Pleural Space Infections

Foley, Sean; Parrish, John S.

doi:10.3390/life13020376

Cited by 6 publications

(13 citation statements)

References 72 publications

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“…Regarding intra-pleural enzyme therapy, consensus has formed around the combination of the fibrinolytic tissue plasminogen activator (TPA) and viscosity-disrupting DNAse to reinitiate arrested pleural drainage. This combination has been shown to decrease referral to surgery but has had no effect on mortality [2 ▪▪ ] and increased the risk of bleeding [12]. This, coupled with poor evidence for the use of single agent TPA, DNAse, or streptokinase has led intra-pleural enzyme therapy to fall short of being part of routine empyema management.…”

Section: Treatmentmentioning

confidence: 99%

“…Mitigation of risk factors, early diagnosis, and prompt and effective treatment are the mainstay of prevention for empyema thoracis. Major risk factors are listed in Table 2[2 ▪▪ ,9,18].…”

Section: Preventionmentioning

confidence: 99%

“…Since antiquity, the mortality of empyema has been recognized and feared [1,2 ▪▪ ]; however, the microbiological cause has evolved over time. A systematic review by Hassan et al [3] identifies wide geographic variation in present-day bacterial cause with Staphylococcus aureus dominating as the leading causative organism globally.…”

Section: Aetiologymentioning

confidence: 99%

“…If indicated, cytology, acid/alcohol fast bacilli analysis, and fungal cultures can also be performed. Pleural biopsy has been shown to increase the yield for microbiological diagnosis [2 ▪▪ ]. Ample and varied microbiological samples should be taken at the earliest possibility to aid diagnosis and provide treatment options in a timely manner.…”

Section: Diagnosismentioning

confidence: 99%

“…Anaerobes can present a challenge to culture and so negative microbiological samples should not be treated as reassuring for anaerobic polymicrobial empyema. Aminoglycosides have no role in empyema treatment due to poor pleural penetration and probable inactivation by the acidity of the empyema [2 ▪▪ ].…”

Section: Treatmentmentioning

confidence: 99%

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Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Merchant,

Liu

2024

Current Opinion in Pulmonary Medicine

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Purpose of review The aim of this study was to review current key points in the aetiology, diagnosis, treatment, and prevention of empyema thoracis. Early postpandemic trends have seen an increasing global incidence and evolution in the aetiology of empyema. Due to varied aetiology and typically lengthy treatment, empyema will be disproportionately affected by the rising tide of antimicrobial resistance (AMR), thus warranting attention and further research. Recent findings Multiple novel biomarkers (e.g. IL-36γ) are under investigation to aid diagnosis, while oral health assessment tools are now available for prognosticating and risk-stratifying patients with thoracic empyema. There exists an ongoing lack of evidence-based guidance surrounding antibiotic treatment duration, surgical intervention indication, and prognostic scoring utility. Summary Understanding aetiologies in different global regions and settings is pivotal for guiding empirical treatment. Antimicrobial resistance will make thoracic empyema increasingly challenging to treat and should prompt increased awareness of prescribing practices. Novel biomarkers are under investigation which may speed up differentiation of pleural effusion types, allowing faster cohorting of patients. Although newly identified predictors of morbidity and mortality have been suggested to be beneficial for incorporation into clinical practice, further work is required to prognosticate, risk-stratify, and standardize treatment.

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Section: Treatmentmentioning

confidence: 99%

Section: Preventionmentioning

confidence: 99%

Section: Aetiologymentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Merchant,

Liu

2024

Current Opinion in Pulmonary Medicine

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Pleural space infection microbiology as assessed using a clinical sequencing-based assay: Fusobacterium nucleatum group, Streptococcus intermedius, and other oral normal microbiota are the most common bacteria identified in community-acquired pleural space infections

Alvarez Otero,

Mandrekar,

Wolf

et al. 2024

J Clin Microbiol

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The definition of the microbiology of pleural space infection has been challenging due to the poor yield of conventional culture. Here, the results of a 16S ribosomal RNA gene PCR/sequencing assay performed on pleural fluid in routine clinical practice between August 2020 and January 2023 were evaluated. Amplified 16S rRNA gene DNA was submitted to Sanger sequencing and/or next-generation sequencing or results were reported as negative, depending on PCR crossing threshold value. In all, 496 pleural fluids were tested at Mayo Clinic Laboratories, with 227 positive results, including 57 from Mayo Clinic patients. Among the 57 Mayo Clinic patients, pleural space infection was community acquired in 48 (84%); Fusobacterium nucleatum group and/or Streptococcus intermedius were detected in 31/57 (54%) cases [including 28/48 (58%) community-acquired cases], with additional facultative and/or anaerobic species also found in various combinations in 17/31 (55%). Results of this study suggest that the most frequent microorganism profile involved in community-acquired pleural space infection may be a combination of F. nucleatum group and/or S. intermedius , with or without other normal microbiota. IMPORTANCE We describe here the most frequent microorganisms detected in community-acquired pleural space infection using a clinically performed sequencing-based assay. We found that the most common detection was the Fusobacterium nucleatum group and/or Streptococcus intermedius , with or without other normal microbiota. We propose the term e-FuSion (effusion with Fusobacterium nucleatum group, Streptococcus intermedius , and other oral normal microbiota) for this entity.

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Immunoassay with Novel Paired Antibodies for Detection of Lipoarabinomannan in the Pleural Fluid and Plasma of Patients with Tuberculous Pleurisy

Yan,

Wang,

Pang

et al. 2023

Microorganisms

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Tuberculous pleurisy (TP) is one of the most common forms of extrapulmonary tuberculosis, but its diagnosis is challenging. Lipoarabinomannan (LAM) antigen is a biomarker for Mycobacterium tuberculosis (Mtb) infection. LAM detection has potential as an auxiliary diagnostic method for TP. We have successfully generated five rabbit anti-LAM monoclonal antibodies (BJRbL01, BJRbL03, BJRbL20, BJRbL52, and BJRbL76). Here, anti-LAM antibodies were tested to detect LAM in the pleural fluid and plasma of patients with TP by sandwich enzyme-linked immunosorbent assays (ELISAs). The results revealed that all of the anti-LAM antibodies were successfully used as capture and detection antibodies in sandwich ELISAs. The BJRbL01/BJRbL01-Bio pair showed better performance than the other antibody pairs for detecting mycobacterial clinical isolates and had a limit of detection of 62.5 pg/mL for purified LAM. LAM levels were significantly higher in the pleural fluid and plasma of patients with TP than in those of patients with malignant pleural effusion or the plasma of non-TB, and LAM levels in the pleural fluid and plasma were positively correlated. Moreover, LAM levels in the pleural fluid sample were significantly higher in confirmed TP patients than in clinically diagnosed TP patients. Our studies provide novel LAM detection choices in the pleural fluid and plasma of TP patients and indicate that LAM detection assay has an auxiliary diagnostic value for TP, which may help to improve the diagnosis of TP.

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Pleural Space Infections

Cited by 6 publications

References 72 publications

Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Pleural space infection microbiology as assessed using a clinical sequencing-based assay: Fusobacterium nucleatum group, Streptococcus intermedius, and other oral normal microbiota are the most common bacteria identified in community-acquired pleural space infections

Immunoassay with Novel Paired Antibodies for Detection of Lipoarabinomannan in the Pleural Fluid and Plasma of Patients with Tuberculous Pleurisy

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