Pseudomonas aeruginosa empyema in an adult with cystic fibrosis

Persistent pleuritic chest pain in a patient with cystic fibrosis

A 14-year-old girl with cystic fibrosis (CF), homozygous for the Phe508del mutation, was electively admitted for optimisation of lung disease. Her CF was complicated by bronchiectasis, gastrostomy feeding, liver disease, and diabetes. Sputum cultures had identified Haemophilus parainfluenzae and Candida albicans in the previous 12 months, but she had never cultured Pseudomonas aeruginosa. She also had comorbid osteogenesis imperfecta (OI), type 3 phenotype, which was complicated by multiple long bone fractures including four rib fractures at birth. Her baseline forced expiratory volume in 1 s (FEV₁) was 44% (0.78 L), forced vital capacity (FVC) 54% (1.06 L), and FEV₁/FVC ratio 81% predicted. The combination of CF and OI had resulted in severe restrictive lung disease with nocturnal hypoventilation managed with bilevel noninvasive ventilation.

Pleural effusion is rare in cystic fibrosis. Infection leading to pleural effusion is likely to be polymicrobial, including contributory fungal infection; microbiology of pleural fluid is commonly discordant with sputum.https://bit.ly/3MJXrhk

Empyema in a woman with cystic fibrosis: a cautionary tale

Cystic fibrosis (CF) is a disease which predisposes individuals to recurrent infective exacerbations of suppurative lung disease; however, empyema is a rare complication in these patients. Empyemas secondary to Staphylococcus aureus and Burkholderia cepacia have been described in patients with CF. We report the case of pleural empyema with mixed S. aureus and Pseudomonas aeruginosa infection in a 34-year-old woman with CF, which was managed with ultrasound-guided pigtail catheter insertion, fibrinolysis, and antibiotic therapy. Physicians should be aware of this unusual complication in CF patients, especially those receiving an immunosuppressive therapy.

Empyema due to a highly transmissible Pseudomonas aeruginosa strain in an adult cystic fibrosis patient

Chronic pulmonary infection with Pseudomonas aeruginosa occurs in up to 85 % of individuals with cystic fibrosis (CF) by the time they reach adulthood, and is the major cause of morbidity and mortality: nearly all patients die from progressive respiratory failure due to repeated pulmonary exacerbations. However, despite the predilection of this organism for the lungs of CF people, infection of the pleura is much less common and is not well described in the CF population. We describe what is believed to be the first case of pleural empyema due to a particularly pathogenic transmissible strain of P. aeruginosa (the Liverpool epidemic strain) in an adult CF patient.