Legionella pulmonary abscess and pleural space infection in an immunocompetent patient

2021 ◽  
Vol 14 (5) ◽  
pp. e243026
Author(s):  
Kristen L Flint ◽  
Maxwell R Lloyd ◽  
Polly van den Berg ◽  
Zahir Kanjee
Keyword(s):  
Antibiotic Therapy ◽  
Immunocompetent Patient ◽  
Fibrinolytic Therapy ◽  
Pleural Space ◽  
Ct Imaging ◽  
Flank Pain ◽  
Parapneumonic Effusion ◽  
Space Infection ◽  
Pulmonary Abscess ◽  
Complicated Parapneumonic Effusion

A 34-year-old woman is admitted to the hospital with dyspnoea, dry cough and left-sided flank pain. Her Legionella urinary test was positive and CT imaging demonstrated multifocal pneumonia with pulmonary abscesses. Although she had initial clinical improvement on appropriate antibiotic therapy, her hospital course was complicated by worsening flank pain, hypoxemia and leucocytosis, prompting clinical re-evaluation and assessment for development of complications involving the pleural space. CT imaging revealed interval development of a loculated complicated parapneumonic effusion. Successful treatment required chest tube drainage assisted by fibrinolytic therapy. This case highlights the importance of considering Legionella in patients with pulmonary abscess, demonstrates an approach to a patient with a non-resolving pneumonia and illustrates the management of parapneumonic effusions.

scholarly journals Empiema

2019 ◽  
Vol 4 (1) ◽  
pp. 26
Author(s):  
Helmia Hasan ◽  
Devi Ambarwati
Keyword(s):  
Antibiotic Therapy ◽  
Pulmonary Infection ◽  
Pleural Cavity ◽  
Mortality Rates ◽  
Fibrinolytic Therapy ◽  
Morbidity And Mortality ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Open Thoracotomy ◽  
Community Aquired Pneumonia

Empyema is a collection of exudative fluid in the pleural cavity associated with the occurrence of pulmonary infection. Empyema is often caused by complications of pneumonia but can also be caused by infection from elsewhere. Community-aquired pneumonia has an incidence of 8 to 15 per 1000 per year. Forty to 57% of patients with pneumonia, may develop into a parapneumonic effusion. Approximately 5 to 10% of parapneumonic effusions develop into empyema. All patients with parapneumonia and empyema effusions require antibiotic therapy early and adequate. Sterile pleural effusions with PH ≥ 7,20 were observed and protected by adequate antibiotics. Empyema and localized pleural effusions and parapneumonic effusions with PH <7.20 or glucose <60 mg / dL or the presence of germs on positive examination and culture require drainage. Delays in drainage may increase morbidity and mortality rates. Management of empyema depending on the stage, antibiotics or thoracocentesis, thoracostomy, thoracostomy with fibrinolytic therapy, thoracoscopy, dekortication and open thoracotomy.

scholarly journals Cumulative radiation dose incurred during the management of complex pleural space infection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher R. Gilbert ◽  
Anee S. Jackson ◽  
Candice L. Wilshire ◽  
Leah C. Horslen ◽  
Shu-Ching Chang ◽  
...  
Keyword(s):  
Ionizing Radiation ◽  
Radiation Exposure ◽  
Effective Dose ◽  
Cumulative Dose ◽  
Linear Regression Analysis ◽  
Fibrinolytic Therapy ◽  
Pleural Space ◽  
Radiographic Imaging ◽  
Space Infection ◽  
Cumulative Effective Dose

Abstract Background Complex pleural space infections are commonly managed with antibiotics, pleural drainage, intrapleural fibrinolytic therapy, and surgery. These strategies often utilize radiographic imaging during management, however little data is available on cumulative radiation exposure received during inpatient management. We aimed to identify the type and quantity of radiographic studies along with the resultant radiation exposure during the management of complex pleural space infections. Methods Retrospective review of community network healthcare system from January 2015 to July 2018. Patients were identified through billing databases as receiving intrapleural fibrinolytic therapy and/or surgical intervention. Patient demographics, clinical outcomes, and inpatient radiographic imaging was collected to calculate cumulative effective dose. Results A total of 566 patients were identified with 7275 total radiographic studies performed and a median cumulative effective dose of 16.9 (IQR 9.9–26.3) mSv. Multivariable linear regression analysis revealed computed tomography use was associated with increased cumulative dose, whereas increased age was associated with lower cumulative dose. Over 74% of patients received more than 10 mSv, with 7.4% receiving more than 40 mSv. Conclusions The number of radiographic studies and overall cumulative effective dose in patients hospitalized for complex pleural space infection was high with the median cumulative effective dose > 5 times normal yearly exposure. Ionizing radiation and modern radiology techniques have revolutionized medical care, but are likely not without risk. Additional study is warranted to identify the frequency and imaging type needed during complex pleural space infection management, attempting to keep ionizing radiation exposure as low as reasonably possible.

Fifteen-minute consultation: A structured approach to children with parapneumonic effusion and empyema thoracis

2021 ◽  
pp. edpract-2021-322621
Author(s):  
Joanna Kirstin B Dykes ◽  
Adam Lawton ◽  
Saskia Burchett ◽  
Atul Gupta
Keyword(s):  
Fibrinolytic Therapy ◽  
Pleural Space ◽  
Parapneumonic Effusion ◽  
Empyema Thoracis ◽  
Children And Young People ◽  
Intravenous Antibiotics ◽  
Lung Expansion ◽  
Infection And Inflammation ◽  
Spread Of Infection ◽  
Structured Approach

Parapneumonic effusion is defined as the accumulation of pleural fluid associated with lung infection/pneumonia. Parapneumonic effusions can be uncomplicated or complicated. They are caused by the spread of infection and inflammation to the pleural space, and can develop into empyema thoracis—frank pus in the pleural space. Chest radiograph and thoracic ultrasound are the key imaging modalities for the diagnosis of parapneumonic effusion. Management aims are reducing inflammation and bacteria in the pleural cavity, and enabling full lung expansion. Broad-spectrum intravenous antibiotics, with the addition of chest tube drainage and fibrinolytic therapy for larger collections, are the mainstays of management. This article provides a clear, evidence-based and structured approach to the assessment and management of parapneumonic effusion/empyema thoracis in children and young people.

scholarly journals The use of fibrinolytic therapy for parapneumonic effusion in pregnancy: a case report and a review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Awrad Nasralla ◽  
Bryce Laing ◽  
Simon R. Turner
Keyword(s):  
Case Report ◽  
Pregnant Women ◽  
Successful Treatment ◽  
Fibrinolytic Therapy ◽  
Parapneumonic Effusion ◽  
Review Of The Literature ◽  
Limited Evidence ◽  
Safe Alternative ◽  
Complicated Parapneumonic Effusion ◽  
In Pregnancy

AbstractThe use of intrapleural fibrinolytics for complicated parapneumonic effusion has been shown to be an effective and safe alternative to surgery. However, there is limited evidence about its use during pregnancy. We present a case and a review of the literature of pregnant women who had successful treatment of their complicated parapneumonic effusion with intrapleural fibrinolytics. To our knowledge this is the first review of cases of pregnant women with parapneumonic effusion managed with intrapleural fibrinolytic.

scholarly journals Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 829
Author(s):  
Yana Kogan ◽  
Edmond Sabo ◽  
Majed Odeh
Keyword(s):  
Area Under The Curve ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
C Reactive Protein ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Significant Difference ◽  
Study Population ◽  
Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

Predicting Factors for Failure of Medical Treatment in Patients With Complicated Parapneumonic Effusion or Empyema

CHEST Journal ◽  
2011 ◽  
Vol 140 (4) ◽  
pp. 705A
Author(s):  
Sung Kyoung Kim ◽  
Hyeon Hui Kang ◽  
Ju Sang Kim ◽  
Sang Haak Lee ◽  
Joong Hyun Ahn ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Parapneumonic Effusion ◽  
Predicting Factors ◽  
Complicated Parapneumonic Effusion
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