Pleural empyema

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  • Def: purulent pleural effusion, typically occurring after pneumonia, thoracic surgery, penetrating thoracic injury or mediastinal oesophageal perforation; in elderly it can occur after gastric aspiration or hematogenous spreading from a different focus of infection
  • Pneumonia is the most common cause but occurs in <1% of pneumonias
  • Organisms: typically staphylococcus and streptococcus and gram negative organisms
  • Symptoms: febrile illness and pleural effusion on chest x-ray; pleural fluid with pH <7.2 and glucose <40 strongly suggests an empyema, WBC > 50K cells/cmm, LDH> 1.000 IU/mL
  • Treatment: throracentesis and antibiotics ( fluroquinolones, macrolides, cefuroxime, metronidazole)
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