardíacos/patología , Hemorragia/patología , Humanos , Lactante , Inflamación/patología , Intestinos/patología , Riñón/patología , Hígado/patología , Pulmón/patología , Masculino , Meningitis Bacterianas/patología , Persona de Mediana Edad , Músculo Esquelético/patología , Miocardio/patología , Necrosis/patología , Neutrófilos/patología , Púrpura/patología , Piel/patología , Bazo/patología , Trombosis/patología , Adulto JovenAsunto(s)
Empiema/etiología , Empiema/patología , Micosis/diagnóstico , Micosis/patología , Ustilaginales/aislamiento & purificación , Anciano de 80 o más Años , Femenino , Humanos , Técnicas Microbiológicas/métodos , Microscopía , Micología/métodos , Micosis/microbiología , Derrame Pleural , Análisis de Secuencia de ADN , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Ustilaginales/química , Ustilaginales/genéticaRESUMEN
Vibrio cholerae is known as a common etiology of epidemic diarrheal disease and rarely causes extra-intestinal infections. In this report, we described a cirrhotic patient with hepatocellular carcinoma who developed spontaneous bacterial empyema due to non-O1, non-O139 V. cholerae. The patient was successfully treated with antimicrobial agents and percutaneous drainage.
Asunto(s)
Carcinoma Hepatocelular/complicaciones , Empiema/diagnóstico , Empiema/microbiología , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/complicaciones , Vibrio cholerae/aislamiento & purificación , Antibacterianos/administración & dosificación , Cólera/diagnóstico , Cólera/microbiología , Cólera/patología , Cólera/terapia , Drenaje , Empiema/patología , Empiema/terapia , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Vibrio cholerae/clasificaciónRESUMEN
Actinomyces meyeri is an uncommon cause of actinomycosis. We present a patient with pneumonia and empyema due to A. meyeri. The patient underwent open thoracotomy with decortication and was discharged home on a twelve-month course of oral penicillin. Review of the English literature revealed thirty-two cases of infection due to A. meyeri. The majority of patients were male, and a significant number had poor dental hygiene and a history of alcoholism. More than other Actinomyces species, A. meyeri causes pulmonary infection and has a predilection for dissemination. Prognosis is favorable with prolonged penicillin therapy combined with surgical debridement, if needed.
Asunto(s)
Actinomyces/aislamiento & purificación , Actinomicosis/diagnóstico , Actinomicosis/patología , Actinomyces/clasificación , Actinomicosis/microbiología , Actinomicosis/terapia , Administración Oral , Antibacterianos/administración & dosificación , Empiema/complicaciones , Empiema/diagnóstico , Empiema/microbiología , Empiema/patología , Humanos , Masculino , Persona de Mediana Edad , Penicilinas/administración & dosificación , Neumonía/complicaciones , Neumonía/diagnóstico , Neumonía/microbiología , Neumonía/patología , Radiografía Torácica , Toracotomía , Tomografía Computarizada por Rayos XRESUMEN
Mycoplasma salivarium infections outside the oral cavity are rare. We describe a 49-year-old man with laryngeal cancer and right pleural space infection with M. salivarium. To our knowledge, this is the first report of empyema due to Mycoplasma salivarium.