RESUMO
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.
Assuntos
Empiema/etiologia , Pré-Escolar , Empiema/epidemiologia , Empiema/patologia , Empiema/terapia , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida , Terapia Trombolítica/métodos , Resultado do TratamentoAssuntos
Empiema/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Abscesso Pulmonar/microbiologia , Micrococcaceae/isolamento & purificação , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/patologia , Idoso , Antibacterianos/uso terapêutico , Empiema/tratamento farmacológico , Empiema/patologia , Infecções por Bactérias Gram-Positivas/patologia , Humanos , Imunocompetência , Abscesso Pulmonar/tratamento farmacológico , Abscesso Pulmonar/patologia , Masculino , Pneumonia Bacteriana/tratamento farmacológicoAssuntos
DNA Helicases/genética , Empiema/diagnóstico por imagem , Proteínas Nucleares/genética , Sarcoma/diagnóstico por imagem , Neoplasias Torácicas/diagnóstico por imagem , Fatores de Transcrição/genética , Empiema/complicações , Empiema/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Sarcoma/complicações , Sarcoma/patologia , Neoplasias Torácicas/complicações , Neoplasias Torácicas/patologia , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologiaRESUMO
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.
Assuntos
Derrame Pleural/etiologia , Tuberculose Pleural/epidemiologia , Tuberculose Pleural/patologia , Tuberculose Pulmonar/epidemiologia , Adenosina Desaminase/metabolismo , Biópsia/métodos , Drenagem/métodos , Empiema/tratamento farmacológico , Empiema/microbiologia , Empiema/patologia , Empiema/cirurgia , Exsudatos e Transudatos/enzimologia , Exsudatos e Transudatos/microbiologia , Feminino , Humanos , Linfócitos/patologia , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Neutrófilos/patologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/microbiologia , Derrame Pleural/patologia , Prevalência , Escarro/microbiologia , Tuberculose Pleural/tratamento farmacológico , Tuberculose Pleural/microbiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologiaRESUMO
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.
Assuntos
Actinobacteria/patogenicidade , Infecções Comunitárias Adquiridas/patologia , Empiema/microbiologia , Infecções por Bactérias Gram-Positivas/patologia , Pneumonia/patologia , Síndrome do Desconforto Respiratório/microbiologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Infecções Comunitárias Adquiridas/microbiologia , Empiema/patologia , Empiema/terapia , Oxigenação por Membrana Extracorpórea , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Pessoa de Meia-Idade , Pneumonia/microbiologia , Síndrome do Desconforto Respiratório/patologia , Síndrome do Desconforto Respiratório/terapia , Resultado do TratamentoRESUMO
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.
Assuntos
Empiema/diagnóstico , Empiema/patologia , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/diagnóstico , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/patologia , Salmonella enteritidis/isolamento & purificação , Antibacterianos/administração & dosagem , Barein , Cefixima/administração & dosagem , Ceftriaxona/administração & dosagem , Empiema/tratamento farmacológico , Empiema/microbiologia , Doença de Hodgkin/complicações , Humanos , Masculino , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/patologia , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/microbiologia , Salmonella enteritidis/classificação , Escarro/microbiologia , Adulto JovemAssuntos
Actinomicose/patologia , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Empiema/patologia , Infecções por Pasteurellaceae/patologia , Derrame Pleural/etiologia , Parede Torácica/patologia , Traqueostomia/efeitos adversos , Actinomyces/isolamento & purificação , Actinomicose/complicações , Criança , Diagnóstico Diferencial , Empiema/complicações , Empiema/diagnóstico por imagem , Feminino , Humanos , Inflamação/diagnóstico , Neoplasias/diagnóstico , Infecções por Pasteurellaceae/complicações , Derrame Pleural/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traqueia/lesões , Traqueíte/complicaçõesRESUMO
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.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Meningites Bacterianas/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/isolamento & purificação , Adulto , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , Empiema/epidemiologia , Empiema/microbiologia , Empiema/patologia , Feminino , Genótipo , Humanos , Incidência , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/microbiologia , Meningites Bacterianas/patologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Prospectivos , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/patologia , Streptococcus pyogenes/classificação , Streptococcus pyogenes/genética , Resultado do TratamentoAssuntos
Empiema/etiologia , Empiema/patologia , Mediastinite/diagnóstico , Mediastinite/patologia , Pescoço/patologia , Necrose/diagnóstico , Necrose/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Dacriocistite/cirurgia , Dacriocistorinostomia , Empiema/cirurgia , Endoscopia , Ducto Nasolacrimal , Doença Aguda , Adulto , Idoso , Dacriocistite/complicações , Dacriocistite/patologia , Empiema/complicações , Empiema/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
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.
Assuntos
Infecções por Bacteroidaceae/diagnóstico , Quilotórax/complicações , Quilotórax/diagnóstico , Empiema/diagnóstico , Prevotella/isolamento & purificação , Administração Intravenosa , Idoso , Antibacterianos/uso terapêutico , Infecções por Bacteroidaceae/microbiologia , Infecções por Bacteroidaceae/patologia , Infecções por Bacteroidaceae/terapia , Quilotórax/patologia , Quilotórax/terapia , Clindamicina/uso terapêutico , Drenagem , Empiema/microbiologia , Empiema/patologia , Empiema/terapia , Humanos , Masculino , Radiografia Torácica , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
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.
Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Pulmão/patologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Necrose/patologia , Pneumonia Estafilocócica/diagnóstico , Pneumonia Estafilocócica/microbiologia , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/patologia , Infecções Comunitárias Adquiridas/terapia , Empiema/diagnóstico , Empiema/etiologia , Empiema/patologia , Feminino , Humanos , Recém-Nascido , Pneumonectomia , Pneumonia Estafilocócica/complicações , Pneumonia Estafilocócica/patologia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/patologia , Vancomicina/uso terapêuticoRESUMO
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).
Assuntos
Empiema Pleural/patologia , Empiema/patologia , Derrame Pleural/patologia , Infecções por Protozoários/patologia , Trichomonadida/isolamento & purificação , Idoso , Diagnóstico Diferencial , Empiema/diagnóstico , Empiema Pleural/diagnóstico , Feminino , Humanos , Japão , Derrame Pleural/diagnóstico , Infecções por Protozoários/diagnósticoRESUMO
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.
Assuntos
Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Sepse/microbiologia , Abscesso/patologia , Adolescente , Glândulas Suprarrenais/patologia , Adulto , Encéfalo/patologia , Causas de Morte , Criança , Pré-Escolar , Coagulação Intravascular Disseminada/patologia , Farmacorresistência Bacteriana Múltipla , Edema/patologia , Empiema/patologia , Encefalite/patologia , Feminino , Patologia Legal , Ventrículos do Coração/patologia , Hemorragia/patologia , Humanos , Lactente , Inflamação/patologia , Intestinos/patologia , Rim/patologia , Fígado/patologia , Pulmão/patologia , Masculino , Meningites Bacterianas/patologia , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Miocárdio/patologia , Necrose/patologia , Neutrófilos/patologia , Púrpura/patologia , Pele/patologia , Baço/patologia , Trombose/patologia , Adulto JovemAssuntos
Empiema/etiologia , Empiema/patologia , Micoses/diagnóstico , Micoses/patologia , Ustilaginales/isolamento & purificação , Idoso de 80 Anos ou mais , Feminino , Humanos , Técnicas Microbiológicas/métodos , Microscopia , Micologia/métodos , Micoses/microbiologia , Derrame Pleural , Análise de Sequência de DNA , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Ustilaginales/química , Ustilaginales/genéticaRESUMO
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.
Assuntos
Carcinoma Hepatocelular/complicações , Empiema/diagnóstico , Empiema/microbiologia , Cirrose Hepática/complicações , Neoplasias Hepáticas/complicações , Vibrio cholerae/isolamento & purificação , Antibacterianos/administração & dosagem , Cólera/diagnóstico , Cólera/microbiologia , Cólera/patologia , Cólera/terapia , Drenagem , Empiema/patologia , Empiema/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Vibrio cholerae/classificaçãoRESUMO
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.
Assuntos
Actinomyces/isolamento & purificação , Actinomicose/diagnóstico , Actinomicose/patologia , Actinomyces/classificação , Actinomicose/microbiologia , Actinomicose/terapia , Administração Oral , Antibacterianos/administração & dosagem , Empiema/complicações , Empiema/diagnóstico , Empiema/microbiologia , Empiema/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Penicilinas/administração & dosagem , Pneumonia/complicações , Pneumonia/diagnóstico , Pneumonia/microbiologia , Pneumonia/patologia , Radiografia Torácica , Toracotomia , Tomografia Computadorizada por Raios XRESUMO
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.