Editorial

Nonsurgical Thoracic Empyema

Authors: S K. Jindal, MD

Abstract

Thoracic empyema following community-acquired pneumonia became a relative rarity with the advent of effective antibiotics in the treatment of respiratory infections. An aggressive and early surgical approach to treatment also helped in diminishing the occurrence of empyema in patients with thoracic trauma and suppurative lung diseases. But there has been a resurgence of interest in the problem in the last decade. Several reports have appeared on the changing clinical and microbiologic spectrum, especially from Asian countries in recent years.1–3 Although Streptococcus pneumoniae is generally the more common known pathogen in both children and adults, a study from Taiwan published in this issue of the Southern Medical Journal4 listsStreptococcus milleri as the most common organism for empyema. S milleri was also reported to be responsible for half the cases of empyema in a report from Canada.5 These pathogens are generally responsible in the presence of comorbidities such as alcoholism, diabetes mellitus, and concurrent malignancies. Tuberculosis also remains an important cause of empyema in the high prevalence countries.3

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Tu CY, Hsu WH, Hsia TC, et al. The changing pathogens of complicated para-pneumonic effusions or empyemas in a medical intensive care unit. Intensive Care Med 2006;32:570–576.
 
2. Chen KY, Hsueh PR, Liaw YS, et al. A 10-year experience with bacteriology of acute thoracic empyema. Chest 2000;117:1685–1689.
 
3. Malhotra P, Aggarwal AN, Agarwal R, et al. Clinical characteristics and outcomes of empyema thoracis in 117 patients: a comparative analysis of tuberculous vs non-tuberculous aetiologies. Respir Med 2007;101:423–430.
 
4. Liang SJ, Chen W, Lin C, et al. Community-acquired thoracic empyema in young adults. South Med J 2007;100:1075–1080.
 
5. Ahmed RA, Marrie TJ, Huang JQ. Thoracic empyema in patients with community-acquired pneumonia. Am J Med 2006;119:877–883.
 
6. Farjah F, Symons RG, Krishnadasan B, et al. Management of pleural space infections: a population-based analysis. J Thorac Cardiovasc Surg 2007;133:346–351.
 
7. Solaini L, Prusciano F, Bagioni P. Video-assisted thoracic surgery in the treatment of pleural empyema. Surg Endosc 2007;21:280–284.
 
8. Bilgin M, Akcali Y, Oguzkaya F. Benefits of early aggressive management of empyema thoracis.ANZ J Surg 2006;76:120–122.
 
9. Light RW. Para-pneumonic effusions and empyema. Proc Am Thorac Soc 2006;3:75–80.
 
10. Coote N, Kay E. Surgical versus non-surgical management of pleural empyema. Cochrane Database Syst Rev 2005;19:CD001956.
 
11. Rahman NM, Chapman SJ, Davies RJ. The approach to the patient with a parapneumonic effusion.Clin Chest Med 2006;27:253–266.
 
12. Schiza S, Siafakas NM. Clinical presentation and management of empyema, lung abscess and pleural effusion. Curr Opin Pulm Med 2006;12:205–211.