Empyema Thoracis: A Current Profile at a Tertiary Care Center

Sethy, Hemanta Kumar; Panda, Geetanjali; Trilochan, Biswal Pradipta; Pradhan, Swetapadma; Sahu, Gopal Krishna; Giri, Pradeep Kumar; Routray, Dipanweeta

doi:10.14260/jemds/2016/126

jemds

2016

DOI: 10.14260/jemds/2016/126

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Empyema Thoracis: A Current Profile at a Tertiary Care Center

Hemanta Kumar Sethy¹,

Geetanjali Panda²,

Biswal Pradipta Trilochan³

et al.

Abstract: BACKGROUNDEmpyema Thoracis (ET), the accumulation of pus in pleural cavity due to infective origin, is a perpetual clinical entity since Hippocratic era. The incidence and prevalence varies depending on different countries, type of infections, age and immune status of the host.

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Cited by 2 publications

References 17 publications

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Non-Tubercular Empyema Thoracis- A Comparative Analysis of Gram Positive and Gram Negative Organism Associated Empyema

Mukherjee¹,

Begum²,

Mitra³

et al. 2017

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BACKGROUNDEmpyema thoracis is an entity resulting in significant morbidity and mortality. Bacterial empyema is the commonest cause of empyema globally. Clinical course and outcome of empyema varies in patients.This study was carried out to evaluate clinical profile, diagnosis and outcome parameters of non-tubercular empyema cases with special interest to find out the differences between Gram positive and Gram negative organism associated empyemas in terms of clinical presentation and outcome issues. MATERIALS AND METHODSA prospective observational study of all cases of bacterial empyema thoracis admitted in the Department of Respiratory Medicine in a teaching institution over a period of 18 months was conducted. Out of the total no. of cases where pleural fluid culture was positive, a comparative analysis was done between cases of empyemas caused by Gram positive organisms and Gram negative organisms in terms of clinical characteristics, treatment and outcome issues. RESULTSA total no. of 95 empyema cases were encountered during the study period, of which fifty five were bacterial empyema. Pleural fluid culture was positive in 54.55% cases. Staphylococcus aureus (15, 27.3%) was the most frequent pathogen isolated. On comparative analysis of empyema cases caused by Gram positive and Gram negative organisms, it was found that Gram negative organism related empyemas was more frequent in older population and in people with co-morbidities. Clinical course of illness was more protracted and mean duration of intercostal tube drainage were longer (39.5 vs 17 days) in patients with Gram negative organism related empyemas. Presence of bronchopleural fistula was more in Gram negative empyemas and the need for surgical intervention was also higher in this group. CONCLUSIONBacterial empyema thoracis is the commonest cause of empyema. Gram negative organism related empyemas significantly differs from Gram positive organism related empyemas in terms of their clinical profile, increased occurrence of bronchopleural fistula and management issues.

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Non-Tubercular Empyema Thoracis- A Comparative Analysis of Gram Positive and Gram Negative Organism Associated Empyema

Mukherjee¹,

Begum²,

Mitra³

et al. 2017

jemds

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Role of Cartridge Based Nucleic Acid Amplification Test in Diagnosing Tuberculous Empyema Thoracis – A Study from Telangana, India

Yadav¹,

Reddy²,

Eshwaramma³

et al. 2021

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BACKGROUND The pleura is involved in pulmonary or systemic tuberculosis by various mechanisms like delayed hypersensitivity. Tuberculous empyema usually results from failure of a primary tubercular effusion to resolve and further progresses to chronic suppurative form. In tuberculous empyema, the pleural fluid is purulent, and is loaded with tuberculous organisms on direct acid-fast bacillus (AFB) smear examination and / or culture of pus. We need to assess the role of cartridge based nucleic acid amplification test (CBNAAT) in the diagnosis of tuberculous empyema. METHODS This study was a prospective observational study of all adult patients of empyema above 15 years of age, admitted in the Department of Pulmonology, over a period of 1 year, 6 months after obtaining clearance from ethical committee and proper consent from the study subjects. RESULTS A total of sixty-three (63) empyema cases were recruited and analysed further. On evaluation, we diagnosed 26 cases with tubercular aetiology (41.27 %) and remaining thirty-seven (58.73 %) cases with non-tubercular aetiology. CONCLUSIONS Pleural fluid (pus) cartridge based nucleic acid amplification test (CBNAAT) is very sensitive and provides a rapid confirmed diagnosis within 2 hrs. including drug susceptibility. In this study, sensitivity of CBNAAT in suspected tuberculous empyema patients was 88.5 % and specificity was 100 %. Pleural fluid CBNAAT is more sensitive in both pleural fluid AFB smear positive (100 %) and pleural fluid AFB smear negative (72.7 %) cases. So, pleural fluid and sputum direct AFB smear and CBNAAT should be sent in all suspected tuberculous empyema cases for early diagnosis of tuberculosis and early detection of rifampicin resistance. KEY WORDS Mycobacterium Tuberculosis, Tubercular Empyema, Pleural Fluid, CBNAAT, AFB, Anti-Tubercular Drugs

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Empyema Thoracis: A Current Profile at a Tertiary Care Center

Abstract: BACKGROUNDEmpyema Thoracis (ET), the accumulation of pus in pleural cavity due to infective origin, is a perpetual clinical entity since Hippocratic era. The incidence and prevalence varies depending on different countries, type of infections, age and immune status of the host.

Cited by 2 publications

References 17 publications

Non-Tubercular Empyema Thoracis- A Comparative Analysis of Gram Positive and Gram Negative Organism Associated Empyema

Non-Tubercular Empyema Thoracis- A Comparative Analysis of Gram Positive and Gram Negative Organism Associated Empyema

Role of Cartridge Based Nucleic Acid Amplification Test in Diagnosing Tuberculous Empyema Thoracis – A Study from Telangana, India

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