Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- 28 Acute and Chronic Bronchitis
- 29 Croup, Supraglottitis, and Laryngitis
- 30 Atypical Pneumonia
- 31 Community-Acquired Pneumonia
- 32 Nosocomial Pneumonia
- 33 Aspiration Pneumonia
- 34 Lung Abscess
- 35 Empyema and Bronchopleural Fistula
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
35 - Empyema and Bronchopleural Fistula
from Part V - Clinical Syndromes – Respiratory Tract
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- 28 Acute and Chronic Bronchitis
- 29 Croup, Supraglottitis, and Laryngitis
- 30 Atypical Pneumonia
- 31 Community-Acquired Pneumonia
- 32 Nosocomial Pneumonia
- 33 Aspiration Pneumonia
- 34 Lung Abscess
- 35 Empyema and Bronchopleural Fistula
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
Summary
Infection of the pleural space leading to empyema formation, and the importance of clearing infection and pus from this space, has been recognized since ancient times. Historically, empyema was associated with pneumococcal pneumonia, with Streptococcus pneumoniae causing up to 70% of pleural space infections. With effective antibiotic treatment for pneumonia, the incidence of empyema has decreased markedly, and the spectrum of causative organisms has widened, with S. pneumoniae now accounting for as few as 10% to 20%. However, parapneumonic effusions occur in 30% to 60% of pneumonia cases, and, when empyema occurs, it is associated with an overall mortality of 20%.
Parapneumonic effusions are classified as simple or uncomplicated, complicated, and empyema, based on the appearance and biochemical characteristics of aspirated fluid, which supports the clinical impression of a continuum of disease (Table 35.1).
This classification also has clinical utility in that, during the early acute phase, with free flowing fluid, treatment is simpler than in the more chronic fibropurulent stage associated with multiple loculations and the need for greater interventional therapy. Empyema may be defined as the presence of organisms and numerous host defense cells, neutrophils, in the pleural fluid, or, more narrowly, as pus apparent to the naked eye. Bronchopleural fistula (BPF) may be caused by an empyema or may be associated with empyema following surgery, penetrating lung injuries, or a lung abscess.
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- Information
- Clinical Infectious Disease , pp. 245 - 250Publisher: Cambridge University PressPrint publication year: 2008