Nonsurgical Thoracic Empyema

Authors: S K. Jindal, MD


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

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