Comparison of Empyema Thoracis in HIV-Infected and Non-Infected Patients With Regard to Aetiology and Outcome

Empyema thoracis remains a problem in developing countries. Human immunodeficiency virus (HIV) is a risk factor for the development of empyema. There is a clinical impression that HIV-infected patients with empyema have worse outcomes. This study was conducted to assess whether HIV infection affected aetiology or outcomes of patients with empyema. A retrospective review was conducted of 172 patients; meeting established criteria for the diagnosis of empyema; who were admitted to Chris Hani Baragwanath Hospital between January 2006 and December 2009. HIV-infected and non-infected patients were evaluated for differences in aetiology and outcomes; including length of stay; surgical intervention and local complications of closed-tube thoracostomy. A sub-analysis of HIV-infected patients stratified according to CD4 cell count and use of antiretrovirals (ARVs) was also performed. Of the 172 patients; 125 (73) were HIV infected; and 47 (27) were non-infected. HIV-infected patients with lower CD4 cell counts were more likely to be diagnosed with clinical tuberculosis. More commonly; the aetiology of empyema was not determined in HIV-non-infected patients. HIV-infected patients on ARVs were more likely to have thoracic surgery and had shorter hospital stays than those not on ARVs. This study failed to demonstrate any significant differences in aetiology among HIV-infected vs. non-infected patients with empyema. There was a trend towards more Gram-negative infections in the HIV-infected group. ARV use was associated with improved outcomes with regard to cardiothoracic intervention and length of hospital stay

Thoracic empyema: cause and treatment outcome at Gondar University Teaching Hospital, Northwest Ethiopia

Background: Despite improved antimicrobial therapy and multiple options for drainage of infected pleural space, thoracic empyema (TE) continues to cause significant morbidity and mortality. The objectives of this study were to assess the causes and treatment outcome of patients with thoracic empyema. Methods: Patients aged ≥ 13year with TE who were admitted to Gondar University Teaching Hospital, Northwest Ethiopia, from Nov 1999 to Dec 2007 were included. Retrospectively, medical records were reviewed and demographic and clinical data were collected. Results: Records of 81 patients were analyzed; majority (82%) were below the age 50 year. The mean duration of symptoms prior to presentation and hospital stay was 97.4 and 38days, respectively. HIV/AIDS was detected in 60%. Causes of empyema were pulmonary tuberculosis (56%), pneumonia (36%) and lung abscess (7%). Closed chest tube was inserted in 86% of cases and was successful in 93% of them. Case-fatality was 12% and poor outcome occurred in 26%. Conclusions: Early identification of TE and aggressive management with antibiotics or antituberculosis, drainage with chest tube, and surgical treatment when closed tube drainage fails is recommended to improve the high mortality and morbidity

Empyema and parapneumonic effusions in children: an update

Childhood empyema is an important complication of bacterial pneumonia. The incidence of empyema is increasing worldwide. Streptococcus pneumoniae and Staphylococcus aureus are the most common aetiologies in high and low-income countries respectively. The diagnosis is based on clinical; radiographic and pleural fluid examination. Tuberculosis (TB) is an important cause of a pleural effusion in high TB prevalence areas. There is controversy about the optimal treatment for empyema in children. Sepsis should be controlled with antibiotics and drainage of the pleural cavity. Intrapleural fibrinolysis and Video Assisted Thorascopic Surgery (VATS) are modern interventions widely used in high-income countries but mostly unavailable in the developed world. There are however few properly conducted studies that would support one therapeutic approach over the other. Despite this; the clinical outcome of paediatric empyema is usually good regardless of therapeutic approach. This review summarises aetiology; pathogenesis and clinical presentation of childhood empyema and discusses the various treatment modalities with an emphasis on clinical practice in developing countries