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Wang C, Xu H, Liu G, Liu J, Yu H, Chen B, Zheng G, Shu M, Du L, Xu Z, Huang L, Li H, Shu S, Chen Y. A multicenter clinical epidemiology of pediatric pneumococcal meningitis in China: results from the Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) 2019-2020. Front Cell Infect Microbiol 2024; 14:1353433. [PMID: 38558854 PMCID: PMC10978625 DOI: 10.3389/fcimb.2024.1353433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To analyze the clinical epidemiological characteristics including clinical features, disease prognosis of pneumococcal meningitis (PM), and drug sensitivity of S. pneumoniae isolates in Chinese children. Methods A retrospective analysis was performed on the clinical, laboratory microbiological data of 160 hospitalized children less than 15 years of age with PM from January 2019 to December 2020 in 33 tertiary hospitals in China. Results A total of 160 PM patients were diagnosed, including 103 males and 57 females The onset age was 15 days to 15 years old, and the median age was 1 year and 3 months. There were 137 cases (85.6%) in the 3 months to <5 years age group, especially in the 3 months to <3 years age group (109 cases, 68.2%); S. pneumoniae was isolated from cerebrospinal fluid (CSF) culture in 95(35.6%), and 57(35.6%) in blood culture. The positive rates of S. pneumoniae detection by CSF metagenomic next-generation sequencing (mNGS)and antigen detection method were 40.2% (35/87) and 26.9% (21/78). Fifty-five cases (34.4%) had one or more predisposing factors of bacterial meningitis; and 113 cases (70.6%) had one or more extracranial infection diseases Fever (147, 91.9%) was the most common clinical symptom, followed by vomiting (61, 38.1%) and altered mental status (47,29.4%). Among 160 children with PM, the main intracranial imaging complications were subdural effusion and (or) empyema in 43 cases (26.9%), hydrocephalus in 24 cases (15.0%), cerebral abscess in 23 cases (14.4%), intracranial hemorrhage in 8 cases (5.0%), and other cerebrovascular diseases in 13 cases (8.1%) including encephalomalacia, cerebral infarction, and encephalatrophy. Subdural effusion and (or) empyema and hydrocephalus mainly occurred in children < 1 years old (90.7% (39/43) and 83.3% (20/24), respectively). 17 cases with PM (39.5%) had more than one intracranial imaging abnormality. S. pneumoniae isolates were completely sensitive to vancomycin (100.0%, 75/75), linezolid (100.0%,56/56), ertapenem (6/6); highly sensitive to levofloxacin (81.5%, 22/27), moxifloxacin (14/17), rifampicin (96.2%, 25/26), and chloramphenicol (91.3%, 21/23); moderately sensitive to cefotaxime (56.1%, 23/41), meropenem (51.1%, 23/45) and ceftriaxone (63.5, 33/52); less sensitive to penicillin (19.6%, 27/138) and clindamycin (1/19); completely resistant to erythromycin (100.0%, 31/31). The cure and improvement rate were 22.5% (36/160)and 66.3% (106/160), respectively. 18 cases (11.3%) had an adverse outcome, including 6 cases withdrawing treatment therapy, 5 cases unhealed, 5 cases died, and 2 recurrences. S. pneumoniae was completely susceptible to vancomycin (100.0%, 75/75), linezolid (100.0%, 56/56), and ertapenem (6/6); susceptible to cefotaxime, meropenem, and ceftriaxone in the order of 56.1% (23/41), 51.1% (23/45), and 63.5 (33/52); completely resistant to erythromycin (100.0%, 31/31). Conclusion Pediatric PM is more common in children aged 3 months to < 3 years old. Intracranial complications mostly occur in children < 1 year of age with fever being the most common clinical manifestations and subdural effusion and (or) empyema and hydrocephalus being the most common complications, respectively. CSF non-culture methods can facilitate improving the detection rate of pathogenic bacteria. More than 10% of PM children had adverse outcomes. S. pneumoniae strains are susceptible to vancomycin, linezolid, ertapenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.
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Affiliation(s)
- Caiyun Wang
- Department of Infectious Disease, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, China
| | - Hongmei Xu
- Department of Infectious Disease, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Liu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Liu
- Department of Infectious Disease, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Hui Yu
- Department of Infectious Disease, The Children’s Hospital of Fudan University, Shanghai, China
| | - Biquan Chen
- Department of Infection, Anhui Province Children’s Hospital, Hefei, Anhui, China
| | - Guo Zheng
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Shu
- Department of Pediatrics, West China Second University Hospital, Sichuan University/West China Women’s and Children’s Hospital, Chengdu, Sichuang, China
| | - Lijun Du
- Department of Neurology, Children’s Hospital of Shanxi, Taiyuan, Shanxi, China
| | - Zhiwei Xu
- Pediatric Inpatient Ward, The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lisu Huang
- Department of Infectious Disease, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, China
- Department of Infectious Disease, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haibo Li
- Outpatient Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Sainan Shu
- Department of Pediatric Infection and Gastroenterology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yinghu Chen
- Department of Infectious Disease, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, China
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Pérez Ramos IS, Gurruchaga Yanes ML, Fernández Vecilla D, Oiartzabal Elorriaga U, Unzaga Barañano MJ, Díaz de Tuesta Del Arco JL. Cavitary pneumonia and empyema thoracis caused by multidrug resistant Nocardia otitidiscaviarum in an elderly patient. Rev Esp Quimioter 2024; 37:97-99. [PMID: 37960833 PMCID: PMC10874667 DOI: 10.37201/req/042.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/05/2023] [Accepted: 09/15/2023] [Indexed: 11/15/2023]
Affiliation(s)
| | | | - D Fernández Vecilla
- Domingo Fernández Vecilla, Clinical microbiology service. Laredo Regional Hospital. Av. Derechos Humanos, 40, 39770, Laredo, Cantabria (Spain).
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Nakamura T, Ishikawa K, Murata N, Sato K, Kitamura A, Mori N, Jinta T. Empyema necessitans caused by methicillin-resistant Staphylococcus aureus: a case report and literature review. BMC Infect Dis 2024; 24:157. [PMID: 38302885 PMCID: PMC10835956 DOI: 10.1186/s12879-024-09062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/26/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Empyema necessitans (EN) is a rare condition characterized by pleural infection with pus spreading into adjacent soft tissues. Although Mycobacterium tuberculosis and Actinomyces israelii are common causative agents, methicillin-resistant Staphylococcus aureus (MRSA) is relatively rare, but it is associated with high mortality in empyema cases. We aimed to report a unique case of EN caused by MRSA and present a literature review to better understand this rare condition. CASE PRESENTATION A 69-year-old man with a history of right ureteral stone presented with fever and left anterior thoracic pain. A physical examination revealed redness and swelling in the left thoracic region. Imaging studies confirmed EN with fluid accumulation around the sternocostal joint of the left first rib. MRSA was identified from blood and pleural fluid cultures. The patient received antimicrobial therapy, and a chest tube was inserted for drainage. Despite initial improvement, vertebral osteomyelitis was diagnosed on day 17. The antimicrobials were subsequently terminated after 6 weeks, but vertebral osteomyelitis recurred, and treatment was resumed and completed on day 215. CONCLUSION EN caused by MRSA is rare, and the literature review revealed 14 cases from human sources. Positive blood cultures were observed in 40% of cases, and metastatic infections were present in 30% of cases. Osteomyelitis was the most common type of metastatic lesion. All the patients underwent drainage. Patients with MRSA-associated EN frequently develop disseminated lesions and should therefore be carefully examined. Moreover, appropriate treatment with antibiotics and drainage is necessary for a good prognosis. Although the prognosis appeared to be favorable in our review, publication bias and treatment challenges for metastatic infections should be considered.
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Affiliation(s)
- Tomoaki Nakamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan.
| | - Kazuhiro Ishikawa
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Murata
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Kuniko Sato
- St. Luke's International University Library, Tokyo, Japan
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
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Smith D, Shaw H, Ryder T. Intrapleural tissue plasminogen activator and deoxyribonuclease administered concurrently and once daily for complex parapneumonic pleural effusion and empyema. Intern Med J 2023; 53:2313-2318. [PMID: 37029951 DOI: 10.1111/imj.16084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/06/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Pleural infection is life-threatening and increasingly prevalent. In addition to usual care, twice-daily, separate administration of tissue plasminogen activator and deoxyribonuclease (tPA-DNase) reduces radiological pleural opacity with lower surgical referral rates. AIMS This retrospective cohort study examines the use of once-daily, concurrent administration of tPA-DNase for complex parapneumonic pleural effusion and empyema. METHODS Patients with pleural infection who received intrapleural tPA-DNase between October 2014 and July 2020 at Logan Hospital, where it is given concurrently and once-daily as salvage therapy, were retrospectively identified. Radiographic opacification, inflammatory markers, clinical response and complications were examined. RESULTS Thirty-one patients were identified. Mean age was 48.8 years (standard deviation [SD], 17.2). Median tPA-DNase administration was 3 (interquartile range [IQR], 2-3). Chest x-ray pleural opacity decreased significantly (P = 0.047) from a median of 39.6% (IQR, 28.8-65.7%) to 9.7% (IQR, 2.5-23.2%), a median relative reduction of 75.5% (IQR, 47.7-93.9%). White cell count and C-reactive protein improved significantly (P = 0.002 and P = 0.032, respectively) from a median of 16.3 × 109 /L (IQR, 11.8-20.6 × 109 /L) to 9.9 × 109 /L (IQR, 8.0-12.3 × 109 /L) and 311.0 mg/L (IQR, 218.8-374.0 mg/L) to 69.0 mg/L (IQR, 36.0-118.0 mg/L), respectively. No patients experienced significant bleeding or died. Five patients (16.1%) were referred for surgery. CONCLUSION This is pilot evidence that a practical regimen of concurrent, once-daily intrapleural tPA-DNase improved pleural opacification and inflammatory markers without bleeding or mortality. The surgical referral rate was higher than in studies assessing twice-daily administration, though the validity of this outcome as a measure of treatment success is limited, and further studies are needed to assess the optimal dose and frequency of intrapleural therapy and indications for surgical referral.
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Affiliation(s)
- Dugal Smith
- Respiratory Department, Logan Hospital, Logan City, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Hannah Shaw
- Respiratory Department, Logan Hospital, Logan City, Queensland, Australia
| | - Timothy Ryder
- Respiratory Department, Logan Hospital, Logan City, Queensland, Australia
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Kelley SR, McCall AS, Qian ET, Ely EW. Intrapleural Dakin's Solution for Refractory Empyema in a Critically Ill Patient. J Bronchology Interv Pulmonol 2023; 30:296-298. [PMID: 35969007 DOI: 10.1097/lbr.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Soibhan R Kelley
- Department of Medicine, Vanderbilt University Medical Center, Division of Allergy, Pulmonary, and Critical Care
| | - Abraham Scott McCall
- Department of Medicine, Vanderbilt University Medical Center, Division of Allergy, Pulmonary, and Critical Care
| | - Edward T Qian
- Department of Medicine, Vanderbilt University Medical Center, Division of Allergy, Pulmonary, and Critical Care
| | - Eugene Wesley Ely
- Department of Medicine, Vanderbilt University Medical Center, Division of Allergy, Pulmonary, and Critical Care
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center
- Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN
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6
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Dasari SP, Patel MA, Saravanan V, Jha S, O'Sullivan KL, Gill HS, Acharya P, Jha P. Clostridioides difficile Pyogenic Liver Abscess With an Empyema. WMJ 2022; 121:E5-E9. [PMID: 35442586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Reports of extraintestinal manifestations of Clostridioides difficile (C difficile) infections are rare. The frequency of these infections comprises approximately 0.17% to 0.6% of all C difficile infections. While they are becoming more frequent worldwide, the precise trend is unclear. CASE PRESENTATION An 83-year-old female patient presented with pleuritic chest pain 2 to 3 months after a needle biopsy of her liver abscess confirmed C difficile. She was found to have extension of the liver abscess into the chest cavity, leading to empyema, and was treated with intravenous antimicrobials. DISCUSSION This is the fifth known reported case of C difficile leading to a pyogenic liver abscess and the first case where the C difficile liver abscess was associated with an empyema. While long-term metronidazole is considered effective for managing extra intestinal C difficile infection, our patient was treated with vancomycin and meropenem. CONCLUSION To determine epidemiology and a proper treatment regimen for extraintestinal C difficile infection, a greater accumulation of cases is necessary.
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Affiliation(s)
- Suhas P Dasari
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Mit A Patel
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vishmayaa Saravanan
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sanjana Jha
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kayla L O'Sullivan
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Harpreet S Gill
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pramod Acharya
- Department of Infectious Disease, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pinky Jha
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Lee EK, Kim J, Park DH, Lee CK, Kim SB, Sohn JW, Yoon YK. Disseminated nocardiosis caused by Nocardia farcinica in a patient with colon cancer: A case report and literature review. Medicine (Baltimore) 2021; 100:e26682. [PMID: 34398037 PMCID: PMC8294930 DOI: 10.1097/md.0000000000026682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities. PATIENT CONCERNS A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests. DIAGNOSES N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing. INTERVENTIONS The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence. OUTCOMES Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer. LESSONS Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.
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Affiliation(s)
- Eung Kyum Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Jin Kim
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Chang Kyu Lee
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
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Lauda-Maillen M, Lemaignen A, Puyade M, Catroux M, Le Moal G, Beraud G, El Hajj H, Michaud A, Destrieux C, Bernard L, Rammaert B, Cazenave-Roblot F. Feasibility of early switch to oral antibiotic in brain abscesses and empyema: a multicentre retrospective study. Eur J Clin Microbiol Infect Dis 2020; 40:209-213. [PMID: 32671654 DOI: 10.1007/s10096-020-03904-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- M Lauda-Maillen
- Université de Poitiers, Poitiers, France.
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France.
| | - A Lemaignen
- Université de Tours, Tours, France
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - M Puyade
- Service de Médecine Interne, CHU de Poitiers, Poitiers, France
| | - M Catroux
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - G Le Moal
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - G Beraud
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - H El Hajj
- Service de Neurochirurgie, CHU de Poitiers, Poitiers, France
| | - A Michaud
- Service de Microbiologie, CHU de Poitiers, Poitiers, France
| | - C Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- Service de Neurochirurgie, CHRU de Tours, Tours, France
| | - L Bernard
- Université de Tours, Tours, France
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - B Rammaert
- Université de Poitiers, Poitiers, France
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
- INSERM U1070, Poitiers, France
| | - F Cazenave-Roblot
- Université de Poitiers, Poitiers, France
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
- INSERM U1070, Poitiers, France
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Takatsuka H, Yamazaki S, Watanabe A, Yokoyama I, Suzuki T, Kamei K, Ishii I. Successful treatment of Aspergillus empyema using combined intrathoracic and intravenous administration of voriconazole: A case report. J Infect Chemother 2020; 26:847-850. [PMID: 32414688 DOI: 10.1016/j.jiac.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/06/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
Aspergillus empyema is treated with either systemic administration of antifungal drugs or surgery, but the mortality rate is very high. Here, we report a case of Aspergillus empyema successfully treated using combined intrathoracic and intravenous administration of voriconazole (VRCZ). Treatment success was achieved by monitoring VRCZ plasma trough concentration. The patient was a 71-year-old Japanese woman diagnosed with Aspergillus empyema whom we started on intravenous administration of VRCZ. Although penetration of VRCZ into the pleural effusion was confirmed, the level was below 1 μg/mL, which is the minimum inhibitory concentration for Aspergillus fumigatus determined by antifungal susceptibility testing in pleural effusion culture. Therefore, we initiated combination therapy with intrathoracic and intravenous administration of VRCZ. VRCZ 200 mg was first dissolved in 50-100 mL of saline and administered into the thoracic cavity via a chest tube. The chest tube was clamped for 5-6 h, and then VRCZ solution was excreted though the chest tube. When a single dose of the VRCZ was administered into the intrathoracic space, the plasma concentration before intravenous administration increased from 1.45 μg/mL on day 27 to 1.53 μg/mL on day 28. Although intravenous administration was continued, the VRCZ plasma trough concentration decreased to 1.36 μg/mL on day 29. We therefore decided on an intrathoracic administration schedule of 2-3 times a week. Intrathoracic administration was performed 14 times in total until fenestration surgery on day 64. Our case suggests that combined intrathoracic and intravenous administration of VRCZ may be a valid treatment option for Aspergillus empyema.
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Affiliation(s)
| | | | - Akira Watanabe
- Divison of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Takaaki Suzuki
- Division of Pharmacy, Chiba University Hospital, Japan; Graduate School of Pharmaceutical Sciences, Chiba University, Japan.
| | - Katsuhiko Kamei
- Divison of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Itsuko Ishii
- Division of Pharmacy, Chiba University Hospital, Japan; Graduate School of Pharmaceutical Sciences, Chiba University, Japan
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Monteiro SRM, Gallucci A, Rousset N, Freeman PM, Ives EJ, Gandini G, Granger N, Vanhaesebrouck AE. Medical management of spinal epidural empyema in five dogs. J Am Vet Med Assoc 2017; 249:1180-1186. [PMID: 27823364 DOI: 10.2460/javma.249.10.1180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 5 dogs were examined because of clinical signs of myelopathy, including signs of pain associated with the spinal region and rapidly progressive neurologic deficits. CLINICAL FINDINGS In all dogs, results of MRI were consistent with spinal epidural empyema. Concurrent infectious processes were identified at adjacent or distant sites in all dogs, including diskospondylitis, prostatitis, dermatitis, paraspinal infection following a penetrating injury, urinary tract infection, and pyothorax. Bacteria were isolated from 3 dogs; Escherichia coli was isolated from blood, urine, and prostatic wash samples from 1 dog; a Pasteurella sp was isolated from a percutaneous aspirate from an adjacent infected wound in a second dog; and a Corynebacterium sp was isolated from a thoracic fluid sample from a third dog. For the remaining 2 dogs, results of bacterial culture were negative. TREATMENT AND OUTCOME All dogs showed clinical improvement within 2 weeks after initiation of antimicrobial treatment, and all had an excellent long-term outcome. CLINICAL RELEVANCE In dogs, spinal epidural empyema has previously been regarded as a surgical emergency. Findings for dogs in the present report suggested that, as is the case for humans, selected dogs with spinal epidural empyema may be successfully managed with medical treatment alone.
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Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT, Juszczyk D, Charlton J, Ashworth M. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ 2016; 354:i3410. [PMID: 27378578 PMCID: PMC4933936 DOI: 10.1136/bmj.i3410] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs). DESIGN Cohort study. SETTING 610 UK general practices from the UK Clinical Practice Research Datalink. PARTICIPANTS Registered patients with 45.5 million person years of follow-up from 2005 to 2014. EXPOSURES Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients. MAIN OUTCOME MEASURES Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice. RESULTS From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. From 2005 to 2014, new episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. Age and sex standardised incidences for pneumonia and peritonsillar abscess were higher for practices in the lowest fourth of antibiotic prescribing compared with the highest fourth. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (95% confidence interval 7.8% to 17.5%, P<0.001) for pneumonia and 9.9% (5.6% to 14.0%, P<0.001) for peritonsillar abscess. If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome were similar in frequency at low prescribing and high prescribing practices. CONCLUSIONS General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre's syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.
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Affiliation(s)
- Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Michael V Moore
- Academic Unit for Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Academic Unit for Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Robin Fox
- The Health Centre, Bicester, Oxford, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Dorota Juszczyk
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Judith Charlton
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, Guy's Campus, London SE1 1UL, UK
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Affiliation(s)
- Jacob Ninan
- Department of Hospital Medicine, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, WI
| | - Sherene Fakhran
- Division of Pulmonary and Critical Care, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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Stockmann C, Ampofo K, Pavia AT, Byington CL, Sheng X, Greene TH, Korgenski EK, Hersh AL. Comparative Effectiveness of Oral Versus Outpatient Parenteral Antibiotic Therapy for Empyema. Hosp Pediatr 2015; 5:605-612. [PMID: 26526596 DOI: 10.1542/hpeds.2015-0100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Treatment of pediatric parapneumonic empyema (PPE) requires several weeks of antibiotic therapy that is typically completed in the outpatient setting. The route of outpatient therapy can be oral or intravenous (outpatient parenteral antibiotic therapy [OPAT]). No studies have compared outcomes between oral therapy and OPAT for PPE. METHODS We identified children <18 years hospitalized from 2005 to 2014 at Primary Children's Hospital with PPE and discharged with oral therapy or OPAT. The primary outcome was the percentage of children who experienced all-cause complications after discharge. Complications included those that were related to pneumonia (including treatment failure, defined as readmission with reaccumulation of pleural fluid or abscess requiring drainage) or antibiotic therapy (eg, allergy, line clot) resulting in either a hospital readmission or emergency department/urgent care visit. All-cause complications were compared between oral therapy and OPAT by using propensity score-weighted logistic regression. RESULTS A total of 391 children were hospitalized with PPE; 337 (86%) were discharged with OPAT; 35 (9%) children experienced an all-cause complication, including 5 with oral (9.3%) and 30 (8.9%) with OPAT. Pneumonia and treatment-related complications were comparable (P = .25 and .78, respectively). Two patients treated with OPAT (1%) experienced treatment failure. After adjustment using propensity score weighting, the frequency of complications was similar between groups (adjusted odds ratio 0.97, 95% confidence interval 0.23-4.65). CONCLUSIONS The frequency of complications was similar with oral therapy and OPAT for children with PPE. Oral antibiotics may be considered safe and effective for children with PPE who will be discharged to complete therapy in the outpatient setting.
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Affiliation(s)
| | | | | | | | - Xiaoming Sheng
- Departments of Pediatrics and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - Tom H Greene
- Departments of Pediatrics and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - Ernest K Korgenski
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
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Das RR, Sami A, Seth R, Nandan D, Kabra SK, Suri V. Thoracic neuroblastoma presenting as recurrent empyema. Natl Med J India 2014; 27:84-85. [PMID: 25471760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Neuroblastoma is the most common intra-abdominal and extracranial solid tumour in children, accounting for 7%-8% of all childhood cancers. It is a malignant tumour of the autonomic nervous system derived from the neural crest. Most children with neuroblastoma have distant metastatic disease at the time of diagnosis. Pulmonary metastasis at the time of diagnosis is rare, and rarer is the presence of associated pleural effusion. We present the case of a child with recurrent empyema, who was diagnosed to have a thoracic neuroblastoma.
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Affiliation(s)
- Rashmi Ranjan Das
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India - Department of Paediatrics
| | - Abdus Sami
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India - Department of Paediatrics
| | - Rachna Seth
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India - Department of Paediatrics
| | - Devki Nandan
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India - Department of Paediatrics
| | - Sushil K Kabra
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India - Department of Paediatrics
| | - Vaishali Suri
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India - Department of Pathology
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15
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Cardile AP, Briggs H, Burguete SR, Herrera M, Wickes BL, Jorgensen JH. Treatment of KPC-2 Enterobacter cloacae empyema with cefepime and levofloxacin. Diagn Microbiol Infect Dis 2013; 78:199-200. [PMID: 24268534 DOI: 10.1016/j.diagmicrobio.2013.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022]
Abstract
Carbapenem-resistant Enterobacteriaceae infections are becoming more common, are associated with high mortality rates, and are difficult to treat due to multiple mechanisms of resistance. We describe the successful treatment of Klebsiella pneumoniae carbapenemase-expressing Enterobacter cloacae empyema in a lung transplant recipient with cefepime and levofloxacin.
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Affiliation(s)
- Anthony P Cardile
- Infectious Disease Service Brooke Army Medical Center, Houston, TX, USA.
| | - Heather Briggs
- Department of Medicine University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - S Rodrigo Burguete
- Department of Medicine University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Monica Herrera
- Department of Microbiology University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Brian L Wickes
- Department of Microbiology University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - James H Jorgensen
- Department of Medicine University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Microbiology University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Pathology University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Mohanty S, Gaind R, Paul P, Deb M. Bacteraemic Haemophilus influenzae type B pneumonia complicated with empyema--report of a case and review of literature. J Commun Dis 2013; 45:95-100. [PMID: 25141560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A case of bacteraemic pneumonia complicated with pleural empyema due to Haemophilus influenzae type b is reported in a one-year old previously healthy child who had apparently no other associated medical condition. The organism was isolated from both the pleural fluid aspirate and blood of the patient with pneumonia. She was successfully treated with parenteral ampicillin and chloramphenicol alongwith intercostal chest tube drainage. The case is notable because it adds to the existing disease spectrum of invasive Hib diseases and brings awareness to the existing burden of the disease in Asia. In addition, it reflects the urgent need to include Hib vaccine in the current immunization program in India.
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Abstract
Empyema thoracis is a common cause of morbidity in children. We conducted a prospective observational study in 50 children (age 0-15 y) diagnosed with empyema to study its clinico-bacteriological profile and outcome in a referral hospital. Staphylococcus aureus was the most common causative organism, most of them being MRSA, followed by Pneumococcus and Pseudomonas. Primary video-assisted thoracoscopy appeared to be a good mode of management with lesser duration of hospital stay. However, the number of children undergoing this procedure was very less, to come to any conclusion.
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Affiliation(s)
- D Narayanappa
- Departments of Pediatrics, and * Pediatric Surgery, JSS Medical College and Hospital, JSS University, Mysore, Karnataka. India. Correspondence to: Dr D Narayanappa, No.534, Sinchana, 15th main, 5th Cross, Saraswathipuram, Mysore 570 009, Karnataka. India.
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Sivolodskiĭ EP, Kotiv BN, Kolobova EN, Gorelova GV, Bogoslovskaia SP, Barinov OV, Ivanov FV. [Isolation of Shewanella algae from pleural exudate of patient with pneumonia]. Zh Mikrobiol Epidemiol Immunobiol 2012:74-76. [PMID: 23163042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Clinical-microbiological description of the first case in Russia of isolation of S. algae bacteria from clinical material. MATERIALS AND METHODS Patient P., 23 years of age, diagnosis: right-sided distal pneumonia, severe course; parapneumonic empyema of pleura. Bacteria isolation, cultural and biochemical tests differentiating S. algae and Shewanella putrefaciens were performed according to Holt H.M. et al., 2005. Identification of bacteria, tests of sensitivity to antibiotics were carried out by automatic system Vitek 2 (bioMerieux) and additionally by disc-diffusion method. RESULTS S. algae in association with Serratia marcescens were isolated from pleural exudate of the patient with pneumonia. S. algae bacteria had typical taxonomical features and pathogenicity factors (lipase, gelatinase, beta-hemolysin); were resistant to benzylpenicillin, amoxicillin, cefazolin and sensitive to other beta-lactam antibiotics, aminoglycosides, fluoroquinolones, macrolides, tetracycline. CONCLUSION S. algae bacteria isolated from pleural exudate of the patient with pneumonia are etiologically significant in parapneumonic empyema of pleura.
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Dulaney CR, Merrill WH, Tesseneer S, Jenkins-Lonidier L, Tribble CG. Current use of intrapleural tissue plasminogen activator in the treatment of complex pleural processes: a review of the literature and report of 9 cases. J Miss State Med Assoc 2012; 53:216-219. [PMID: 23066590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Intrapleural tissue plasminogen activator is increasingly being utilized to treat complex pleural processes, such as complicated pleural effusions and empyemas, without surgical intervention. This technique is especially useful for patients with numerous co-morbidities or who are poor surgical candidates. We present our experience in treating nine adult patients with intrapleural tissue plasminogen activator for complex pleural processes. Patients were treated with one to eight doses until their condition resolved or surgical intervention was necessary. Seven patients had complete resolution, two patients required surgical intervention, and there were no complications from therapy. A review of all available literature on the use of intrapleural tissue plasminogen activator in adults is presented, comparing the various methods and techniques used by others.
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Affiliation(s)
- Caleb R Dulaney
- University of Mississippi School of Medicine, Jackson 39216, USA
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Mahajan RK, Kharbanda P, Ahuja S, Omprakash B, Duggal N, Hans C. Salmonella enterica serotype Typhi from a case of empyema. J Commun Dis 2011; 43:85-87. [PMID: 23785888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Rakesh K Mahajan
- Department of Microbiology, Dr. R. M. L Hospital & PGIMER, New Delhi-110001.
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Luo L, Zhou Q, Chen XJ, Qin SM, Ma WL, Shi HZ. Effects of the TREM-1 pathway modulation during empyema in rats. Chin Med J (Engl) 2010; 123:1561-1565. [PMID: 20819512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The activation of triggering receptor expressed on myeloid cells-1 (TREM-1) in the presence of microbial components amplifies the inflammatory response. The aim of the present study was to investigate the effect of the modulation of the TREM-1 pathway during empyema in rats. METHODS Adult male Wistar rats were subjected to empyema induced by intrapleural injection of Pseudomonas aeruginosa and Staphylococcus aureus. The animals were treated with LP17 (a synthetic TREM-1 inhibitor), a control peptide, or a vehicle (normal saline). Differential cell count, flow cytometry and histological examination were performed to evaluate local inflammatory alterations. Concentrations of tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6 in both pleural effusion and serum were measured by enzyme-linked immunosorbent assay. RESULTS Although differential counts of each type of leukocytes in pleural effusion were not affected by LP17, a marked reduction in neutrophil numbers was seen in LP17 treated rats due to the reduction of both pleural effusion volume and total cell numbers. LP17 administration impaired concentration elevation in tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6 in both pleural effusion and serum. It was found that survival rate in LP17 treated rats was much higher than that in control rats. CONCLUSION The modulation of the TREM-1 pathway by the use of LP17 appears to be beneficial during empyema in rats in attenuating pleural and systemic inflammatory responses.
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Affiliation(s)
- Ling Luo
- Department of Respiratory Diseases, Union Hospital, Key Lab of Pulmonary Diseases of Health Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
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Ho MY, Chen HY, Yen YH, Yang YS, Lien SH. Intrapleural streptokinase for the treatment of childhood empyema. Acta Paediatr Taiwan 2007; 48:251-256. [PMID: 18254573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients. METHODS In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone. RESULTS We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscopic surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days. CONCLUSIONS Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.
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Affiliation(s)
- Man-Yau Ho
- Department of Pediatrics, Taipei Medical University - Wanfang Hospital, Taipei, Taiwan
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Daly MW, Riddle DJ, Ledeboer NA, Dunne WM, Ritchie DJ. Tigecycline for Treatment of Pneumonia and Empyema Caused by Carbapenemase-ProducingKlebsiella pneumoniae. Pharmacotherapy 2007; 27:1052-7. [PMID: 17594211 DOI: 10.1592/phco.27.7.1052] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Strains of Klebsiella pneumoniae that produce one of three possible carbapenemases--KPC--have recently been identified with increasing frequency among isolates recovered from patients residing along the East Coast of the United States, particularly within the New York City metropolitan region. These strains have exhibited resistance to multiple antibiotic classes, including carbapenem agents. We report a case of nosocomial pneumonia and empyema caused by a KPC-producing isolate of K. pneumoniae at a large midwestern U.S. tertiary care facility in which the patient was treated with tigecycline. Although the pneumonia was treated successfully, the empyema recurred in association with a treatment-emergent tigecycline minimum inhibitory concentration (MIC) increase from 0.75 to 2 microg/ml. Clinicians should be aware of the potential occurrence of this treatment-emergent MIC increase, especially in the setting of sustained tigecycline therapy. In addition, the emergence of carbapenem-resistant Enterobacteriaceae reinforces the importance of antibiotic stewardship and strict infection control practices.
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Affiliation(s)
- Michael W Daly
- Department of Pharmacy, Barnes-Jewish Hospital, and St. Louis College of Pharmacy, St. Louis, Missouri 63110, USA
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Abstract
Empyema necessitans is a rare complication of pleural space infections and occurs when the infected fluid dissects spontaneously into the chest wall from the pleural space. This process may result from bronchopleural extension of a peripheral lung infection. These cases result from inadequate treatment of an empyema and usually occur after a necrotizing pneumonia or pulmonary abscess. We present two cases of empyema thoracic necessitans.
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Affiliation(s)
- Saud I Ahmed
- Department of Internal Medicine and Infectious Diseases, Harlem Hospital Center, New York, New York 10037, USA
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Dikensoy O, Zhu Z, Na MJ, Liao H, Donnelly E, Light RW. Intrapleural heparin or heparin combined with human recombinant DNase is not effective in the treatment of empyema in a rabbit model. Respirology 2007; 11:755-60. [PMID: 17052304 DOI: 10.1111/j.1440-1843.2006.00934.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE AND BACKGROUND The aim of this study was to investigate the effectiveness of intrapleural heparin or heparin combined with human recombinant DNase in the treatment of empyema. METHODS Empyema was induced in rabbits with an intrapleural injection of 10(9)Pasteurella multicoda organisms in infusion agar via a surgically placed chest tube. Once empyema was verified, a blinded investigator administered drugs via the chest tube. There were three treatment groups each with six rabbits. One group was given 1000 IU heparin, a second group was given 1000 IU heparin plus 1 mg of human recombinant DNase via chest tube and the control group received saline. The rabbits received treatment every 12 h for a total of six treatments and the volume of each treatment was 3 mL. The animals were sacrificed at day 10 and the amount of empyema and pleural thickening was scored macroscopically on a scale of 0-6. RESULTS The total volume of pleural effusion aspirated was significantly higher in the heparin group (25.8+/-10.7 mL) compared with either saline (8+/-8.9) or heparin plus human recombinant DNase (6.8+/-6.1) groups (P=0.003). The mean empyema and pleural thickening scores did not differ significantly between the groups (P=0.8, P=0.5 respectively). A weak correlation was found between total volume of aspirated pleural fluid and pleural parameters of white blood cell counts and LDH levels (r=0.546 and P=0.02, r=0.631 and P=0.02 respectively). CONCLUSION The intrapleural administration of 1000 IU heparin alone or in combination with 1 mg of human recombinant DNase is no more effective than saline in the treatment of empyema in rabbits. Intrapleural heparin significantly increased the drainage of pleural fluid compared with the combination and saline group.
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Affiliation(s)
- Oner Dikensoy
- Pulmonary Division, St. Thomas Hospital and Vanderbilt University, Nashville, TN, USA.
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Taniguchi H, Izumi S. [A case of Mycobacterium intracellulare infection with chronic empyema]. Kekkaku 2006; 81:425-8. [PMID: 16838681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A 83-year-old man had been treated for pulmonary infiltration was referred to a nearby hospital because of slight fever and cough. His chest radiograph and CT showed right chronic empyema, and in which pleural aspirate was smear positive for acid-fast bacilli and positive for PCR-Mycobacterium intracellulare. He was diagnosed as chronic empyema caused by M. intracellulare. A month later exacerbation of bronchopleural fistula was observed and M. intracellulare infection expanded into the lung. He was treated with combined use of ethambutol, rifampicin, clarithromycin, and streptomycin for six months, and his chest radiograph showed improvement, however, finally he died as he was in advanced age and emaciation due to chronic lung infection.
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Affiliation(s)
- Hirokazu Taniguchi
- Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78, Nishinagae, Toyama-shi, Toyama 930-8550, Japan.
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Chen JP, Lue KH, Liu SC, Cheng SL, Sheu JN. Intrapleural urokinase treatment in children with complicated parapneumonic effusion. Acta Paediatr Taiwan 2006; 47:61-6. [PMID: 16927629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Intrapleural instillation of fibrinolytic agent such as urokinase has been shown to be effective as an adjunctive therapy for children with complicated parapneumonic effusion and empyema. In this study, we described our experience with the use of intrapleural urokinase in the management of complicated parapneumonic effusion in children. We collected 13 patients with a mean age of 50.8 months with parapneumonic pleural effusion or empyema; all were treated with intrapleural urokinase after poor response to appropriate antibiotics and simple tube drainage. We also reviewed another 13 patients with a mean age of 45.8 months from the clinical records of children hospitalized with the same conditions prior to urokinase introduction as a control group. The mean fluid drained during the first 24 hours and the first 72 hours after urokinase instillation were significantly greater than those during 24 hours before instillation, p=0.002 and p<0.001, respectively. The total volume of fluid drained was also greater in the urokinase group than that in the control group (p<0.001). The mean duration of chest tube drainage was significantly shorter in the urokinase group (8.7 +/- 2.8 days vs. 14.7 +/- 6.1 days, p<0.02). The mean length of hospitalization was also significantly shorter in the urokinase group (15.5 +/- 5.3 days vs. 24.4 +/- 6.9 days, p=0.002). All 13 patients were managed successfully with urokinase treatment without further surgical procedures. None of the patients experienced any side effect or adverse event after urokinase instillation. Two patients of the control group finally underwent surgical debridement. In conclusion, the use of intrapleural urokinase treatment in children with complicated parapneumonic effusion is an effective and safe therapy.
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Affiliation(s)
- Jung-Pin Chen
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
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Chen WC, Huang JW, Chen KY, Hsueh PR, Yang PC. Spontaneous bilateral bacterial empyema in a patient with nephrotic syndrome. J Infect 2006; 53:e131-4. [PMID: 16457891 DOI: 10.1016/j.jinf.2005.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 12/08/2005] [Indexed: 11/23/2022]
Abstract
Spontaneous bacterial empyema (SBEM), a rare infectious complication among liver cirrhosis patients, is characterized by infection in the presence of pleural effusion without evidence of pre-existing pneumonia. The prevalence of SBEM in cirrhotic patients with hydrothorax is about 13%. However, it has previously not been reported in medical literature in patients with nephrotic syndrome. The most common microorganism identified is Escherichia coli, followed by Streptococcus species, Enterococcus species, Klebsiella pneumoniae, and Pseudomonas stutzeri. We present a patient with a history of nephrotic syndrome caused by membranous nephropathy, who received steroids and cyclophosphamide. He developed bilateral SBEM due to Aeromonas hydrophila and E. coli, which were isolated from the left- and right-side pleural fluid, respectively. The detailed clinical course, treatment, and outcome are described.
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Affiliation(s)
- Wan-Chin Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
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31
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Abstract
Administration routes for antimicrobial agents used in clinical practice include the topical, inhaled, enteral and parenteral routes. An antibiotic administration route used frequently worldwide, although not well-studied, involves the irrigation of wounds with antibiotic-containing solutions for the prevention and treatment of infections. This review considers the data available from various experimental and clinical studies in order to provide an update on the use of antibiotic-containing solutions in modern clinical practice. Although irrigation with antibiotic-containing solutions has been suggested to be beneficial in the prevention or treatment of infections in several settings and patient populations, no firm, evidence-based recommendations can be made regarding its use until additional data from well-designed, randomised clinical trials become available. Current exceptions include empyema following lobectomy, or pneumonectomy and pyocystis (vesical empyema), since irrigation with solutions containing antimicrobial agents seems to be a crucial component of the management of these conditions.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
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32
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Perlroth MG, Miller J. Pseudoallescheria boydii pneumonia and empyema: a rare complication of heart transplantation cured with voriconazole. J Heart Lung Transplant 2004; 23:647-9. [PMID: 15135387 DOI: 10.1016/s1053-2498(03)00298-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2002] [Accepted: 06/18/2003] [Indexed: 11/22/2022] Open
Abstract
Pseudoallescheria boydii pneumonia is a rare occurrence, usually resistant to amphotericin B and other anti-fungal agents. We report a complete response to voriconazole in an immunosuppressed host.
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Affiliation(s)
- Mark G Perlroth
- Division of Cardiovascular Disease, Department of of Medicine, Stanford University, Stanford, California 94305, USA.
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33
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Ulku R, Onat S, Kiliç N. Intrapleural fibrinolytic treatment of multiloculated pediatric empyemas. Minerva Pediatr 2004; 56:419-23. [PMID: 15457139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM The aim of this paper was to compare the efficacy of adjunctive intrapleural fibrinolygic agents (streptokinase, urokinase) on fibrinopurulent stage empyema and chronic stage empyema. METHODS In our clinic, we used intrapleural fibrinolytic agents in 78 pediatric patients (36 fibrinopurument stage empyemas, 42 chronic stage empyemas) between December 1994 and September 2002. Pleural biopsy was done for staging. Streptokinase 250,000 units in 100 ml 0.9% saline solution (62 patients) and 125000 units in 100 ml 0.9% saline solution (16 patients) was instilled daily to the chest tube, and the tube was clamped for 4 h followed by suction. This treatment was continued daily for 2 to 8 days until resolution was demonstrated by chest radiograms and/or computed chest tomography. RESULTS The treatment was discontinued due to allergic reaction and pleural hemorrhage in 1 patient with fibrinopurulent empyema. This patient died 1 day later in a septic condition. The regimen was completely successful in 24/36 (66.6%) fibrinopurulent empyemas, and partially successful in other 11/36 (30.55%). Treatment was ineffective in 38 of 42 patients with chronic empyemas (90.6%). Two cases in chronic phase empyema completely recovered and 2 other patients had a partial response. Success of the treatment was 91.66% (35/36) (complete response: 24/36' partial response 11/36) in the fibropurulent stage and 9.4% (2/42 complete response, 2/42 partial response in chronic cases. CONCLUSIONS Our study suggests that intrapleural fibrinolytic treatment is an effective and safe therapy in children with fibrinopurulent phase thoracic empyema.
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Affiliation(s)
- R Ulku
- Thoracic and Cardiovascular Surgery Department, Dicle University School of Medicine, Diyarbakir, Turkey.
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34
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Lodge BA, Ashley ED, Steele MP, Perfect JR. Aspergillus fumigatus empyema, arthritis, and calcaneal osteomyelitis in a lung transplant patient successfully treated with posaconazole. J Clin Microbiol 2004; 42:1376-8. [PMID: 15004125 PMCID: PMC356879 DOI: 10.1128/jcm.42.3.1376-1378.2004] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 64-year-old male with Aspergillus fumigatus infection that had disseminated from the lung to the ankle and adjacent bone was treated successfully with posaconazole after therapy with itraconazole and amphotericin B lipid complex failed. Marked clinical improvement occurred within 6 weeks of initiation of posaconazole therapy; after 6 months, infection had resolved at all sites. The patient has had no recurrence of infection.
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Affiliation(s)
- Barbara Alexander Lodge
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
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35
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Abstract
We report the first case of Enterococcus cecorum empyema thoracis and spontaneous bacterial peritonitis in a 44-year-old man with underlying cirrhosis. The patient responded to cefotaxime (MIC, 0.25 microg/ml) treatment and drainage of the empyema. Susceptibility of E. cecorum to expanded-spectrum cephalosporins could be due to its production of types of penicillin-binding proteins similar to those produced by Streptococcus species rather than to those produced by Enterococcus species (as predicted by phylogenetic analysis of the 16S rRNA gene sequences).
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Affiliation(s)
- Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong
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36
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Köse M, Oztürk M, Kuyucu T, Güneş T, Akçakuş M, Sümerkan B. Community-acquired pneumonia and empyema caused by Pseudomonas stutzeri: a case report. Turk J Pediatr 2004; 46:177-8. [PMID: 15214751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Pseudomonas stutzeri is an aerobic, nonfermentative, gram-negative rod with polar monotrichous flagella. We report the case of a four-year-old boy who developed community-acquired pneumonia and empyema caused by P. stutzeri. To our knowledge, this is the first report on community-acquired pneumonia and empyema caused by this organism in childhood.
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Affiliation(s)
- Mehmet Köse
- Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
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37
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Borisov AE, Udod VM, Maliar AV, Akimov VP, Maliar LV. [Prophylactics and treatment of pyo-inflammatory complications after appendectomy]. Vestn Khir Im I I Grek 2004; 163:53-5. [PMID: 15626075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The developed method of prophylactics and treatment of pyo-inflammatory complications in the wound after operation of appendectomy with the help of mid-frequency ultrasound with dioxidin as phonophoresis allows to make suppurations in the postoperative patients 5.15 times rarer and the number of pyo-inflammatory complications 6.68 times rarer. The time of healing the wounds was 1.2+/-0.3 days shorter and the duration of treatment of such patients in the hospital 1.8+/-0.8 days less.
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38
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Dilber E, Cakir M, Kalyoncu M, Okten A. C-reactive protein: a sensitive marker in the management of treatment response in parapneumonic empyema of children. Turk J Pediatr 2003; 45:311-4. [PMID: 14768795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
C-reactive protein (CRP) is one of the best indicators of the acute phase response to inflammation. The rapid kinetics of CRP metabolism appears to closely parallel the degree of inflammation. The purpose of this prospective study was to analyze the clinical value of CRP, erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) in the assessment response to treatment in children with parapneumonic empyema. Thirty-eight children were prospectively studied. CRP was elevated in all patients on the day of hospital admission. With antibiotic treatment, serum CRP levels fell rapidly within the first days, and in 32 patients who had uncomplicated course, serial CRP levels fell progressively at each measurement. All but four patients had normal CRP levels on the day of hospital discharge. ESR was also elevated in all patients on the day of hospital admission. Despite antibiotic treatment, ESR continued to increase in all patients in the first few days, with peak values reached on day 3. Only three patients had normal ESR levels on the day of hospital discharge. In six patients who had a complicated course, after an initial decrease, CRP levels began to rise earlier than ESR and WBC count. Plasma CRP level is a sensitive marker not only in the diagnosis of parapneumonic empyema, but also in the management of treatment response.
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Affiliation(s)
- Embiya Dilber
- Department of Pediatrics, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
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39
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Polito WF, Arabia FA, Tsau PH, Paramesh V, Woolley DS, Bose RK, Sethi GK, Copeland JG. Successful management of empyema in a patient with a total artificial heart. Ann Thorac Surg 2003; 76:610-1. [PMID: 12902117 DOI: 10.1016/s0003-4975(03)00157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A description of successful management of a patient who developed an empyema as a postoperative complication following the insertion of a CardioWest total artificial heart (TAH) as a bridge to cardiac transplantation is presented. By using traditional methods of management, the patient recovered and went on to transplant.
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Affiliation(s)
- William F Polito
- University of Arizona Sarver Heart Center, Tucson, Arizona 85724-5071, USA
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40
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41
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Dawis MA, Bottone EJ, Vlachos A, Burroughs MH. Unsuspected Toxoplasma gondii empyema in a bone marrow transplant recipient. Clin Infect Dis 2002; 34:e37-9. [PMID: 11941570 DOI: 10.1086/339960] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2001] [Revised: 11/13/2001] [Indexed: 11/03/2022] Open
Abstract
Toxoplasma gondii is an opportunistic parasite that can cause severe disease in immunosuppressed individuals. We report a case of unsuspected T. gondii empyema in a bone marrow transplant recipient that was diagnosed by the visualization of numerous intracellular and extracellular tachyzoites in Giemsa- and Gram-stained smears. The patient was treated with pyrimethamine, sulfadiazine, clindamycin, and atovaquone, and she survived 110 days after diagnosis, despite having a large parasite burden.
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Affiliation(s)
- Maria Agnes Dawis
- Department of Pediatrics, Division of Infectious Diseases, Mount Sinai School of Medicine, New York, NY, 10029, USA.
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42
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Chen SM, Sheu JN, Chen JP, Yang MH. Community-acquired Pseudomonas aeruginosa pneumonia complicated with loculated empyema in an infant with selective IgA deficiency. Acta Paediatr Taiwan 2002; 43:157-61. [PMID: 12148967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Pseudomonas aeruginosa is widely prevalent in the hospital environment, especially in intensive care units. Selective IgA deficiency is characterized by a serum IgA level less than 5 mg/dl with no deficiency of other immunoglobulins. The occurrence of community-acquired P. aeruginosa pneumonia with empyema is rare in pediatric patients. We present a 10-month-old male infant who was referred due to persistent fever and progressive respiratory distress for 1 week. A chest radiograph revealed a right lobar pneumonia with pleural effusion. P. aeruginosa that was subsequently isolated from both blood and pleural effusion cultures. The patient received treatment with ceftazidime and intrapleural instillation of urokinase to promote drainage of empyema. Subsequent immunological screening revealed a very low serum IgA level (<5 mg/dl). We present our experience in successfully treating a loculated empyema with intrapleural instillation of urokinase in an infant. It is also important for pediatricians to be aware that they should be alert for the patient who present with respiratory infections due to unusual organisms. An advanced immunological study to investigate the underlying disorders in these patients is mandatory.
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Affiliation(s)
- Shan-Ming Chen
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
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43
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Apostolova E, Papadopoulos V, Leptidou-Kerestetzi T. Branchial cyst empyema due to Brucella melitensis infection as a form of focal Brucellosis. J Infect 2002; 44:271. [PMID: 12099739 DOI: 10.1053/jinf.2002.0983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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44
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Abstract
BACKGROUND The role of intrapleural fibrinolytic agents in the treatment of childhood empyema has not been established. A randomised double blind placebo controlled trial of intrapleural urokinase was performed in children with parapneumonic empyema. METHODS Sixty children (median age 3.3 years) were recruited from 10 centres and randomised to receive either intrapleural urokinase 40 000 units in 40 ml or saline 12 hourly for 3 days. The primary outcome measure was length of hospital stay after entry to the trial. RESULTS Treatment with urokinase resulted in a significantly shorter hospital stay (7.4 v 9.5 days; ratio of geometric means 1.28, CI 1.16 to 1.41 p=0.027). A post hoc analysis showed that the use of small percutaneous drains was also associated with shorter hospital stay. Children treated with a combination of urokinase and a small drain had the shortest stay (6.0 days, CI 4.6 to 7.8). CONCLUSION Intrapleural urokinase is effective in treating empyema in children and significantly shortens hospital stay.
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Affiliation(s)
- A H Thomson
- Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.
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45
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Abstract
Over the past 20 years at the authors' institution, the management of empyema has evolved. The authors recently have developed a critical pathway in an effort to facilitate diagnosis, guide therapy, and reduce cost. Currently, the average length of stay using this pathway is 4 to 5 days with decreased cost compared to the historic length of stay and a national children's hospital database. The authors review steps to develop a critical pathway as well as discuss their pathway for empyema management.
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Affiliation(s)
- Christine Finck
- Department of Pediatric Surgery University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72202, USA
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46
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Barthwal MS. Intrapleural streptokinase in a two-year-old child with a parapneumonic effusion. Indian J Chest Dis Allied Sci 2001; 43:165-8. [PMID: 11529436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A two-year-old child was hospitalised with features of parapneumonic effusion. He was initially managed with parenteral antibiotics and chest tube drainage. After three days drainage became insignificant inspite of chest tube being patent and appropriately positioned. CT scan of chest showed multiloculated effusion. In view of multiloculated effusion it was decided to try intrapleural fibrinolysis with streptokinase. Streptokinase in a dose of 1,25000 IU dissolved in 50 ml of normal saline was instilled through the chest tube daily. After instilling three doses, there was a significant increase in the drainage followed by almost complete radiological resolution. There were no side effects. Intrapleural streptokinase is a useful adjunctive threapeutic modality in the management of complicated parapneumonic effusion or empyema in paediatric patients.
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Affiliation(s)
- M S Barthwal
- Department of Medicine, Base Hospital, Delhi Cantt, Delhi, India.
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47
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Fukushima K, Nanba K, Shirakawa T, Honda I, Sugimoto M, Naoe H. [A case of post-tuberculosis chronic empyema with effective low-dose, long-term clarithromycin administration]. Nihon Kokyuki Gakkai Zasshi 2001; 39:476-81. [PMID: 11579526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A 78-year-old woman with post-tuberculosis chronic empyema who underwent unsuccessful decortication in July 1993, was admitted to our hospital in November 1994 because of M. tuberculosis in her sputum. One month after anti-tuberculosis treatment, the M. tuberculosis disappeared from the sputum, but a pleurocutaneous fistula that exuded abundant bloody pus containing Pseudomonas aeruginosa persisted in the area of chronic empyema. In July 1997, 200 mg of clarithromycin (CAM) was administered daily; 21 months later, the pus and pleurocutaneous fistula had disappeared. Post-tuberculosis chronic empyema with a fistula is generally an intractable condition that necessitates surgery. In this case, the empyema did not improve during the 4 years after the surgery. However, low-dose, long-term CAM administration brought about a disappearance of pus from the fistula and closure of the empyema spaces.
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Affiliation(s)
- K Fukushima
- Department of Respiratory Medicine, National Saishunso Hospital, 2659 Suya, Nishigoshi-machi, Kikuchi-gun, Kumamoto 861-1196, Japan
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48
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Hawkins JF, Frank N, Sojka JE, Levy M. Fistulation of the auditory tube diverticulum (guttural pouch) with a neodymium:yttrium-aluminum-garnet laser for treatment of chronic empyema in two horses. J Am Vet Med Assoc 2001; 218:405-7, 361. [PMID: 11201568 DOI: 10.2460/javma.2001.218.405] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two horses with chronic empyema of the auditory tube diverticulum (guttural pouch) were refractory to medical treatment; empyema was bilateral in 1 horse and unilateral in the other. Both horses were treated by fistulation of the cartilage of the pharyngeal orifice by use of a neodymium:yttrium-aluminum-garnet laser in a noncontact manner. To maintain patency of the fistulae, indwelling catheters were placed into the openings created by the laser. For both horses, long-term follow-up did not reveal complications, and both owners were satisfied with results of the procedure. The authors recommend this procedure for horses that are unresponsive to medical treatment for chronic guttural pouch empyema.
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Affiliation(s)
- J F Hawkins
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907-1248, USA
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49
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Ndiaye O, Diack-Mbaye A, Ba M, Sylla A, Sow HD, Sarr M, Fall M. [Empyema caused by Staphylococcus aureus in children: the experience of the Albert Royer Children's Hospital at Fann University Hospital, Dakar]. Sante 2000; 10:93-6. [PMID: 10960805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
We report a retrospective study of 58 cases of empyema caused by Staphylococcus aureus at the Albert Royer Children's Hospital at the Fann University Hospital, between January 1st 1992 and December 31st 1995. Staphylococcus aureus is the principal bacterium responsible for pleural effusions in children (54%), way ahead of Streptococcus pneumoniae (19%). Most of the children affected (86%) are less than 30 months old. Theses infections are often serious due to the resistance of the bacterium to the usual antibiotics, the lack of solid research data and mechanical complications associated with the effusion. Treatment is based on the use of an appropriate bactericidal antibiotic treatment and pleural drainage.
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Affiliation(s)
- O Ndiaye
- Service de pédiatrie, Université Cheikh-AntaDiop de Dakar, BP 15872, Dakar, Sénégal.
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50
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Kachel T, Paździor E, Lisiecka E. [A case of empyema after pneumonectomy caused by methicillin-resistant staphylococcus aureus infection treated successfully with local administration with vancomycin]. Pneumonol Alergol Pol 1999; 67:60-4. [PMID: 10481526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
A 55-year-old man underwent left pneumonectomy due to squamous cell carcinoma. Three weeks later bronchopleural fistula and pleural empyema with MRSA infection were recognized. Treatment was based on closed pleural drainage and antibiotic therapy. Initially patient was treated with trimethoprin-sulfamethoxazole and then vancomycin intravenously but empyema was not cured completely. Therefore repeated instillation of vancomycin into the empyema cavity was applied. After 6 days of treatment, culture studies of the pleural fluid became negative and drainage tube was removed 5 days later. We suggest that local administration of vancomycin is an effective method in postpneumonectomy empyema with MRSA infection.
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Affiliation(s)
- T Kachel
- Oddziału Pulmonologicznego Specjalistycznego, Zespołu Chorób Płuc i Gruźlicy w Bystrej Slaskiej
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