Loculated Empyema and SARS-CoV-2 Infection: A Report of Two Cases and Review of the Literature

Ayad, Sarah; Gergis, Kirolos; Elkattawy, Sherif; Mirza, Noreen; Abdelazeem, Basel; Patel, Latika; Remolina, Carlos

doi:10.12890/2021_002706

Cited by 10 publications

(8 citation statements)

References 10 publications

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“…This is the first territory-wide study that included patients with COVID-19 related pleural empyema with an electronic patient record system covering the vast majority of hospitalized cases allowing ample data collection retrospectively. Case reports on COVID-19 related pleural empyema reported yielding of Pseudomonas aeruginosa [ 28 ], community-acquired MRSA [ 29 ], S. anginosus or negative culture [ 30 ]. The presence of alveolar-pleural fistula was reported [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in Etiology and Clinical Outcomes of Pleural empyema during the COVID-19 Pandemic

Chan

Sridhar

et al. 2023

Microorganisms

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Healthcare-seeking behavior changed during the COVID-19 pandemic and might alter the epidemiology of pleural empyema. In this study, the incidence, etiology and outcomes of patients admitted for pleural empyema in Hong Kong in the pre-COVID-19 (January 2015–December 2019) and post-COVID-19 (January 2020–June 2022) periods were compared. Overall, Streptococcus pneumoniae was the predominant organism in <18-year-old patients, while Streptococcus anginosus, anaerobes and polymicrobial infections were more frequent in adults. In the post-COVID-19 period, a marked decline in the incidence of pleural empyema in children was observed (pre-COVID-19, 18.4 ± 4.8 vs. post-COVID-19, 2.0 ± 2.9 cases per year, p = 0.036), while the incidence in adults remained similar (pre-COVID-19, 189.0 ± 17.2 vs. post-COVID-19, 198.4 ± 5.0 cases per year; p = 0.23). In the post-COVID-19 period, polymicrobial etiology increased (OR 11.37, p < 0.0001), while S. pneumoniae etiology decreased (OR 0.073, p < 0.001). In multivariate analysis, clinical outcomes (length of stay, ICU admission, use of intrapleural fibrinolytic therapy, surgical intervention, death) were not significantly different in pre- and post-COVID-19 periods. In conclusion, an increase in polymicrobial pleural empyema was observed during the pandemic. We postulate that this is related to the delayed presentation of pneumonia to hospitals.

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Section: Discussionmentioning

confidence: 99%

Changes in Etiology and Clinical Outcomes of Pleural empyema during the COVID-19 Pandemic

Chan

Sridhar

et al. 2023

Microorganisms

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“…Other etiologies include Pneumococci , Escherichia coli , Pseudomonas , Klebsiella , and anaerobes 1 . Previous reports indicate that secondary bacterial pneumonia or less commonly empyema can complicate the course of a COVID‐19 infection even in immunocompetent patients resulting in worse outcomes 3–5 . Management includes empirical antibiotic therapy and drainage; decortication might be considered in patients with organized or established fibrothorax or evidence of trapped lung alternatively intrapleural tissue plasminogen activator with DNase can be utilized in non‐operable cases.…”

Section: Case Presentationmentioning

confidence: 99%

“… 1 Previous reports indicate that secondary bacterial pneumonia or less commonly empyema can complicate the course of a COVID‐19 infection even in immunocompetent patients resulting in worse outcomes. 3 , 4 , 5 Management includes empirical antibiotic therapy and drainage; decortication might be considered in patients with organized or established fibrothorax or evidence of trapped lung alternatively intrapleural tissue plasminogen activator with DNase can be utilized in non‐operable cases. Long‐term prognosis is overall favorable in cases of empyema with a higher risk of mortality in patients who required open surgery or decortication.…”

Section: Case Presentationmentioning

confidence: 99%

Empyema necessitans complicating a mild COVID‐19 infection in a young immunocompetent patient

Sullivan

Davalos

Sheikh

et al. 2023

Clinical Case Reports

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“…Most patients with spontaneous pneumothorax do not have findings of pleural effusion on chest radiography because the increase in pleural pressure caused by the pneumothorax inhibits the transfer of interstitial liquid into the pleural space [12] . To our knowledge only few cases were described in the literature where unilateral pleural effusion appeared almost at the same time as the pneumothorax in patients with COVID-19 pneumonia [ 2 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Bilateral parapneumonic pleural effusion with pneumothorax in a patient with covid 19 pneumonia: case report

Kalenchic

Kabak

Primak

et al. 2022

Radiology Case Reports

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Recurrent pyogenic effusion combined with bilateral pneumothorax is a rare complication associated with the COVID−19 infection. Current article presents the case report of a 68-year-old male with the severe community-acquired bilateral polysegmental viral COVID−19 pneumonia. Chest radiography on the 15th day after admission to the hospital showed the presence of air and pleural effusion in the right pleural cavity with collapse of the right lung. Thoracentesis and thoracostomy in the sixth intercostal space on the mid-axillary line were performed. About 1400 ml of a yellowish opaque liquid were evacuated from the pleural cavity. Pleural fluid analysis confirmed an exudative lymphocytic-rich effusion with no growth of acid-fast bacteria (AFB). In the pleural fluid such gram-negative bacteria as Acinetobacter baumannii and Pseudomonas aeruginosa were cultured. Chest computed tomography obtained on the third day after thoracentesis showed radiological sings of bilateral hydropneumothorax. Needle thoracocentesis and new pleural drainage in the second intercostal space on the right midclavicular line were established. Five days later after the second drainage of the pleural space was initiated the patient was diagnosed with pleural empyema and transferred to the Surgical Clinic. This case report highlights that in patients with COVID-19 recurrent pyogenic effusion combined with bilateral pneumothorax may occur.

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Loculated Empyema and SARS-CoV-2 Infection: A Report of Two Cases and Review of the Literature

Cited by 10 publications

References 10 publications

Changes in Etiology and Clinical Outcomes of Pleural empyema during the COVID-19 Pandemic

Changes in Etiology and Clinical Outcomes of Pleural empyema during the COVID-19 Pandemic

Empyema necessitans complicating a mild COVID‐19 infection in a young immunocompetent patient

Bilateral parapneumonic pleural effusion with pneumothorax in a patient with covid 19 pneumonia: case report

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