Tuberculous empyema — A case history extending over 30 years

Reeve, P.; Seaton, Douglas

doi:10.1016/0041-3879(86)90009-7

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Clearly INH, PZA and EMB achieved better pleural fluid concentrations relative to serum than did RIF, though if we assume that the albumin fraction of the total protein concentration in the pleural fluid was similar to that in the serum, free RIF and MOX concentrations in our case may have been proportionately higher in the pleural space (in serum RIF and MOX are 85 % and 50 % protein bound, respectively) [ 8 , 10 ]. Good penetration of INH is supported by the observation that INH resistance developed in all cases of CTE reported to have acquired drug resistance [ 2 , 6 , 7 , 13 ]. In the two cases in which PZA was measured, it too appeared to penetrate well achieving pleural fluid concentrations that were 50-85 % of serum concentrations, a fortuitous event given that PZA works best in an acid environment and CTEs are characteristically acidic [ 2 , 3 , 14 , 15 ].…”

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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“…In that case, pleural fluid as well as serum T max and C max for ethambutol were virtually identical. Acquired drug resistance has been reported in eight cases of TB empyema (1)(2)(3)(4). All cases were resistant to INH, presumably because it was the only drug that achieved therapeutic concentrations in the pleural space.…”

Section: Discussionmentioning

confidence: 99%

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

Long

Stewart

et al. 2008

Canadian Respiratory Journal

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A 71-year-old man was diagnosed with an uncomplicated tuberculous (TB) empyema. Differential penetration of anti-TB drugs, believed to explain the phenomenon of acquired drug resistance in TB empyema, was confirmed by measurement of serum and pleural fluid anti-TB drug concentrations. Simultaneous oral and intrapleural anti-TB drugs were administered and a cure was achieved. The present case is discussed in the context of the literature on acquired drug resistance in TB empyema. It is argued that high-end doses of oral drugs or combined oral plus intrapleural drugs, along with tube thoracostomy or intermittent thoracentesis, will cure uncomplicated TB empyema without threatening to induce drug resistance or having to resort to surgery.

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Empyema

Seaton¹

2000

Crofton and Douglas's Respiratory Diseases

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Tuberculous empyema — A case history extending over 30 years

Cited by 3 publications

References 8 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

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

Empyema

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