Pseudomonas aeruginosa Empyema in an Adult with Cystic Fibrosis

Mestitz, Hugh; Bowes, Glenn

doi:10.1378/chest.98.2.485

Cited by 4 publications

(9 citation statements)

References 5 publications

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“…Ps. aeruginosa empyema in a 20-year-old with CF on long-term oral corticosteroid therapy was also reported [9]. Additionally, a 14-year-old patient with CF and hypersplenism developed an empyema [7].…”

Section: Discussionmentioning

confidence: 99%

Empyema in a Woman with Cystic Fibrosis: A Cautionary Tale

Coates

Schaefer²,

et al. 2013

Case Reports in Pulmonology

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

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Section: Discussionmentioning

confidence: 99%

Empyema in a Woman with Cystic Fibrosis: A Cautionary Tale

Coates

Schaefer²,

et al. 2013

Case Reports in Pulmonology

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“…Whilst empyema secondary to S. aureus (Taussig et al, 1974), Burkholderia gladioli (Khan et al, 1996) and the Burkholderia cepacia complex (Noyes et al, 1994) have been documented, we report what is to the best of our knowledge the first case of empyema caused by the LES of P. aeruginosa in an adult CF patient. Although there is one case of P. aeruginosa empyema in the literature, the genotype of the strain is not known (Mestitz & Bowes, 1990).…”

Section: Discussionmentioning

confidence: 99%

“…This may relate to the use of aggressive microbiological surveillance, targeted antibiotic treatment, chest physiotherapy and the presence of an intact immunological defence mechanism in CF. Furthermore, it has been postulated that the host defence mechanisms restrict the infection to the airways (Mestitz & Bowes, 1990). Empyema in CF has largely been observed in infants (before the diagnosis of CF has been established) where the innate immunity is low (Taussig et al, 1974).…”

Section: Discussionmentioning

confidence: 99%

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

Mohan

Lakshman

Fothergill

et al. 2010

Journal of Medical Microbiology

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Chronic pulmonary infection with Pseudomonas aeruginosa occurs in up to 85 % of individuals with cystic fibrosis (CF) by the time they reach adulthood, and is the major cause of morbidity and mortality: nearly all patients die from progressive respiratory failure due to repeated pulmonary exacerbations. However, despite the predilection of this organism for the lungs of CF people, infection of the pleura is much less common and is not well described in the CF population. We describe what is believed to be the first case of pleural empyema due to a particularly pathogenic transmissible strain of P. aeruginosa (the Liverpool epidemic strain) in an adult CF patient. Case reportA 34-year-old woman with cystic fibrosis (CF) (DF508/ DF508) was admitted to the Liverpool Heart and Chest Hospital in 2008 following a 2 week history of left-sided chest pain, breathlessness and a worsening productive cough. She was a non-smoker and had no history of CFrelated diabetes or chronic liver disease. Since 2003, she had been infected with the Liverpool epidemic strain (LES) and a unique Pseudomonas aeruginosa strain, but required only one course of intravenous (i.v.) antibiotics per year for pulmonary exacerbations. Prior to this, her sputum cultures had intermittently grown Staphylococcus aureus. Her baseline forced expiratory volume in 1 s (FEV 1 ) was around 54 % (predicted) and her body mass index was 20 kg m 22. Her medication included inhaled salbutamol, and a combination of a steroid and a long-acting beta 2 agonist as an inhaled therapy for asthma, and she had been on a maintenance dose of 10 mg prednisolone for 9 months for allergic bronchopulmonary aspergillosis.On examination she was pyrexial (38.2 u C), with tachypnoea (respiratory rate of 25 min 21) and hypoxaemia (blood oxygen saturation 91 % with room air). Chest auscultation revealed reduced breath sounds on the left and her FEV 1 had fallen to 34 %. Serological investigations showed a white cell count of 31.6610 3 cells dl 21 (91 % neutrophils), a platelet count 945610 9 platelets l 21 and 418 mg C-reactive protein l 21. Immunoglobulin levels (IgG, IgA, IgM) were normal.A chest X-ray showed consolidation in the left mid zone and a left pleural effusion (Fig. 1). Diagnostic aspiration of this under ultrasound guidance revealed frank pus and subsequently 2.5 l purulent fluid was drained through a 16 F Seldinger chest drain. A subsequent computed tomography Abbreviations: CF, cystic fibrosis; FEV 1 , forced expiratory volume in 1 s; i.v., intravenous; LES, Liverpool epidemic strain; tds, three times a day.

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“…Immunocompromised CF adults post lung transplantation have been reported with empyema secondary to Burkholderia gladioli septicaemia 3 and empyema necessitatis caused by Burkholderia cepacia. 4 A single case report of P. aeruginosa empyema in a young adult with cystic fibrosis on long‐term oral corticosteroids has also been described 1 …”

mentioning

confidence: 99%

“…Pleural empyema, however, is rarely seen in this group of patients. This may be due in part to the host response which localises infection to the airways 1 …”

mentioning

confidence: 99%