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De Schuyter K, Boelens J, Messiaen AS, Schelstraete P, Verhasselt B, Huis In't Veld D, Callens S, Sermijn E, Vande Weygaerde Y, Vandendriesche S. Rapid detection of S. pyogenes and S. pneumoniae in pleural fluid for diagnosis of parapneumonic empyema. Eur J Clin Microbiol Infect Dis 2024; 43:195-201. [PMID: 37981632 DOI: 10.1007/s10096-023-04710-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
The aim of this study was to assess the reliability of rapid antigen detection tests (RADT) for Streptococcus pyogenes (GAS) and Streptococcus pneumoniae on pleural fluid samples for diagnosis of parapneumonic effusion/empyema (PPE) and their potential for improving pathogen identification rates. Sixty-three pleural samples were included from 54 patients on which GAS and S. pneumoniae RADT (BinaxNOW), culture, 16S rRNA PCR, and S. pneumoniae-specific PCR were performed. GAS RADT showed a sensitivity of 95.2% and a specificity of 100%. Pneumococcal RADT showed a sensitivity of 100% and specificity of 88.6%. Both RADT increased the pathogen identification rate in PPE compared to culture.
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Affiliation(s)
- Kelly De Schuyter
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Jerina Boelens
- Department of Medical Microbiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Anne-Sophie Messiaen
- Department of Medical Microbiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Petra Schelstraete
- Department of Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Medical Microbiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Diana Huis In't Veld
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Steven Callens
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Erica Sermijn
- Department of Infectious Diseases, Algemeen Stedelijk Ziekenhuis Aalst, Merestraat 80, 9300, Aalst, Belgium
| | - Yannick Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stien Vandendriesche
- Department of Medical Microbiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Jarrah A, Sweidan HB, Alratroot A, Esber Z. Rapidly progressive empyema in the setting of vaping in an otherwise healthy patient. BMJ Case Rep 2023; 16:e255876. [PMID: 38129087 DOI: 10.1136/bcr-2023-255876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Vaping is defined as inhaling and exhaling vapour that is a product of heating a liquid or wax-like material. Electronic cigarettes (e-cigarettes) have become a popular method of smoking in the last decade and are advertised as an alternative to conventional smoking. Since the increase in e-cigarette use, various lung injury patterns have started to appear among users. Recent studies have shown an increased susceptibility to respiratory tract infections among e-cigarette/vaping product users. We present a case of pneumonia caused by Pseudomonas fluorescens complicated by rapidly developing empyema in an otherwise healthy patient.
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Affiliation(s)
- Abdullah Jarrah
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
- Internal Medicine, DMC Sinai-Grace Hospital, Detroit, Michigan, USA
| | - Hisham Botrus Sweidan
- Internal Medicine, DMC Sinai-Grace Hospital, Detroit, Michigan, USA
- Internal Medicine, DMC Sinai-Grace Hospital, Farmington, Michigan, USA
| | - Ahmad Alratroot
- Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Zahia Esber
- Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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Dyrhovden R, Eagan TM, Fløtten Ø, Siljan W, Leegaard TM, Bø B, Fardal H, Grøvan F, Kildahl-Andersen A, Larssen KW, Tilseth R, Hjetland R, Løes S, Lindemark F, Tellevik M, Breistein R, Kommedal Ø. Pleural Empyema Caused by Streptococcus intermedius and Fusobacterium nucleatum: A Distinct Entity of Pleural Infections. Clin Infect Dis 2023; 77:1361-1371. [PMID: 37348872 PMCID: PMC10654859 DOI: 10.1093/cid/ciad378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Many community-acquired pleural infections are caused by facultative and anaerobic bacteria from the human oral microbiota. The epidemiology, clinical characteristics, pathogenesis, and etiology of such infections are little studied. The aim of the present prospective multicenter cohort study was to provide a thorough microbiological and clinical characterization of such oral-type pleural infections and to improve our understanding of the underlying etiology and associated risk factors. METHODS Over a 2-year period, we included 77 patients with community-acquired pleural infection, whereof 63 (82%) represented oral-type pleural infections. Clinical and anamnestic data were systematically collected, and patients were offered a dental assessment by an oral surgeon. Microbial characterizations were done using next-generation sequencing. Obtained bacterial profiles were compared with microbiology data from previous investigations on odontogenic infections, bacteremia after extraction of infected teeth, and community-acquired brain abscesses. RESULTS From the oral-type pleural infections, we made 267 bacterial identifications representing 89 different species. Streptococcus intermedius and/or Fusobacterium nucleatum were identified as a dominant component in all infections. We found a high prevalence of dental infections among patients with oral-type pleural infection and demonstrate substantial similarities between the microbiology of such pleural infections and that of odontogenic infections, odontogenic bacteremia, and community-acquired brain abscesses. CONCLUSIONS Oral-type pleural infection is the most common type of community-acquired pleural infection. Current evidence supports hematogenous seeding of bacteria from a dental focus as the most important underlying etiology. Streptococcus intermedius and Fusobacterium nucleatum most likely represent key pathogens necessary for establishing the infection.
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Affiliation(s)
- Ruben Dyrhovden
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Tomas Mikal Eagan
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Øystein Fløtten
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - William Siljan
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Truls Michael Leegaard
- Division of Medicine and Laboratory Sciences, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Microbiology and Infection Control, Akershus University Hospital, Akershus, Norway
| | - Bjørnar Bø
- Department of Pulmonary Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Hilde Fardal
- Department of Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Fredrik Grøvan
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Arne Kildahl-Andersen
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kjersti Wik Larssen
- Department of Medical Microbiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rune Tilseth
- Department of Medicine, Førde Central Hospital, Førde, Norway
| | - Reidar Hjetland
- Department of Microbiology, Førde Central Hospital, Førde, Norway
| | - Sigbjørn Løes
- Department of Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
- Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Frode Lindemark
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marit Tellevik
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Rebecca Breistein
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Kommedal
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
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Duan Y, Feng W, Shen Y, Li Y, Li N, Chen X, Wang Y. Severe pneumonia with empyema caused by Parvimonas micra and Streptococcus constellatus co-infection: a case report. J Int Med Res 2023; 51:3000605231210657. [PMID: 37994021 PMCID: PMC10666820 DOI: 10.1177/03000605231210657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/12/2023] [Indexed: 11/24/2023] Open
Abstract
Empyema is a common complication of pneumonia, caused by the accumulation of purulent exudate due to pathogenic bacteria invading the pleural cavity. Parvimonas micra and Streptococcus constellatus are pathogens that rarely cause pneumonia with empyema. Herein, a case of severe empyema caused by these two pathogens, confirmed by metagenomic next-generation sequencing (mNGS) of pleural effusion cultures, is reported. A male Chinese patient in his late sixties presented with wheezing, cough, sputum expectoration, and fever. Blood and sputum cultures were negative for pathogens, but the pleural effusion culture was positive for S. constellatus, and was also found to contain P. micra, confirmed by mNGS. The patient's symptoms improved after treatment with cefoperazone/sulbactam and moxifloxacin. Pneumonia caused by P. micra and S. constellatus is rare; however, coinfection with these pathogens may cause severe pneumonia, with or without empyema.
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Affiliation(s)
- Yao Duan
- General Internal Medicine Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wenshi Feng
- General Internal Medicine Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuxin Shen
- General Internal Medicine Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yue Li
- General Internal Medicine Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ni Li
- General Internal Medicine Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xuyan Chen
- General Internal Medicine Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yiqun Wang
- General Internal Medicine Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Park K, Hur KH, Sung H, Kim MN. Culture-Negative Fusobacterium nucleatum Brain Abscess and Pleural Empyema Cases Revealed by 16S rRNA Sequencing. Clin Lab 2023; 69. [PMID: 37057929 DOI: 10.7754/clin.lab.2022.220722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND We reported two Fusobacterium nucleatum cases each of brain abscesses and pleural empyema, using 16S rRNA sequencing technology. METHODS We reviewed clinical records and microbiological findings in four patients with F. nucleatum infection. RESULTS All conventional culture results from peripheral blood, cerebrospinal fluid, and pleural fluid samples were found to be negative for this pathogen. Three patients were treated with antimicrobial agents for more than a week before specimen sampling. All patients recovered from their fusobacterial infections and were discharged. CONCLUSIONS Molecular identification methods such as 16S rRNA sequencing should accompany conventional culture to detect obligate anaerobic bacteria in deep-seated sites and organs.
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Samoel GVA, Herbichi AP, Nunes GT, Machado CS, Fernandes FD, Vogel FSF, Cargnelutti JF. Isolation and characterization of Buchananella hordeovulneris from feline pyothorax. Braz J Microbiol 2022; 53:2329-2334. [PMID: 36242745 PMCID: PMC9679070 DOI: 10.1007/s42770-022-00845-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/04/2022] [Indexed: 01/13/2023] Open
Abstract
A 1-year-old female mixed-breed cat was admitted to a veterinary hospital in Southern Brazil with tachypnea, low thoracic amplitude, restrictive breathing pattern, and cyanotic mucous membranes 2 days after elective castration surgery. Radiography revealed pleural effusion, and approximately 100-200 mL of fluid was collected by thoracocentesis. The reddish purulent exudate contained large numbers of yellowish-white granules with branched filamentous structures on cytological examination. The fluid was plated on blood agar and incubated under aerobiosis at 37 °C. On the third day of incubation, circular, dry, and opaque colonies, measuring < 0.5 mm in diameter, were observed. Their phenotypic and molecular characteristics were compatible with Buchananella hordeovulneris (basonym: Actinomyces hordeovulneris), a pathogenic actinomycete rarely detected in cats. Our findings indicate that B. hordeovulneris should be included in the differential diagnosis of pyothorax in cats together with Actinomyces spp. and Nocardia spp. Taxonomic confirmation of disease-causing microorganisms in animals is important to understand the course of infection and its association with disease epidemiology.
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Affiliation(s)
- Gisele Vaz Aguirre Samoel
- Departamento de Medicina Veterinária Preventiva, Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Programa de Residência em Área Profissional da Saúde-Medicina Veterinária, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Alana Pivoto Herbichi
- Departamento de Medicina Veterinária Preventiva, Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Programa de Residência em Área Profissional da Saúde-Medicina Veterinária, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Gabriela Tormes Nunes
- Departamento de Medicina Veterinária Preventiva, Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Programa de Residência em Área Profissional da Saúde-Medicina Veterinária, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Carolina Sleutjes Machado
- Departamento de Medicina Veterinária Preventiva, Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Medicina Veterinária (PPGMV), Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Fagner D'ambroso Fernandes
- Departamento de Medicina Veterinária Preventiva, Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Medicina Veterinária (PPGMV), Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Fernanda Silveira Flores Vogel
- Departamento de Medicina Veterinária Preventiva, Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Juliana Felipetto Cargnelutti
- Departamento de Medicina Veterinária Preventiva, Centro de Ciências Rurais, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
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Gautam A, Wiseman G, Legg R, Lindsay D, Puvvadi R, Rathnamma BM, Stalewski H, Norton R, White AV. Management of Pediatric Thoracic Empyema in the North Queensland Region of Australia and Impact of a Local Evidence-based Treatment Guideline. Pediatr Infect Dis J 2022; 41:1-5. [PMID: 34889868 DOI: 10.1097/inf.0000000000003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The North Queensland region of Australia has a high incidence of pediatric thoracic empyema (pTE). We describe the management of empyema at the Townsville University Hospital which is the regional referral center for these children. The impact of a newly developed institutional guideline is also discussed. METHODS This retrospective audit included children under the age of 16 years treated for empyema between 1 Jan 2007 and 31 December 2018. Demographic and management-related variables were correlated to outcomes. A local guideline was introduced at the beginning of 2017 and patient outcomes characteristics pre, and post introduction of this guideline are compared. RESULTS There were 153 children with pTE (123 before and 30 after the introduction of a local guideline). Nonsurgical management was associated with a higher treatment failure rate. Median length of stay (LOS) was 11.8 (IQR 9.3-16) days. Longer hospital LOS was associated with younger age (r2 -0.16, P = 0.04), Aboriginal and/or Torres Strait (ATSI) ancestry (13.8 vs. 10.5 days, P = 0.002) and concomitant respiratory viral infections (14.4 vs. 10.9 days, P = 0.003). The introduction of local guideline was associated with significant decrease in the use of empirical chest CT scans (54.4% before vs. 6.7% after, P < 0.001) and duration of intravenous antibiotics (14 days before vs. 10 days after, P = 0.02). There was no significant change in the hospital LOS (12.1 days pre and 11.7 post, P = 0.8). CONCLUSIONS Younger age, concomitant viral respiratory infections and ATSI ancestry were identified as potential risk factors for increase LOS. Hospital LOS following the adoption of an institutional guideline was unchanged. However, such a guideline may identify populations at risk for an unfavorable course and avoid unnecessary antibiotic treatment and radiation exposure.
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Affiliation(s)
- Anil Gautam
- From the Pediatric Intensive Care Unit, Townsville University Hospital, Douglas, Queensland, Australia
- James Cook University, Douglas, Queensland, Australia
| | - Gregory Wiseman
- From the Pediatric Intensive Care Unit, Townsville University Hospital, Douglas, Queensland, Australia
| | - Robert Legg
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
- Great Ormond Street Institute of Child Health, University College London
| | - Daniel Lindsay
- Department of Public Health, James Cook University, Douglas, Queensland, Australia
| | - Ramaa Puvvadi
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
| | | | - Harry Stalewski
- Pediatric Surgery, Townsville University Hospital, Douglas, Queensland, Australia
| | - Robert Norton
- Department of Microbiology, Townsville University Hospital, Douglas, Queensland, Australia
- University of Queensland, Brisbane, Australia
| | - Andrew Vernon White
- James Cook University, Douglas, Queensland, Australia
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
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Borghesi L, Viaggi V, Franzetti M, Montoli M, Mauri C, Moioli G, Benvenuti MR, Piconi S, Luzzaro F. Successful prolonged cefiderocol treatment of a chronic left pleural empyema caused by Pseudomonas aeruginosa in a patient affected by COVID-19: a case report. J Glob Antimicrob Resist 2021; 27:157-159. [PMID: 34562658 PMCID: PMC8455353 DOI: 10.1016/j.jgar.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Luca Borghesi
- Infectious Diseases Unit, A. Manzoni Hospital, Lecco, Italy
| | - Valentina Viaggi
- Microbiology and Virology Unit, A. Manzoni Hospital, Lecco, Italy
| | | | - Matteo Montoli
- Thoracic Surgery Department, A. Manzoni Hospital, Lecco, Italy
| | - Carola Mauri
- Microbiology and Virology Unit, A. Manzoni Hospital, Lecco, Italy
| | - Giovanni Moioli
- University Division of Infectious and Tropical Diseases, University of Brescia, Spedali Civili Hospital, Brescia, Italy
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Forster J, Piazza G, Goettler D, Kemmling D, Schoen C, Rose M, Streng A, Liese JG. Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema. Pediatr Infect Dis J 2021; 40:544-549. [PMID: 33395211 DOI: 10.1097/inf.0000000000003036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parapneumonic pleural effusion and pleural empyema (PPE/PE) are complications of community-acquired pneumonia. The objective of this study was to analyze prehospital antibiotic therapy (PH-ABT) of children with PPE/PE and investigate its effects on clinical outcome and pathogen detection. METHODS Prospective nationwide active surveillance in Germany between October 2010 and June 2018. Children and adolescents <18 years of age with pneumonia-associated PE or PPE requiring drainage or with persistence of PPE/PE >7 days were included. RESULTS A total of 1724 children with PPE/PE were reported, of whom 556 children (32.3% of 1719 with available data) received PH-ABT. Children with PH-ABT had a shorter median hospital length of stay (15 vs. 18 days, P < 0.001), a longer time from onset of symptoms until hospital discharge (25 vs. 23 days, P = 0.002), a lower rate of intensive care unit admission (58.3% vs. 64.4%, P = 0.015) and fewer infectious complications (5.9% vs. 10.0%; P = 0.005). Bacterial pathogens in blood or pleural fluid culture were detected in 597 (34.5%) of 1513 children. Positive culture results were less frequent in children with than without PH-ABT (81/466 [17.4%] vs. 299/1005 [29.8%]; P < 0.001), whereas detection rates in pleural fluid samples by polymerase chain reaction were similar (91/181 [50.3%] vs. 220/398 [55.3%]; P = 0.263). CONCLUSIONS In children with PPE/PE, PH-ABT significantly reduced the overall rate of bacterial pathogen detection by culture, but not by polymerase chain reaction. PH-ABT was associated with a lower rate of infectious complications but did not affect the overall duration of disease. We therefore speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be influenced by antibiotic treatment.
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Affiliation(s)
- Johannes Forster
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Giuseppina Piazza
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Daniel Kemmling
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schoen
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Markus Rose
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
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Yamazaki A, Ito A, Ishida T, Washio Y. Polymicrobial etiology as a prognostic factor for empyema in addition to the renal, age, purulence, infection source, and dietary factors score. Respir Investig 2019; 57:574-581. [PMID: 31427269 DOI: 10.1016/j.resinv.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/19/2019] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Empyema is an important and serious disease with high morbidity and mortality worldwide. However, the bacteriology and prognostic factors of empyema remain poorly understood, and data on the relationships among these parameters are scant. METHODS We retrospectively analyzed a prospectively collected database of patients with empyema admitted to Kurashiki Central Hospital, Japan, between May 2007 and September 2015. Only patients who had positive results on pleural fluid bacterial culture were included. We collected patient characteristics, bacteriology findings, treatments, and outcomes, and we assessed the prognostic factors for in-hospital mortality. RESULTS We included 71 patients in this study. The most commonly isolated bacteria were members of the Streptococcus anginosus group (37%), followed by anaerobes (30%). In-hospital mortality was 11%. On multivariate analysis, polymicrobial empyema (odds ratio [OR], 8.25; 95% confidence interval [CI], 1.08-62.90) and RAPID (renal, age, purulence, infection source, and dietary factors) score (OR, 6.89; 95% CI, 1.73-27.40) were significant risk factors for in-hospital mortality. The most common etiology of polymicrobial empyema was a combination of the members of the S. anginosus group and anaerobes, but no relationship was observed between the combination of microorganisms and outcomes. Although no significant difference was observed in treatment between the survivor and non-survivor groups, all patients who underwent surgery survived. CONCLUSIONS Members of the S. anginosus group and anaerobes were frequent pathogens in empyema, and polymicrobial etiology was independently associated with mortality in addition to the RAPID score. Surgery may be one option for preventing mortality.
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Affiliation(s)
- Akio Yamazaki
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-0052, Japan; Department of Respiratory Medicine, Shiga University of Medical Science, Setatsukinowacho, Otsu, Shiga 520-2192, Japan.
| | - Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-0052, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-0052, Japan.
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-0052, Japan; Department of Respiratory Medicine, Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan.
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Qian Z, Yeye Z, Pan C, Jie C. REPORT-Pleural lavage of amphotericin B for treatment of empyema caused by Candida albicans infections: A case report. Pak J Pharm Sci 2019; 32:2757-2759. [PMID: 31969312 DOI: pmid/31969312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chest fungal infection is a rarely seen lethal disease with rapid progression. Sufficient residence time of antifungal agent with therapeutic concentration in the chest is an essential point during anti-infection therapy, which is hard to achieve via conventional systemic drug delivery. We here by describe a case of successful treatment of fungal Chest infection via local pleural lavage. A 59 years old male was hospitalized due to chest pain. X-ray of chest and bacterial culture of thoracic drainage fluid and blood indicated severe chest infection of Candida albicans. The patient was initially administered intravenously with amphotericin B (25mg/day). However, the symptoms were not significantly improved after 5 days of treatment. Then one-hour pleural lavage of 5mg amphotericin B in volume of 50ml 5% glucose solution was added once daily. On day 12, bacterial cultures showed negative, and chest X-ray exhibited apparent decrease of shadow area, also other examinations such as body temperature and white blood cell count suggested significant improvement of infection. The therapeutic strategy of amphotericin B was maintained until two consecutive bacterial cultures were negative, then was switched back to intravenous drip alone for another one month found. No significant adverse effects were observed during the treatment. In conclusion, this case demonstrates a new local pleural lavage method of amphotericin B for chest fungal infection, which may provide a reference for the treatment of such cases.
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Affiliation(s)
- Zhang Qian
- Department of Pharmacy, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhuo Yeye
- Department of Pharmacy, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Chen Pan
- Department of Pharmacy, The First Affiliated Hospital, Sun yat-sen University, Guangzhou, Guangdong, China
| | - Chen Jie
- Department of Pharmacy, The First Affiliated Hospital, Sun yat-sen University, Guangzhou, Guangdong, China
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Valle Feijoo ML, Bermúdez Sanjurjo JR, Valle Feijoo B, de la Fuente Aguado J. [Mixed pleural empyema due to Leuconostoc pseudomesenteroides and Streptococcus mitis/oralis]. Rev Esp Geriatr Gerontol 2019; 54:301-302. [PMID: 31006507 DOI: 10.1016/j.regg.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/07/2019] [Accepted: 01/31/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Begoña Valle Feijoo
- Servicio Medicina Interna, Hospital do Salnés, Vilagarcía de Arousa, Pontevedra, España
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Jud P, Fink-Neuboeck N, Lindenmann J. Massive ventilator-associated pleural empyema. Korean J Intern Med 2019; 34:942-943. [PMID: 30836744 PMCID: PMC6610191 DOI: 10.3904/kjim.2017.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Correspondence to Philipp Jud, M.D. Tel: +43-316-385-30174 Fax: +43-316-385-3788 E-mail:
| | - Nicole Fink-Neuboeck
- Division of Thoracic Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Joerg Lindenmann
- Division of Thoracic Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Volpe-Chaves CE, Rodrigues ACS, Lacerda MLGG, de Oliveira CTF, Castilho SB, Franciscato C, Santos ICDO, Assef APDC, Roever L, de Oliveira SMDVL, Paniago AMM. Melioidosis, an emerging infectious disease in the Midwest Brazil: A case report. Medicine (Baltimore) 2019; 98:e15235. [PMID: 31008955 PMCID: PMC6494395 DOI: 10.1097/md.0000000000015235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Melioidosis is an emerging infectious disease in Brazil and caused by Burkholderia pseudomallei, with high morbidity and mortality rates. A total of 28 melioidosis cases were reported in Brazil until 2015. The majority of melioidosis cases were reported in the Northwest region of Brazil and such cases were not previously detected in the Midwest region of Brazil. PATIENT CONCERNS A 42-year-old man was admitted with a non-productive cough, dyspnea, myalgia, diffuse abdominal pain. Pulmonary auscultation revealed a vesicular murmur, snoring sounds, and the presence of basal crackling rales in the left hemithorax. The patient evolved with several respiratory failures and he was diagnosed as the first case of community-acquired pneumonia with sepsis caused by B pseudomallei in Mato Grosso do Sul, Midwest state of Brazil. DIAGNOSIS The cell isolates were subjected to 16S rRNA gene sequencing to confirm the bacterial species. INTERVENTIONS Administration of trimethoprim/sulfamethoxazole and meropenem stabilized the clinical condition of the patient. Subsequently upon discharge, the patient was also treated with trimethoprim/sulfametothoxazole for a year. OUTCOME We reported the first case of community-acquired pneumonia with sepsis caused by B pseudomallei in Mato Grosso do Sul, Midwest state of Brazil and the patient survived. LESSONS The emergence of melioidosis in the Midwest region is being neglected and underestimated and melioidosis must be considered of the differential diagnosis in community infections.
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Affiliation(s)
- Cláudia Elizabeth Volpe-Chaves
- Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul
| | - Ana Cláudia Souza Rodrigues
- Graduate Program on Health and Development in West Central Region of Federal University of Mato Grosso do Sul
- UNIDERP – Medical School
| | | | | | | | - Caroline Franciscato
- Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul
| | | | | | - Leonardo Roever
- Federal University of Uberlandia, Department of Clinical Research, Brazil
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Yamaguchi Y, Fujita Y, Ikeda T, Mai Y, Miyazawa H, Matsumura W, Nomura T, Shimizu H. Severe Septic Vasculitis Preceding Thoracic Empyema: Staphylococcus aureus Enterotoxin Deposition in Vessel Walls as a Possible Pathomechanism. Acta Derm Venereol 2019; 99:464-465. [PMID: 30653244 DOI: 10.2340/00015555-3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yasuyuki Yamaguchi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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Amin M, Yousef pour S, Navidifar T. Detection of the major bacterial pathogens among children suffering from empyema in Ahvaz city, Iran. J Clin Lab Anal 2019; 33:e22855. [PMID: 30739335 PMCID: PMC6528561 DOI: 10.1002/jcla.22855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 11/07/2022] Open
Abstract
Introduction Empyema is one of the important causes of pediatric hospital admissions. Aim In this study, we had investigated the frequency rates of S aureus, S pneumoniae, H influenzae, and P aeruginosa using PCR and bacterial culture among children suffering from empyema in Ahvaz city, Iran. Methods This was a descriptive study conducted on the patients hospitalized in ICUs of two teaching Hospitals of Ahvaz, Iran, between March and September 2018 on 105 pleural fluid (PF) samples of the children less than 16 years of age with the diagnosis of empyema thoracis. These specimens were inoculated on the bacterial culture media and identified using biochemical characteristics. Then, the existence of the four pathogens mentioned above was evaluated using PCR method. Result In this study, these bacteria agents were identified in 81 (77.14%) and 30 (28.57%) cases using the PCR assay and bacterial culture, respectively. Moreover, the PCR assay identified the infectious agents in 51 (68%) of PFs where the culture method failed. S pneumoniae (63 cases) was recognized as the most common pathogen, followed by P aeruginosa(19 cases), S aureus(15 cases), and H influenzae (9 cases) using the bacterial culture and PCR. Co‐infections were detected in 21 samples (20%) using PCR and one sample using the bacterial culture (P aeruginosa and S pneumoniae). Conclusion In this study, we found the higher frequencies of these microorganisms using PCR than culture. In addition, we showed that PCR was a sensitive and accurate method that unaffected by antibiotic therapy and could detect well co‐infections.
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Affiliation(s)
- Mansour Amin
- Infectious and Tropical Diseases Research CenterHealth Research Institute, Ahvaz Jundishapur University of Medical SciencesAhvazIran
- Department of microbiology, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Samaneh Yousef pour
- Department of microbiology, school of scienceIslamic Azad UniversityYasoujIran
| | - Tahereh Navidifar
- Department of microbiology, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
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Nyanti LE, Kho SS, Tie ST. The great masquerade: Empyema thoracis as an unusual presentation of primary lung malignancy. Med J Malaysia 2019; 74:79-81. [PMID: 30846667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Primary lung malignancy presenting as empyema is rare, with a reported incidence of 0.3%. We report a case of a 60- year-old man presenting with unilateral pleural effusion; diagnostic thoracocentesis confirmed Salmonella empyema. Post-drainage, chest radiograph showed persisting right hemithorax opacity; subsequent computed tomography revealed a right lung mass with right upper lobe bronchus obliteration. Percutaneous biopsy confirmed advanced stage lung adenocarcinoma. We discuss the mechanism of post-obstructive pneumonia in lung cancerassociated empyema and the utility of bedside ultrasound in diagnosis of lung masses. Clinicians are alerted to the possibility of lung malignancy in elderly patients presenting with empyema.
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Affiliation(s)
- L E Nyanti
- Sarawak General Hospital, Department of Medicine, Division of Respiratory Medicine, Sarawak, Malaysia.
| | - S S Kho
- Sarawak General Hospital, Department of Medicine, Division of Respiratory Medicine, Sarawak, Malaysia
| | - S T Tie
- Sarawak General Hospital, Department of Medicine, Division of Respiratory Medicine, Sarawak, Malaysia
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Dyrhovden R, Nygaard RM, Patel R, Ulvestad E, Kommedal Ø. The bacterial aetiology of pleural empyema. A descriptive and comparative metagenomic study. Clin Microbiol Infect 2018; 25:981-986. [PMID: 30580031 DOI: 10.1016/j.cmi.2018.11.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The view of pleural empyema as a complication of bacterial pneumonia is changing because many patients lack evidence of underlying pneumonia. To further our understanding of pathophysiological mechanisms, we conducted in-depth microbiological characterization of empyemas in clinically well-characterized patients and investigated observed microbial parallels between pleural empyemas and brain abscesses. METHODS Culture-positive and/or 16S rRNA gene PCR-positive pleural fluids were analysed using massive parallel sequencing of the 16S rRNA and rpoB genes. Clinical details were evaluated by medical record review. Comparative analysis with brain abscesses was performed using metagenomic data from a national Norwegian study. RESULTS Sixty-four individuals with empyema were included. Thirty-seven had a well-defined microbial aetiology, while 27, all of whom had community-acquired infections, did not. In the latter subset, Fusobacterium nucleatum and/or Streptococcus intermedius was detected in 26 patients, of which 18 had additional facultative and/or anaerobic species in various combinations. For this group, there was 65.5% species overlap with brain abscesses; predisposing factors included dental infection, minor chest trauma, chronic obstructive pulmonary disease, drug abuse, alcoholism and diabetes mellitus. Altogether, massive parallel sequencing yielded 385 bacterial detections, whereas culture detected 38 (10%) and 16S rRNA gene PCR/Sanger-based sequencing detected 87 (23%). CONCLUSIONS A subgroup of pleural empyema appears to be caused by a set of bacteria not normally considered to be involved in pneumonia. Such empyemas appear to have a similar microbial profile to oral/sinus-derived brain abscesses, supporting spread from the oral cavity, potentially haematogenously. We suggest reserving the term 'primary empyema' for these infections.
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Affiliation(s)
- R Dyrhovden
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway.
| | - R M Nygaard
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - R Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA; Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester MN, USA
| | - E Ulvestad
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ø Kommedal
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
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Rashwan R, Varano della Vergiliana JF, Lansley SM, Cheah HM, Popowicz N, Paton JC, Waterer GW, Townsend T, Kay I, Brown JS, Lee YCG. Streptococcus pneumoniae potently induces cell death in mesothelial cells. PLoS One 2018; 13:e0201530. [PMID: 30059559 PMCID: PMC6066251 DOI: 10.1371/journal.pone.0201530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/17/2018] [Indexed: 01/22/2023] Open
Abstract
Pleural infection/empyema is common and its incidence continues to rise. Streptococcus pneumoniae is the commonest bacterial cause of empyema in children and among the commonest in adults. The mesothelium represents the first line of defense against invading microorganisms, but mesothelial cell responses to common empyema pathogens, including S. pneumoniae, have seldom been studied. We assessed mesothelial cell viability in vitro following exposure to common empyema pathogens. Clinical isolates of S. pneumoniae from 25 patients with invasive pneumococcal disease and three reference strains were tested. All potently induced death of cultured mesothelial cells (MeT-5A) in a dose- and time-dependent manner (>90% at 107 CFU/mL after 24 hours). No significant mesothelial cell killing was observed when cells were co-cultured with Staphylococcus aureus, Streptococcus sanguinis and Streptococcus milleri group bacteria. S. pneumoniae induced mesothelial cell death via secretory product(s) as cytotoxicity could be: i) reproduced using conditioned media derived from S. pneumoniae and ii) in transwell studies when the bacteria and mesothelial cells were separated. No excess cell death was seen when heat-killed S. pneumoniae were used. Pneumolysin, a cytolytic S. pneumoniae toxin, induced cell death in a time- and dose-dependent manner. S. pneumoniae lacking the pneumolysin gene (D39 ΔPLY strain) failed to kill mesothelial cells compared to wild type (D39) controls, confirming the necessity of pneumolysin in D39-induced mesothelial cell death. However, pneumolysin gene mutation in other S. pneumoniae strains (TIGR4, ST3 and ST23F) only partly abolished their cytotoxic effects, suggesting different strains may induce cell death via different mechanisms.
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Affiliation(s)
- Rabab Rashwan
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minya, Egypt
| | - Julius F. Varano della Vergiliana
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Sally M. Lansley
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Hui Min Cheah
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Natalia Popowicz
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Pharmacy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - James C. Paton
- Research Centre for Infectious Diseases, Department of Molecular and Cellular Biology, University of Adelaide, Adelaide, South Australia, Australia
| | - Grant W. Waterer
- Respiratory Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Tiffany Townsend
- Dept of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ian Kay
- Dept of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jeremy S. Brown
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, United Kingdom
| | - Y. C. Gary Lee
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- * E-mail:
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Demirci M, Gemicioglu B, Saribas S, Taner Z, Mamal-Torun M, Karatoka B, Asik-Cagli L, Guven O, Demiryas S, Kocazeybek BS, Bahar-Tokman H. A Retrospective Analysis of Anaerobic Bacteria Isolated in 236 Cases of Pleural Empyema and their Prevalance of Antimicrobial Resistance in Turkey. Clin Lab 2018; 64:1269-1277. [PMID: 30146848 DOI: 10.7754/clin.lab.2018.180317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Parapneumonic effusions usually occur secondary to an infection and produce pus (empyema) that accumulates in the pleural space. We aimed to evaluate the prevalence of anerobes in patients with empyema and to assess their resistance patterns for seven antimicrobials. METHODS Pleural fluid specimens from 236 patients were inoculated on Schaedler agar. Anaerobic bacteria were identified via API 20 A. Susceptibility testing for penicillin, ampicillin + sulbactam, amoxicillin + clavulanate, cefoxitin, clindamycin, metronidazole, and imipenem were performed with the E-test. RESULTS There were 118 anaerobic bacterial strains detected in 66 (27.9%) of the 236 specimens. Gram-positive anaerobic cocci were detected in 54.23% and the predominant cocci were 41 Peptostreptococcus spp, (34.75%) followed by 17 P. acnes (14.41%) and 6 C. tertium (5.08%). The Gram-negative anaerobes were B. fragilis (28, 23.73%), P. melaninogenica (8, 6.78%), P. intermedia (4, 3.39%), F. nucleatum (6, 5.08%), F. mortiferum (5, 4.24%), and P. asaccharolytica (3, 2.54%). All anaerobic strains were susceptible to ampicillin + sulbactam, amoxicillin + clavulanate, and imipenem. The highest MIC was found to be > 256 µg/mL for penicillin in B. fragilis strains, 128 µg/mL for cefoxitin in P. melaninogenica strains, 32 µg/mL for clindamycin and 64 µg/mL for metronidazole in P. acnes strains. Clindamycin resistance was detected in 46.6% B. fragilis, and 17.6% for P. acnes. Thirty-eight (32.2%) strains produced beta-lactamase. CONCLUSIONS The use of antimicrobial agents for thoracic empyema should be based on the isolated pathogens and their resistance profiles. Clinicians should be aware of the wide diversity of anaerobic genera and species in cases of pleural empyema.
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Pinnola A, Kuo YH, Sciarretta JD, McIntyre A, Messier R, Davis JM. Bacteriology and Comorbidities in Patients Requiring Surgical Management of Empyema. Am Surg 2018; 84:599-603. [PMID: 29712613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Concern over the changing bacteriology of empyema has led to numerous attempts to characterize the most common locoregional bacterial isolates. The purpose of this study is to better characterize the bacteriology and demographics in patients with community-acquired pneumonia (CAP) and hospital-acquired pneumonia requiring surgery for empyema. All patients diagnosed with empyema preoperatively and had either a video-assisted thoracoscopic or open decortication surgery from January 2010 to September 2015 were reviewed. Forty-seven patients were identified with a mean age of 54.7 ± 16.8 years (X ± SD). Sixty per cent of patients had CAP. Anaerobes were the most common isolate at 21 per cent, followed by Streptococcus species and Staphylococcus aureus (50% Methicillin Resistant). Coagulase-negative Staphylococcus species were the next most frequent at 13 per cent. Hospital-acquired pneumonia patients had a higher incidence of S. aureus infections (P = 0.047). Cancer history had higher rates of both fungal (P = 0.004) and gram-negative infections (P = 0.03). Older patients had increased incidence of gram-negative infections (P = 0.05). The median length of stay for CAP patient who were intravenous drug abusers (n = 3) were 31 days (95% confidence interval (CI) [15, NA]), which was significantly longer than the others (median 12 days, 95% CI: [9, 18], P = 0.014). Streptococcus pneumoniae was not found in any of the isolates. Our data reveal that anaerobes and Staphylococcus species have replaced S. pneumoniae as the major regional pathogens in surgically treated empyema. In addition, anaerobic isolates were found in higher incidence in CAP than previously reported.
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Popowicz ND, Lansley SM, Cheah HM, Kay ID, Carson CF, Waterer GW, Paton JC, Brown JS, Lee YCG. Human pleural fluid is a potent growth medium for Streptococcus pneumoniae. PLoS One 2017; 12:e0188833. [PMID: 29190798 PMCID: PMC5708656 DOI: 10.1371/journal.pone.0188833] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/14/2017] [Indexed: 12/03/2022] Open
Abstract
Empyema is defined by the presence of bacteria and/or pus in pleural effusions. However, the biology of bacteria within human pleural fluid has not been studied. Streptococcus pneumoniae is the most common cause of pediatric and frequent cause of adult empyema. We investigated whether S. pneumoniae can proliferate within human pleural fluid and if growth is affected by the cellular content of the fluid and/or characteristics of pneumococcal surface proteins. Invasive S. pneumoniae isolates (n = 24) and reference strain recovered from human blood or empyema were inoculated (1.5×106CFU/mL) into sterile human malignant pleural fluid samples (n = 11). All S. pneumoniae (n = 25) strains proliferated rapidly, increasing by a median of 3009 (IQR 1063–9846) from baseline at 24hrs in all pleural effusions tested. Proliferation was greater than in commercial pneumococcal culture media and concentrations were maintained for 48hrs without autolysis. A similar magnitude of proliferation was observed in pleural fluid before and after removal of its cellular content, p = 0.728. S. pneumoniae (D39 strain) wild-type, and derivatives (n = 12), each with mutation(s) in a different gene required for full virulence were inoculated into human pleural fluid (n = 8). S. pneumoniae with pneumococcal surface antigen A (ΔpsaA) mutation failed to grow (2207-fold lower than wild-type), p<0.001, however growth was restored with manganese supplementation. Growth of other common respiratory pathogens (n = 14) across pleural fluid samples (n = 7) was variable and inconsistent, with some strains failing to grow. We establish for the first time that pleural fluid is a potent growth medium for S. pneumoniae and proliferation is dependent on the PsaA surface protein and manganese.
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Affiliation(s)
- Natalia D. Popowicz
- Pharmacy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Division of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Institute for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
| | - Sally M. Lansley
- Institute for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
| | - Hui M. Cheah
- Institute for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
| | - Ian D. Kay
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Christine F. Carson
- Division of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Grant W. Waterer
- Division of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Respiratory Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - James C. Paton
- Research Centre for Infectious Diseases, Department of Molecular and Cellular Biology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy S. Brown
- Centre for Inflammation and Tissue Repair, Respiratory Medicine, University College London, London, England
| | - Y. C. Gary Lee
- Division of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Institute for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- Respiratory Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- * E-mail:
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Abstract
RATINALE Empyema is a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. An empyema caused by colo-pleural fistula is a rare but potentially life-threatening condition. PATIENT CONCERNS We describe a case of 42-year-old man was brought to our Emergency Department for chest pain with dyspnea and fever. DIAGNOSES The final diagnoses are empyema caused by colo-pleural fistula and colon cancer. INTERVENTIONS The patient underwent laparotomy surgery, during which a tumor was found in the splenic flexure of the descending colon. The tumor penetrated the colonic serosa and invaded the left side of the diaphragm. A left hemicolectomy was performed. OUTCOMES After the operation, the patient recovered smoothly and was discharged on postoperative day 14. It's been over 3 years now, CT and colonoscopy assessments show no recurrence or metastasis. LESSONS This case serves as a reminder to test for pathogens in patients with an unexplained empyema. If normal intestinal bacteria are detected, the empyema may be derived from intestinal disease. In addition, an abdominal examination should be performed in patients with an empyema of unknown origin.
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Affiliation(s)
- Rui Lian
- Department of Emergency Medicine
| | - Guochao Zhang
- Departmentof General Surgery, China-Japan Friendship Hospital, Beijing, China
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Abstract
The proper management of empyema thoracis in children continues to be a source of debate. This study assessed the clinical profile and outcome of patients managed by tube thoracostomy. Chart review was performed in 31 patients managed from January 1989 to December 2003. Outcome measures were duration and outcome of thoracostomy, number of days to radiologic lung re-expansion, length of hospitalization, and microbiologic flora involved. The mean age was 9 years (male/female, 2:1) and the most commonly affected group were those aged 1 year and below. Staphylococcus aureus was the most frequent infecting organism. A few (6%) achieved lung re-expansion 1 week postoperatively, but 64% did not achieve full lung re-expansion even after 3 weeks. Most (71%) of the thoracostomies were converted to open drainage. Half (52%) of the patients were hospitalized for at least 5 weeks. There were 3 recurrences and 3 deaths, 2 of which were most likely associated with empyema. Empyema managed by tube thoracostomy alone showed evidence of delayed lung re-expansion, prolonged drainage and hospitalization, and unfavorable outcome.
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Chubar IV. [ANALYSIS OF MICROFLORA OF PLEURAL CAVITY IN PLEURAL EMPYEMA]. Klin Khir 2016:47-49. [PMID: 27434955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the pleural empyema (PE) treatment, not depending on introduction of multiple operative procedures and the medicinal preparations application, some issues remain unsolved, including the infection agents verification, the most rapid bronchial fistula elimination and the lung volume restoration. The EP infection agents spectrum, their sensitivity to preparations were revealed, as well as the enhanced rate of the methicillin-resistant stamms (MRSA) and the microorganisms associations verification. A reduction of the infection agents sensitivity towards "simple" antibacterial preparations was established, so the physicians, treating PE, must prescribe "hard" antibiotics, what enhances its cost.
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Nigo M, Vial MR, Munita JM, Jiang Y, Tarrand J, Jimenez CA, Kontoyiannis DP. Fungal empyema thoracis in cancer patients. J Infect 2016; 72:615-21. [PMID: 26945845 DOI: 10.1016/j.jinf.2016.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fungal empyema thoracis (FET) is a rare life-threatening infection. We sought to describe the clinical characteristics of FET in a large academic cancer center. METHODS We conducted a retrospective chart review of all cancer patients who had a fungal isolate from the pleural fluid culture between 1/2005 and 8/2013. RESULTS A total of 106 fungal isolates were identified in 97 patients. Yeasts accounted for 62% of the isolates whereas 38% were identified as molds. The most frequent pathogens were Candida spp. (58%) and Aspergillus spp. (12%). All patients with Aspergillus and 83% with Candida met criteria for proven fungal disease. Compared to the Aspergillus group, Candida FET was associated with recent abdominal or thoracic surgical procedures (44% vs. 0%, p = 0.01). Overall, 6-week mortality was high, with no significant differences between Candida and Aspergillus (31% vs. 45%, respectively [p = 0.48]). Only 1 out of 11 patients with uncommon molds died at 6 weeks, despite only 2 of them received appropriate antifungal therapy. CONCLUSIONS Development of FET carries a high mortality in cancer patients. A history of a recent surgical procedure is a risk factor for FET due to Candida. Isolation of uncommon molds is likely to represent a contamination of the pleural fluid.
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Affiliation(s)
- Masayuki Nigo
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Macarena R Vial
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose M Munita
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Tarrand
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Burton C, Walls T, Price N, Glasgow T, Walker C, Beasley S, Best E. Paediatric empyema in New Zealand: a tale of two cities. N Z Med J 2015; 128:25-33. [PMID: 26117509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS We aimed to identify the causative organisms and sensitivities in community-acquired paediatric empyema at Starship Children's Hospital and Christchurch Hospital and to determine if current antibiotic recommendations are appropriate. METHODS Retrospective analysis was undertaken of all cases with clinical, radiological, and microbiological evidence of empyema at Starship Children's Hospital and Christchurch Hospital between June 2009 and March 2013 (3.8 years), and January 2009 and May 2014 (5.4 years) respectively. RESULTS Ninety-eight children were managed with empyema at Starship Children's Hospital and 30 children at Christchurch Hospital. Staphylococcus aureus was the most common pathogen identified at both sites followed by Streptococcus pneumoniae. A significant proportion had no pathogen identified. Amongst S.aureus isolates, 1/5th were methicillin-resistant, contributing 8% of all culture positive empyema cases. Māori and Pacific groups were over-represented. Cases occurred more often in boys and those <5 years. Blood cultures and S.pneumoniae pleural antigen were important in diagnosis. CONCLUSIONS Our audit confirms the important role of S.aureus in paediatric empyema in New Zealand and a high rate of this disease, particularly in the North Island. Antimicrobial susceptibilities of the pathogens of empyema demonstrate current initial antibiotic recommendation.
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Affiliation(s)
| | | | | | | | | | | | - Emma Best
- Senior Lecturer, Department of Paediatrics, University of Auckland Paediatric Infectious Diseases Consultant, Starship Children's Health, ADHB Postal Address: Level 5 offices, Starship Children's Health, ADHB, Park Road, Grafton, Auckland, New Zealand.
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Oshodi T, Carlan SJ, Busowski M, Sand ME. Video assisted thoracic surgery in a second trimester pregnant woman with thoracic empyema: a case report. J Reprod Med 2015; 60:172-174. [PMID: 25898483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND An empyema is an infection of the pleural space that occurs most frequently secondary to the progression of pneumonia. The stages of empyema are based on pleural characteristics and reflect the risks of the condition for morbidity and mortality. Pregnancy is a risk factor for major complications of pneumonia, including empyema. CASE A pregnant woman at 25 weeks' gestation with a community-acquired Streptococcus pneumoniae pneumonia underwent video-assisted thoracotomy decortication and debridement of a large loculated, gelatinous empyema after conservative medical therapy failed. CONCLUSION Conservative medical therapy with antibiotics alone may not be adequate for advanced bacterial empyema in pregnancy.
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Abstract
Multidisciplinary management of thoracic infection, including experts in thoracic surgery, pulmonology, infectious disease, and radiology, is ideal for optimal outcomes. Initial assessment of parapneumonic effusion and empyema requires computed tomographic evaluation and consideration for fluid sampling or drainage. Goals for the treatment of parapneumonic effusion and empyema include drainage of the pleural space and complete lung reexpansion. Pulmonary abscess is often successfully treated with antibiotics and observation. Surgical intervention for the treatment of fungal or tuberculous lung disease should be undertaken by experienced surgeons following multidisciplinary assessment. Sternoclavicular joint infection often requires joint resection.
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Affiliation(s)
- Daniel Raymond
- Thoracic & Cardiovascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, J4-1, Cleveland, OH 44195, USA.
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Alonso Renedo FJ, Casas Herrero Á, Martínez Velilla N, Gonzalo Lázaro M. [Minimally symptomatic empyema due to Actinomyces]. Rev Esp Geriatr Gerontol 2014; 49:196-197. [PMID: 24703339 DOI: 10.1016/j.regg.2014.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/04/2014] [Accepted: 02/27/2014] [Indexed: 06/03/2023]
Affiliation(s)
| | - Álvaro Casas Herrero
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - María Gonzalo Lázaro
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Johannesen KMH, Bødtger U. [Empyema é deux]. Ugeskr Laeger 2014; 176:V10130622. [PMID: 25351671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a case of a married couple with a cluster of empyema. Clusters are rarely seen, but have previously been described in children. Reasons for clustering of empyemas include close relationship between patients, increased susceptibility in patients, increased virulence of the bacteria, co-morbidity and age. Drainage and relevant antibiotic treatment remain key therapies.
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Cvijanović V, Vojvodić D, Djurdjević D, Jović M, Stanić V, Sekulović L, Perić T. Experimental pleural empyema model in rabbits: Why, how and what are the next steps. VOJNOSANIT PREGL 2014; 71:491-498. [PMID: 26137715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND/AIM The use of new therapeutic methods to prevent development of fibrothorax as the final complication of the human pleural infections requires research with experimental animals. The aim of this study was to standardize the procedures for the establishment of our own experimental model of empyema in rabbits, since it should be able to offer similar conditions found in human pleural infections. METHODS This experiment included 15 chinchilla rabbits, weighing from 2.3 to 2.8 kg. There were 12 rabbits in the experimental group, while 3 rabbits formed the control group. On the first day, we administered 0.4-0.5 mL of turpentine in the right pleural space of the rabbits from the experimental group in order to provoke sterile exudative pleurisy. After 24 h we injected 1 mL of Staphylococcus aureus and 1 mL of Escherichia coli bacteria in the same concentration of 4.5 x 10(8) bacteria/mL. Thoracocentesis for the pleural fluid analysis was performed 24, 48, 72, and 96 h after bacteria instillation. In these pleural samples we estimated the number of leucocytes and the values of lactate dehydrogenase (LDH), glucose and pH in pleural fluid, as well as the presence of bacteria. We did not protect the animals with antibiotics, and on the day 7 of the experiment they were sacrificed with the lethal dose of barbiturate (iv). The lung from the empyemic side of all experimental animals and the lung of one control animal were histopathologically examined. RESULTS A total of 4 animals had a small amount of clear pleural fluids or there was no fluid obtained with thoracocentesis 24 and 48 h after the bacteria instillation. after the bacteria instillation. In the remaining 8 rabbits 24 h after bacteria administration the mean values (± SD) of the parameters monitored were as follows: Le 34.75 ± 6.13 x 109/L, LDH 17,000 ± 4,69 U/L, glucose 1.23 ± 0.45 mmol/L, and pH 6.975 ± 0.15. The obtained values met the criteria for the evaluation of effusion as pleural empyema or complex and complicated pleural effusion (LDH > 1000 U/L, glucose < 2.31 mmol/L and pH < 7.20). Bacterial cultures were positive in 5 out of 8 first pleural samples and in only 2 samples after 48 h of bacteria administration. There was a positive correlation between the number of leukocytes and the LDH value (r = 0.071, p < 0.001), and a negative correlation between the number of leukocytes and the glucose level (r = 0.864, p < 0.001), and the leukocytes number and pH of the pleural fluid (r = 0.894, p < 0.001). The mean glucose value increased after 48 h (3.23 ± 0.44 mmol/L), and the pH value rose after 72 h (7.22 ± 0.03) which was beyond the empyema level. CONCLUSION The creation of the experimental empyema model is a very delicate work with uncertain success. Its value and importance are crucial for pleural pathology research. With the intention to obtain a more empyemic pleural reaction we created a model with two different human pathogen bacteria. We generated the satisfactory results, but not as good as those contained in some of the reference literature data.
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Lin PY, Jean SS, Ou TY, Chen FL, Lee WS. Successful salvage therapy with micafungin for Candida empyema thoracis. J Microbiol Immunol Infect 2014; 48:459-60. [PMID: 24530254 DOI: 10.1016/j.jmii.2013.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 12/30/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Pai-Yang Lin
- Division of Chest Medicine, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Shio-Shin Jean
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Tsong-Yih Ou
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Fu-Lun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan.
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Lee MR, Wang HC, Yang CY, Lin CK, Kuo HY, Ko JC, Sheng WH, Lee LN, Yu CJ, Hsueh PR. Clinical characteristics and outcomes of patients with pleural infections due to Stenotrophomonas maltophilia at a medical center in Taiwan, 2004-2012. Eur J Clin Microbiol Infect Dis 2014; 33:1143-8. [PMID: 24458500 DOI: 10.1007/s10096-014-2060-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/09/2014] [Indexed: 01/09/2023]
Abstract
Stenotrophomonas maltophilia can cause various clinical diseases; however, pleural infections due to S. maltophilia are rare. We evaluated the clinical characteristics and outcomes of patients with pleural infections (complicated parapneumonic effusion or empyema) due to S. maltophilia who were treated at a medical center in Taiwan from 2004 to 2012. During the study period, 40 patients were treated for pleural infections due to S. maltophilia. The incidence of S. maltophilia pleural infections ranged from 2.66 per 1,000,000 patient-days in 2009 to 12.44 per 1,000,000 patient-days in 2011. Most of the patients with S. maltophilia pleural infections were immunocompromised male adults and all of the infections were acquired in healthcare settings. The majority of patients had polymicrobial pleural infections (n = 31, 77.5 %) and the most common pathogen was Pseudomonas aeruginosa (n = 12). The causes of pleural infections due to S. maltophilia were pneumonia due to S. maltophilia in two patients (5 %), post-surgical/tube thoracostomy in 26 (65 %) patients, and fistula (bronchopleural, esophagopleural and biliopleural) in 12 (30 %) patients. The 14-day and 30-day mortality rates were 32.5 % and 42.5 %, respectively. Pleural infections due to S. maltophilia are most commonly the result of surgical procedures, thoracostomy, and underlying fistulas. These infections are associated with a high mortality rate, especially among immunocompromised patients.
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Affiliation(s)
- M-R Lee
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
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Noguchi S, Yatera K, Kawanami T, Yamasaki K, Fukuda K, Naito K, Akata K, Nagata S, Ishimoto H, Taniguchi H, Mukae H. Pneumonia and empyema caused by Streptococcus intermedius that shows the diagnostic importance of evaluating the microbiota in the lower respiratory tract. Intern Med 2014; 53:47-50. [PMID: 24390528 DOI: 10.2169/internalmedicine.53.0971] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The bacterial species in the Streptococcus anginosus group (S. constellatus, S. anginosus, S. intermedius) are important causative pathogens of bacterial pneumonia, pulmonary abscesses and empyema. However, the bacteria in this group are primarily oral resident bacteria and unable to grow significantly on ordinary aerobic culture media. We experienced a case of pneumonia and empyema caused by Streptococcus intermedius detected using a 16S rRNA gene sequencing analysis of bronchoalveolar lavage fluid and pleural effusion, but not sputum. Even when applying the molecular method, sputum samples are occasionally unsuitable for identifying the causative pathogens of lower respiratory tract infections.
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Affiliation(s)
- Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
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Jha VK, Borpujari PJ, Shenoy G, Bhargav S. Empyema with pleuropulmonary mucormycosis. J Assoc Physicians India 2013; 61:665-667. [PMID: 24772711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pleuropulmonary mucormycosis is relatively rare disease and that too localised disease is very rare but has got better prognosis. Maintaining a high level of suspicion is important in right clinical setting with pleuropulmonary involvement that fails to antibacterial agent either clinically or radiologically.
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Lee JH, Noh YS, Lee YH, Jang IA, Song HC, Choi EJ, Kim YK. Pleural and pericardial empyema in a patient with continuous ambulatory peritoneal dialysis peritonitis. Korean J Intern Med 2013; 28:626-7. [PMID: 24009463 PMCID: PMC3759773 DOI: 10.3904/kjim.2013.28.5.626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/13/2013] [Accepted: 05/24/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jong Hoon Lee
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Young Sun Noh
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Youn Hee Lee
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - In-Ae Jang
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Ho Chul Song
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Euy Jin Choi
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Yong Kyun Kim
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Yamauchi Y, Isaka M, Maniwa T, Takahashi S, Kurai H, Ohde Y. Chest tube tip culture as a predictor of postoperative infection in lung cancer operations. Ann Thorac Surg 2013; 96:1796-802. [PMID: 23987900 DOI: 10.1016/j.athoracsur.2013.06.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Postoperative infection is one of the most frequently observed complications after lung resection and should be addressed in perioperative management. This study evaluated the clinical significance of chest tube tip culture relevant to postoperative infection. METHODS From September 2002 to December 2011, 1,438 patients who underwent lung cancer operations in Shizuoka Cancer Center Hospital were evaluated. Postoperative infections, including surgical site infection, postoperative pneumonia, and postoperative empyema without fistula, were defined as those occurring within 30 days of thoracotomy. RESULTS Postoperative infections developed in 84 of the 1,438 patients (5.8%), including 42 (2.9%) with surgical site infection, 36 (2.5%) with pneumonia, and 13 (0.9%) with empyema. The sensitivity, specificity, and positive predictive value of chest tube tip culture were 23%, 98%, and 41.3%, respectively. Multivariate analysis demonstrated that the independent risk factors associated with the development of postoperative infections were coexisting diabetes mellitus and positive chest tube tip culture. Positive chest tube tip culture was the only independent risk factor associated with surgical site infection. The independent risk factors associated with postoperative pneumonia were age 70 years or older, coexisting diabetes mellitus, and positive chest tube tip culture. Finally, positive chest tube tip culture was the only independent risk factor associated with postoperative empyema. CONCLUSIONS Positive chest tube tip culture strongly predicts postoperative infections in lung cancer surgery and necessitates careful observation in the perioperative period.
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Affiliation(s)
- Yoshikane Yamauchi
- Division of General Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
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Magness DJ. Empyema necessitans caused by Mycobacterium tuberculosis in an immunocompetent patient. WMJ 2013; 112:129-130. [PMID: 23894811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 22-year-old man, a recent immigrant from Mexico, was admitted to a Wisconsin hospital because of a swelling of the chest wall and right axilla. Originally, it was thought to be a skin infection with Staphylococcus aureus. When the treatment was unsuccessful, the patient returned to the hospital and the abscesses were found to have been caused by Mycobacterium tuberculosis. Furthermore, there were pleural collections and it was thought that he had a manifestation called empyema necessitans, an extension of purulent pleural liquid through adjacent tissues to form an abscess on the thoracic wall.
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Giuliano S, Rubini G, Conte A, Goldoni P, Falcone M, Vena A, Venditti M, Morelli S. Streptococcus anginosus group disseminated infection: case report and review of literature. Infez Med 2012; 20:145-154. [PMID: 22992554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infections. There are very few reports of disseminated infections sustained by members of this streptococcal group. We report a case of a highly disseminated infection and analyse previous literature reports. Disseminated pyogenic infection has been defined as an infection affecting two or more of the following organs/systems: central nervous system, lung, liver and spleen. We performed a PubMed search using the terms: S. milleri, S. anginosus, brain abscess, pulmonary abscess, hepatic abscess, spleen abscess. We reviewed 12 case reports including the one presented in this paper. Underlying conditions such as dental infections, malignancy, gastrointestinal and respiratory tract disease accounted for 42% of cases. No definite endocarditis was encountered, even though positive blood cultures were found in 67% of patients. Concomitant brain-liver, brain-lung and brain-spleen involvement occurred in 50%, 42% and 8% of cases respectively. Ninety-one percent (91%) of patients were treated with β-lactams, and surgical procedures were performed in 67% of patients. Infections caused by S. anginosus group members are satisfactorily treated with penicillin G and cephalosporins. It is very important to associate surgery to antimicrobial chemotherapy in order to achieve a full or nearly full clinical recovery.
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Affiliation(s)
- Simone Giuliano
- Dipartimento di Sanità Pubblica, Università Sapienza, Roma, Italy
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Jiang LB, Zhu YH, Yao YF, Xu J, Wang Z. [Pyopneumothorax caused by Salmonella choleraesuis: a case report and review of the literature]. Zhonghua Jie He He Hu Xi Za Zhi 2012; 35:683-686. [PMID: 23158072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To improve understanding of the clinical features, diagnosis and treatment of pyopneumothorax caused by Salmonella choleraesuis. METHODS One case of pyopneumothorax caused by Salmonella choleraesuis diagnosed and treated in our hospital in 2010 was reported and the related literatures were reviewed. As of May 2011, the literature review was carried out with "Salmonella choleraesuis" and "thoracic empyema" as the search terms in Wanfang Med Online and Pubmed Database. RESULTS A 43-year-old Chinese woman presenting with fever and chest pain for 4 days was admitted to our hospital. A CT scan of the chest revealed a massive shadow with mixed density in the right hemithorax, from the top of thorax to diaphragmatic surface, and there was air inside or surrounding the mass irregularly but without an air-fluid level. Blood culture and bronchial secretion culture by bronchoscope both showed some serotypes of Salmonella strains. At first intravenous antibiotic therapy (piperacillin-tazobactam, ceftazidime, and then imipenem-cilastatin) was ineffective. Open chest surgery was performed, and chest tube placed. Salmonella choleraesuis was isolated from the drained pleural fluid. Chest tube drainage remained in place for more than 6 weeks, and with prolonged antibiotic therapy, which contributed to a good outcome. Literature review found no related reports in Wanfang Med Online, while 3 literatures were found in Pubmed, including 2 of case report and 1 of retrospective study. Among 973 patients with empyema thoracis in the retrospective study, 12 of these patients, including 9 men and 3 women, were infected with Salmonella species. The median age was 49 years, and 10 patients were immunocompromised, including malignancy, liver cirrhosis, and diabetes mellitus. Seven patients were infected with Salmonella choleraesuis, and 4 (57%) of them died. CONCLUSIONS Pyopneumothorax or thoracic empyema is a rare complication of Salmonella choleraesuis infection. Higher rates of death were noted in this disease. Salmonella choleraesuis infection is even more serious in adult patients with underlying diseases. Early diagnosis, appropriate antimicrobial drug therapy, and aggressive drainage are necessary to improve the outcome of patients with pyopneumothorax or thoracic empyema due to Salmonella choleraesuis.
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Affiliation(s)
- Li-bin Jiang
- Department of Respiratory Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
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Guihaire J, Flecher E, de Latour B, Verhoye JP. Traumatic false aneurysms of the left ventricle after an attempt at video-thoracoscopic surgery. Interact Cardiovasc Thorac Surg 2012; 15:145-7. [PMID: 22493150 DOI: 10.1093/icvts/ivs119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Video-thoracoscopic surgery (VTS) has been accepted as a safe and credible technique since 1990. Lung injury is one of the main perioperative complications. Few data are available about cardiac trauma and VTS-related false aneurysm of the left ventricular (LV) wall has not yet been reported. METHODS A 62-year old woman presented with a left thoracic empyema. Video-thoracoscopy was attempted for bacterial sampling and surgical drain of the pleura. A rapid conversion to open thoracotomy was necessary to control massive bleeding after the first thoracic port intrusion. An apical systolic murmur was found 2 weeks later during a systematic clinical examination. The patient was asymptomatic and had no personal history of cardiac disease. RESULTS Colour Doppler imaging showed two spurious aneurysms on the LV wall without any haemopericardium. Pericardial enhancement around the left ventricle was observed on the chest computerized tomography scan with the injection of contrast. After the careful excision of the two false aneurysms, a surgical repair was strengthened with a suture under a cardiopulmonary bypass. The postoperative course was uneventful and the patient was safe at 3 years. CONCLUSIONS This is the first report of LV traumatic false aneurysms secondary to an attempt of a video-thoracoscopic procedure. This is a rare but life-threatening complication because of the risk of spontaneous rupture. Left persistent thoracic empyemas associated with the ipsilateral mediastinum deviation carry a high risk of myocardial damage related to the trocar port intrusion.
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MESH Headings
- Aneurysm, False/diagnosis
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Anti-Bacterial Agents/therapeutic use
- Blood Loss, Surgical
- Cardiac Surgical Procedures
- Cardiopulmonary Bypass
- Echocardiography, Doppler, Color
- Empyema, Pleural/diagnosis
- Empyema, Pleural/microbiology
- Empyema, Pleural/surgery
- Female
- Heart Aneurysm/diagnosis
- Heart Aneurysm/etiology
- Heart Aneurysm/surgery
- Heart Injuries/diagnosis
- Heart Injuries/etiology
- Heart Injuries/surgery
- Heart Ventricles/injuries
- Humans
- Middle Aged
- Reoperation
- Suture Techniques
- Thoracic Surgery, Video-Assisted/adverse effects
- Thoracotomy
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Julien Guihaire
- Department of Thoracic and Cardiovacular Surgery, Pontchaillou Hospital, University of Rennes 1, Rennes, France.
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Shteinberg M, Perek S, Ghanem N, Sarafov I, Peysakhovich Y, Adir Y. [Actinomyces empyema treated with decortications]. Harefuah 2012; 151:205-254. [PMID: 22616146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Actinomyces infections are rare infections, involving the head and neck, abdominal cavity, and the lung. We report a case of a 66 year old woman with shortness of breath and a pleural effusion from which Actinomyces meyeriwas cultured. The diagnosis was confirmed by the polymerase chain reaction technique. The infection was successfully treated with a combination of ampicillin and surgical decortication. Due to their rarity, Actinomyces infections are not often suspected. These infections are difficult to diagnose due to specific microbiologic requirements for isolation of Actinomyces. In many reviewed cases of Actinomyces infection, patients underwent surgery for presumed cancer but were eventually diagnosed as being infected with actinomycosis. Due to lack of improvement of our patient, surgical decortication was performed, which led to a successful outcome.
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Nitzan O, Elias M, Raz R, Saliba WR. Spontaneous bacterial empyema caused by Streptococcus pneumoniae. Isr Med Assoc J 2012; 14:190-191. [PMID: 22675862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Orna Nitzan
- Infectious Disease Unit, HaEmek Medical Center, Afula, Israel
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Schwarz YA. Is streptokinase fibrinolysis the best treatment for empyema in pediatric patients? And must we tap every cirrhotic patient with bilateral pleural effusion? Isr Med Assoc J 2012; 14:168-169. [PMID: 22675857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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