Treatment of a Tuberculous Empyema with Simultaneous Oral and Intrapleural Antituberculosis Drugs

Long, Richard; J, Barrie; Stewart, Ken G.; Peloquin, Charles A.

doi:10.1155/2008/747206

Cited by 17 publications

(12 citation statements)

References 7 publications

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“…Simultaneous serum and pleural fluid anti-TB drug concentrations have been measured in two other cases and these along with our own and reference measures are shown in the Table 1 [ 7 – 12 ]. For all drugs, pleural fluid C max was lower and T max was later (usually) than serum C max and T max over the sampling intervals.…”

Section: Case Contextmentioning

confidence: 99%

Therapeutic drug monitoring and the conservative management of chronic tuberculous empyema: case report and review of the literature

Long

Peloquin

2015

BMC Infect Dis

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BackgroundChronic tuberculous empyema (CTE) is a rare and unusual, low grade and protracted, infection of the pleural space resulting in marked thickening, even calcification of the visceral and parietal pleura. Historically its management has been extraordinarily challenging. Differential penetration of anti-TB drugs into the pleural space has resulted in acquired drug resistance and surgery to remove the empyema or close a complicating bronchopleural fistula (BPF) has been technically difficult or unacceptably hazardous. On the basis of limited experience, the combination of tube thoracostomy or catheter drainage and high-end dosing of anti-TB drugs has been recommended as an initial approach to these lesions. Herein we report the first well documented case of closure of a BPF and cure of a CTE using this approach. The chances of a favorable outcome are improved, we suggest, by using therapeutic drug monitoring (TDM) to guide high-end drug dosing.Case PresentationAn 84 year old male immigrant to Canada from Croatia was diagnosed with a CTE after he developed a BPF. The diagnosis was made 62 years after what was, in retrospect, an episode of tuberculous pleurisy. He was treated with computed tomography-guided catheter drainage and TDM-guided high-end dosed anti-TB drugs (serum and pleural fluid drug concentrations) over a 10 month period. Sustained closure of the BPF and mycobacteriologic cure of the CTE was achieved. Drug concentrations in the present case and all other reported cases are summarized and interpreted.ConclusionWhen serum concentrations of the anti-TB drugs isoniazid, pyrazinamide and ethambutol at the high end of the normal range are achieved, pleural fluid concentrations at the low end of the normal range may be anticipated in CTE. Though highly protein bound drugs such as rifampin and moxifloxacin appear to penetrate CTEs less well, their free concentrations in the pleural space may be proportionately higher on account of lower protein concentrations. Interventional radiology and TDM increase the chances that conservative management of CTE will be successful.

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Section: Case Contextmentioning

confidence: 99%

Therapeutic drug monitoring and the conservative management of chronic tuberculous empyema: case report and review of the literature

Long

Peloquin

2015

BMC Infect Dis

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“…All cases of simple empyema with thin pus and those cases of simple empyema with thick pus where size of empyema is small should be managed by aspiration. 5 Anti-TB drug treatment and intercostal drainage may be adequate in the management of Tuberculous empyema 6 .However certain studies have proved that irrigation and aspiration alone have been of no apparent value in treating tuberculous empyema. 7 Drainage by surgical procedures, like decortication, decortication plus lobectomy are the preferred treatment to reduce the postoperative morbidity and for an early expansion of trapped lung.…”

Section: Introductionmentioning

confidence: 99%

A Study on Tuberculo Us Empyema Thoracis in Children

J¹,

Kilim²

2015

jemds

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INTRODUCTION: Pleural decortication is surgical removal of the fibrous peel that covers the lungs in third stage empyema thoracis. Pleural biopsy, increased pleural fluid adenosine deaminase level are diagnostic of tuberculous pleuritis. Pleural decortication can be done in either intra pleural or extrapleural approach. We performed a study with the objective of comparing the clinical profiles and outcome of patients with tuberculous and non-tuberculous empyema thoracis who underwent open pleural decortication. MATERIALS AND METHODS: A study was conducted in the General Hospital during a period of 2 years. All the cases of empyema thoracis that underwent decortication were examined and pleural fluid analysis, pleural biopsy, physical examination, chest Xray, CT-scan, Montoux test were done. Etiology of empyema was decided based on history, clinical examination and laboratory tests. RESULTS: In our study, non-tuberculous empyema was more frequent in infants and children below 6 years and tuberculous empyema was more frequent in 6-10 years. Among children with non-tuberculous empyema 28 children (42.42%) underwent intra pleural decortication and 38 children (57.57%) underwent extra pleural decortication. Among children with tuberculous empyema 2 children (25%) underwent extra pleural decortication and 6 children (75%) underwent intra pleural decortication. DISCUSSION: Non tuberculous empyemas required surgery (decortication) more often than tuberculous empyema and extrapleural approach of decortication was possible in slightly higher percentage of children with non tuberculous empyema compared to tuberculous empyema thoracis. Pulmonary tuberculosis probably had good response to antituberculous treatment for which they did not progress to organizing phase requiring surgery.

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“…This is mostly self limited but rarely may lead to a chronic active infection of the pleural space. [1][2][3] Active infection of the pleural space causes erosion of the pleural space and air-…”

Section: Introductionmentioning

confidence: 99%

Endobronchial Watanabe Spigot Embolisation in the Treatment of Bronchopleural Fistula due to Tuberculous Empyema in Intensive Care Unit

Dalar

Kosar

Eryüksel

et al. 2013

ATCS

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Tuberculosis may be complicated with empyema and fistula in patients with cellular immune deficiency. The case presented was a 39-year-old male patient with diagnosis of rheumatoid arthritis developed hydropneumothorax while taking steroid and immunosuppressive treatment and examination of pleural fluid revealed acid-fast bacilli. The patient was admitted to the intensive care unit due to respiratory failure and underwent bronchoscopic examination due to air leakage. The right middle lobe was obliterated by using an endobronchial Watanabe Spigot (EWS), and the amount of leakage decreased considerably after the procedure. On day 7, chest tube drainage was removed, and empyema was drained with a Pezzer drain. On day 50, upon the cessation of empyema drainage, spigots were removed with rigid and flexible bronchoscope. In conclusion, EWS use in the treatment of bronchopleural fistula is an effective, safe and a reversible procedure.

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Treatment of a Tuberculous Empyema with Simultaneous Oral and Intrapleural Antituberculosis Drugs

Cited by 17 publications

References 7 publications

Therapeutic drug monitoring and the conservative management of chronic tuberculous empyema: case report and review of the literature

Therapeutic drug monitoring and the conservative management of chronic tuberculous empyema: case report and review of the literature

A Study on Tuberculo Us Empyema Thoracis in Children

Endobronchial Watanabe Spigot Embolisation in the Treatment of Bronchopleural Fistula due to Tuberculous Empyema in Intensive Care Unit

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