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    Empyema

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    RomMy WiEn MicKho
    1. Empyema is a bacterial infection of the pleural space that develops as a complication of bacterial pneumonia or lung abscess. It occurs when bacteria invade the pleural space, causing an inflammatory response and accumulation of pus. 2. There are typically three stages of empyema progression: exudative (thin fluid), fibrinopurulent (thick pus with fibrin deposition), and organizing (fibroblast proliferation and fluid resorption). The most common causative bacteria are Streptococcus pneumoniae, Staphylococcus aureus, and Group A streptococci. 3. Diagnosis involves chest imaging, thoracentesis of pleural fluid for analysis, and culture of fluid

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    Empyema

    Uploaded by

    RomMy WiEn MicKho
    530 views18 pages
    1. Empyema is a bacterial infection of the pleural space that develops as a complication of bacterial pneumonia or lung abscess. It occurs when bacteria invade the pleural space, causing an inflammatory response and accumulation of pus. 2. There are typically three stages of empyema progression: exudative (thin fluid), fibrinopurulent (thick pus with fibrin deposition), and organizing (fibroblast proliferation and fluid resorption). The most common causative bacteria are Streptococcus pneumoniae, Staphylococcus aureus, and Group A streptococci. 3. Diagnosis involves chest imaging, thoracentesis of pleural fluid for analysis, and culture of fluid

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    empyema

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    1. Empyema is a bacterial infection of the pleural space that develops as a complication of bacterial pneumonia or lung abscess. It occurs when bacteria invade the pleural space, causing an inflammatory response and accumulation of pus. 2. There are typically three stages of empyema progression: exudative (thin fluid), fibrinopurulent (thick pus with fibrin deposition), and organizing (fibroblast proliferation and fluid resorption). The most common causative bacteria are Streptococcus pneumoniae, Staphylococcus aureus, and Group A streptococci. 3. Diagnosis involves chest imaging, thoracentesis of pleural fluid for analysis, and culture of fluid

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    530 views18 pages

    Empyema

    Uploaded by

    RomMy WiEn MicKho
    1. Empyema is a bacterial infection of the pleural space that develops as a complication of bacterial pneumonia or lung abscess. It occurs when bacteria invade the pleural space, causing an inflammatory response and accumulation of pus. 2. There are typically three stages of empyema progression: exudative (thin fluid), fibrinopurulent (thick pus with fibrin deposition), and organizing (fibroblast proliferation and fluid resorption). The most common causative bacteria are Streptococcus pneumoniae, Staphylococcus aureus, and Group A streptococci. 3. Diagnosis involves chest imaging, thoracentesis of pleural fluid for analysis, and culture of fluid

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    1

    Synonyms :
    - Parapneumonic effusion
    - Empyema thoracis
    - Bacterial pneumonia
    - Pleural empyema, pleural effusion
    - Lung abscess
    - Complicated parapneumonic effusions (CPE)
    EMPYEMA
    2
    Bacterial pneumonia with associated pleural
    empyema pleural effusion

    FREQUENCY
    Parapneumonic effusions :
    - exudative ( predominately)
    - In the US: 50-70% of patients complicated
    pneumonia
    More extensive therapy :
    decreased morbidity and extended hospital
    stay
    3
    The most commonly are :
    -Streptococcus pneumoniae,
    -Staphylococcus aureus
    - Group A streptococci

    Complication from:
    Infected skin disorder (varicella, impetigo, or
    infected eczema)
    Haemophilus influenzae rarely

    4
    Parapneumonic effusion pleural effusion with
    - Bacterial pneumonia or/ lung abscess
    - Organisms with chest wall trauma

    Development is gradual

    The progression of pleural fluid collection evolves
    from stage 1-3
    PATHOPHYSIOLOGY
    5
    Stage 1 (Exudative stage)
    - From a contiguous infection
    - The effusion is thin
    - Mostly neutrophils, sterile


    Stage 2 (fibrinopurulent stage)
    - Invasion of the organism into the pleural space
    - Progressive
    - Leukocyte (PMN) invasion
    - Formation of fibrin membrane deposition,
    - Pleural fluid :
    Glucose & pH
    Protein & lactate dehydrogenase (LDH)
    6
    Stage 3 (Organizing stage)
    - Resorption of fluid
    - Fibroblast proliferation parenchymal
    entrapment

    Accumulation of pleural effusions can :
    - Occur rapidly
    - Transudative fluid :
    * Protein < 1.5 g/dL
    * Lymphocytes, macrophages, and mesothelial
    cells (+) but neutrophils (-)

    7
    Inflammatory mediators pleural permeability
    Neutrophil chemotactic mediators
    Significant pleocytosis

    The pleural inflammatory :
    - Procoagulant activity
    - Depressed fibrinolytic activity fibrin deposition
    - Loculations result :
    * fibrin strands
    * proliferate and deposit basement membrane
    proteins separation of the visceral and
    parietal pleura formation pleural peel

    8
    DEFINITION

    Empyema = presence of intrapleural pus
    = advanced parapneumonic
    effusion

    Complicated parapneumonic effusions (CPE)
    require tube thoracostomy or surgery
    9
    CLINICAL MANIFESTATIONS

    Like bacterial pneumonia
    Acute febrile response, pleuritic chest pain,
    cough, dyspnea, and possibly cyanosis
    Abdominal pain, vomiting
    Splinting of the affected side
    Immunocompromised:
    - Symptoms blunted
    - fever may not be present
    10
    PHYSICAL EXAMINATION

    Vary depending : organism and the duration of
    the illness

    Auscultation : crackles, decreased breath sounds,
    pleural rub (if the fluid <<)

    Percussion: dullness, decreased breath sounds

    Physical findings and presentation may
    11
    DIFFERENTIALS

    Congestive Heart Failure
    Hemothorax
    Nephrotic Syndrome
    Pleural Effusion
    Pulmonary Infarction
    Pulmonary Sequestration
    12
    LAB STUDIES

    CBC count
    Blood culture
    Serum LDH
    Total protein
    Glucose concentration
    Bacterial, mycobacterial, and fungal cultures
    Serologic studies of the aspirated pleural fluid
    pH
    Amylase concentration
    Lipid stain or triglycerides


    13
    Cell count and differential thoracentesis :
    typically purulent, elevated WBC count,
    predominance of PMNs
    Early: transudative, WBC count <<, less PMN-
    predominant
    the treatment : based on clinical and the
    culture
    14
    DIAGNOSTIC EVALUATION

    Radiologic: chest radiography Lateral
    decubitus

    Sonography or CT imaging

    Chest CT imaging to detect :
    - pleural fluid and image the airways
    - guide interventional procedures
    - discriminate between pleural fluid and chest
    consolidation
    15
    Thoracentesis diagnostic and therapeutic
    Pus (+) empyema
    The Gram stain, cell differential, and
    chemistries helps to guide therapy
    The fluid cultures specific antimicrobial
    therapy


    16
    TREATMENT

    Control of the infection
    Drainage of the pleural fluid
    Appropriate antibiotic : 10-14 days / IV
    Oxygen
    Oral antibiotics for 1-3 weeks after discharge
    if complicated infections (+)
    17
    ANTIBIOTICS

    Cefuroxime = 150 mg/kgbb/day (: 3 dose)
    Clyndamycin = 25 40 mg/kg/day (: 3 dose)

    PROGNOSIS
    Good most patients recover without sequelae

    Early recognition initiation of definitive
    therapy reduce morbidity and complications
    18
    empyema

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