Massive pleural empyema secondary to amoebic liver abscess in a child / Empiema pleural masivo secundario a absceso hepático amebiano en un niño

Abstract Background: Pleural empyema secondary to a ruptured amoebic liver abscess is a rare complication in the pediatric population. Case report: We report the case of a 13-year-old male with right flank abdominal pain, productive cough with foul-smelling sputum, fever, and respiratory distress. Physical examination revealed breathlessness, decreased vesicular murmur in the right hemithorax, abdominal distension, hepatomegaly, and lower limb edema. Laboratory tests revealed mild anemia, leukocytosis without eosinophilia, elevated alkaline phosphatase, hypoalbuminemia, and positive immunoglobulin G antibodies against Entamoeba histolytica in pleural fluid. He required a chest tube and treatment with metronidazole. After 2 months of follow-up, the abscesses disappeared, and the empyema decreased. Conclusions: Massive pleural empyema secondary to a ruptured liver abscess is a rare complication. The epidemiological link associated with the symptoms and serological tests can help in the diagnosis.

Resumen Introducción: El empiema pleural secundario a ruptura de absceso amebiano hepático es una complicación poco frecuente en la población pediátrica. Caso clínico: Se reporta el caso de un paciente de sexo masculino de 13 años que presentó dolor abdominal en flanco derecho, tos productiva con esputo de mal olor, fiebre y dificultad respiratoria. Al examen físico se encontró amplexación y murmullo vesicular disminuido en hemitórax derecho, distensión abdominal, hepatomegalia y edema de miembros inferiores. Los resultados del laboratorio evidenciaron anemia leve, leucocitosis sin eosinofilia, elevación de fosfatasa alcalina, hipoalbuminemia y anticuerpos IgG contra Entamoeba histolytica positivo en líquido pleural. Requirió tubo de drenaje torácico y tratamiento con metronidazol. A los dos meses de seguimiento los abscesos desaparecieron y el empiema disminuyó. Conclusiones: El empiema pleural masivo secundario a ruptura de absceso hepático es una complicación poco frecuente. El nexo epidemiológico asociado con la sintomatología y pruebas serológicas pueden ser de ayuda en el diagnóstico.

Empiema pleural por Parvimonas micra en un paciente inmunocompetente: reporte de un caso / Pleural empyema by Parvimonas micra in an immunocompetent patient: a case report

Se presenta el caso de un paciente joven inmunocompetente, con antecedente de tuberculosis pulmonar, que acude al hospital por un cuadro clínico subagudo de fiebre persistente, baja de peso, disnea y abolición del murmullo vesicular. La tomografía de tórax mostró un extenso empiema en hemitórax izquierdo. Se le toman muestras para detección de gérmenes comunes y se le colocan un tubo de drenaje torácico y se inicia antibioticoterapia. La prueba de MALDI-TOF MS identificó a Parvimonas micra, una bacteria anaerobia, comensal de la flora oral, asociado a periodontitis severa, escasamente reportado en empiema pleural, especialmente, en personas inmunocompetentes. En la evaluación odontológica se realizó el diagnóstico de gingivitis y pericoronaritis de la tercera molar. El paciente evolucionó favorablemente. Se sugiere que, en casos de empiemas pleurales subagudos o crónicos, se debe considerar, además de las micobacterias, como agente etiológico al Parvimonas micra, y optar por exámenes como MALDI-TOF MS o secuenciamiento del 16S rRNA, colocación de tubo de tórax, cobertura antibiótica empírica y evaluación odontológica.

We present the case of a young immunocompetent patient, with a history of pulmonary tuberculosis, who attended the hospital with a subacute clinical picture of persistent fever, weight loss, dyspnea and abolition of vesicular murmur. Chest CT scan showed an extensive empyema in the left hemithorax. Samples were taken for detection of common germs. Then, a chest drainage tube was placed and antibiotic therapy started. The MALDI-TOF MS test identified Parvimonas micra, an anaerobic bacterium, commensal to the oral flora, associated with severe periodontitis, but rarely reported in cases of pleural empyema, especially in immunocompetent patients. Gingivitis and pericoronaritis of the third molar were diagnosed during oral evaluation. The patient progressed favorably. Parvimonas micra should be considered as a possible etiological agent in cases of subacute or chronic pleural empyema, in addition to mycobacteria. Tests such as MALDI-TOF MS or 16S rRNA sequencing, chest tube placement, empirical antibiotic coverage and an adequate oral evaluation should be considered in these cases.

Factores de riesgo de neumonía adquirida en la comunidad, complicada con empiema pleural

Introducción: la neumonía es la principal causa de derrame pleural (DP) en los niños. Un elevado número de los pacientes ingresan a las unidades de cuidados intensivos pediátricos con derrame pleural paraneumónico (DPP), terminando en el empiema pleural. Objetivo: identificar los factores de riesgo que influyen de forma independiente en la aparición de neumonía adquirida en la comunidad, complicada con empiema pleural. Métodos: se realizó un estudio observacional analítico de casos y controles, se seleccionaron 30 casos y 90 controles. Con una proporción de 1:3. Se realizó el análisis estadístico univariado y multivariado. Resultados: en el análisis univariado, la edad menor de 5 años y el sexo masculino se mostraron sin influencia estadísticamente significativa, mientras que el multivariado mostró que el factor con independencia más importante fue el uso previo de antimicrobiano (OR 6,329 ajustado IC 95% 2,764-8,678), seguido del diagnóstico tardío (OR ajustado 5,492IC 95% 2,559-8,522) y la presencia de comorbilidad (OR ajustado 4,341 IC 95% 2,321−7,529) de manera similar. Conclusiones: los factores de mayor riesgo que contribuyeron al riesgo de desarrollar la neumonía complicada con empiema pleural fueron el uso previo de antimicrobiano, el diagnóstico tardío de empiema y la presencia de comorbilidad.

Introduction: pneumonia is the main cause of pleural effusion (PE) in children. A high number of patients enter pediatric intensive care units with parapneumonic pleural effusion (PPE), ending in pleural empyema. Objective: to identify the risk factors that independently influences the occurrence of community-acquired pneumonia, complicated by pleural empyema. Methods: an analytical observational study of cases and controls was carried out, 30 cases and 90 controls were selected. With a ratio of 1:3. Univariate and multivariate statistical analysis was performed. Results: in the univariate analysis, age under 5 years and male sex showed no statistically significant influence, while the multivariate analysis showed that the most important independent factor was the previous use of antimicrobial (OR 6.329 adjusted CI 95% 2.764-8.678), followed by late diagnosis (adjusted OR 5.492 CI 95% 2.559-8.522) and the presence of comorbidity (adjusted OR 4.341 CI 95% 2.321−7.529) similarly. Conclusions: the highest risk factors that contributed to the risk of developing pneumonia complicated with pleural empyema were previous use of antimicrobials, late diagnosis of empyema, and the presence of comorbidity.

Introdução: A pneumonia é a principal causa de derrame pleural (DP) em crianças. Um número elevado de pacientes é admitido em unidades de terapia intensiva pediátrica com derrame pleural parapneumônico (DPP), terminando em empiema pleural. Objetivo: Identificar os fatores de risco que influenciam independentemente a ocorrência de pneumonia adquirida na comunidade complicada por empiema pleural. Métodos: Foi realizado um estudo observacional analítico caso-controle, selecionados 30 casos e 90 controles. Com uma proporção de 1:3. Foram realizadas análises estatísticas univariada e multivariada. Resultados: Na análise univariada, idade menor de 5 anos e sexo masculino não foram estatisticamente significativos, enquanto a análise multivariada mostrou que o fator independente mais importante foi o uso prévio de antimicrobianos (OR ajustado 6,329 IC 95% 2,764-8,678), seguido pelo diagnóstico tardio (OR ajustado 5,492 IC 95% 2,559-8,522) e presença de comorbidade (OR ajustado 4,341 IC 95% 2,321−7, 529) da mesma forma. Conclusões: Os maiores fatores de risco que contribuíram para o desenvolvimento de pneumonia complicada com empiema pleural foram o uso prévio de antimicrobianos, o diagnóstico tardio de empiema e a presença de comorbidade.

Tuberculosis pulmonar y extrapulmonar en niños / Pulmonary and extrapulmonary tuberculosis in children

La Organización Mundial de la Salud (OMS) informa que ocurren 1.1 millones de casos de tuberculosis (TBC) en niños <15 años. En Chile se observa un aumento de casos en el tiempo. La pandemia por SARS-Cov2 ha implicado una disminución de la pesquisa y un retardo de la atención y diagnóstico de TBC. Se presenta dos casos clínicos de tuberculosis en adolescentes. El primero corresponde a un adolescente con una tuberculosis pulmonar de difícil y tardío diagnóstico, habiéndose descartado inicialmente TBC por estudio molecular y PPD no reactivo. El segundo caso corresponde a un adolescente con una tuberculosis pulmonar y extrapulmonar de diagnóstico tardío, de 8 meses de evolución, posterior a un cuadro leve de Covid.

The World Health Organization (WHO) reports that 1.1 million cases of tuberculosis (TB) occur in children <15 years of age. In Chile, an increase in cases is observed over time. The SARS-Cov2 pandemic has led to a decrease in screening and a delay in care and diagnosis of TB. Two clinical cases of tuberculosis in adolescents are presented. The first corresponds to an adolescent with TB of difficult and late diagnosis, having initially ruled out TB by molecular study and non-reactive PPD. The second case corresponds to an adolescent with pulmonary and extrapulmonary tuberculosis of late diagnosis, of 8 months of evolution, after a mild respiratory infection of Covid.

Toracostomía abierta: en ocasiones la mejor opción / Open thoracostomy: Sometimes the best option

El tratamiento quirúrgico del empiema ha evolucionado, desde la medicina hipocrática, a través de los años, teniendo como premisa el drenaje. Con los avances médicos, el abordaje mínimamente invasivo se ha convertido en el estándar, dejando de lado otras técnicas quirúrgicas. La toracostomía abierta, en pacientes seleccionados, puede llegar a ser la última y mejor opción para el control del foco infeccioso: es una opción quirúrgica para el tratamiento de los empiemas en pacientes mórbidos y en fase de organización, cuando otros tratamientos han fallado, con una aceptable morbilidad y mortalidad. Esta técnica debe estar en el arsenal terapéutico del cirujano. Presentamos una serie de 4 casos de pacientes con empiema en fase de organización, en los cuales el riesgo quirúrgico era muy alto, por lo que se optó por realizar una toracostomía abierta, con éxito

The surgical treatment of empyema has evolved from Hippocratic medicine over the years, with drainage as its premise. With medical advances, the minimally invasive approach has become the standard, leaving aside other surgical techniques. Open thoracostomy, in selected patients, may become the last and best option for the control of the infectious focus: it is a surgical option for the treatment of empyemas in morbid patients and in the organization phase when other treatments have failed, with an acceptable morbidity and mortality. This technique should be in the surgeon's therapeutic arsenal. We present a series of four cases of patients with empyema in the organization phase, in which the surgical risk was very high, so it was decided to perform an open thoracostomy, which turn out successful

Tuberculosis y una Gemella spp: Una combinación indeseable / Tuberculosis and a Gemella spp: An undesirable combination

El género Gemella spp corresponde a cocos gram positivos, anaerobios facultativos, catalasa negativos, no móviles y no formadores de esporas, usualmente comensales de la cavidad oral, que no suelen ser patógenos en pacientes inmunocompetentes. Sin embargo, puede comportarse como germen oportunista en pacientes inmunosuprimidos o con otros factores de riesgo como mala higiene dental, cirugía gastrointestinal, enfermedades metabólicas entre otras, y se asocia con endocarditis, meningitis y en menor medida compromiso pulmonar. La información respecto a la susceptibilidad antimicrobiana es limitada y se asemeja a la de S viridans, por lo que la penicilina y ampicilina son los medicamentos de elección, sin tener claridad en cuanto a duración del tratamiento, usualmente considerando llevar a 4 semanas o hasta el drenaje de la colección. Éste reporte de caso describe una paciente con tuberculosis en tratamiento, que desarrolla una infección invasiva con documentación de empiema y bacteriemia secundaria por Gemella morbillorum, representando la asociación poco común de ésta infección bacteriana con tuberculosis.

Gemella spp. corresponds to gram positive cocci, facultative anaerobes, negative catalase, non mobile and non spore producers, part of colonizing flora of the oral cavity that are not common pathogens in immunocompetent patients. Nevertheless it may behave as an opportunistic germ in immunosuppressed patients or with other risk factors that include bad dental hygiene, bowel surgery, and metabolic diseases among others. It's associated with infections such as endocarditis, meningitis and less frecuently can implicate the lung. The information regarding antimicrobial susceptibility is limited and resembles S viridans, so penicillin and ampicillin are the medications of choice, without being clear about the duration of treatment, usually giving 4 weeks or until collection drain. This case report describes a patient with known tuberculosis diagnosis and under treatment, that develops an invasive infection with empyema and secondary bloodstream infection by Gemella morbillorum, depicting a previously uncommon but described association of this bacterial infection with tuberculosis.

Complicated pneumonia with empyema caused by streptococcus anginosus in a child / Complicated pneumonia with empyema caused by streptococcus anginosus in a child

ABSTRACT Objective: To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy. Case description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Pleural fluid cultures grew Streptococcus anginosus. On day 11, the child had a clinical deterioration with recurrence of fever, hypoxia, and respiratory distress. At this point, considering the causative agent, he was submitted to video-assisted thoracoscopic decortication, with good progress thereafter. Comments: Streptococcus anginosus is a commensal bacterium of the human oral cavity capable of causing severe systemic infections. Although reports of complicated thoracic infections with this agent are rare in the pediatric population, they have been increasing in adults. Streptococcus anginosus has a high capacity to form abscess and empyema, requiring different therapeutic approaches when compared to complicated pneumonia caused by other agents.

RESUMO Objetivo: Alertar para a patogenicidade do Streptococcus anginosus que, apesar de raro em pediatria, pode causar infeções graves que necessitam de tratamento invasivo e antibioterapia de longo curso para obter um melhor prognóstico. Descrição do caso: Criança de seis anos, com atraso do desenvolvimento psicomotor, avaliado no serviço de urgência por febre e dificuldade respiratória. O exame físico, juntamente com os exames complementares, revelou uma pneumonia complicada com empiema no hemitórax esquerdo, tendo iniciado antibioterapia e sido submetido à drenagem do líquido pleural. Foi identificado Streptococcus anginosus nesse líquido. No 11º dia de doença, a criança agravou o seu estado clínico, com recidiva da febre, hipoxemia e dificuldade respiratória. Considerando-se o microrganismo identificado, o paciente foi submetido à decorticação pulmonar por videotoracoscopia, com boa evolução clínica posterior. Comentários: Streptococcus anginosus é uma bactéria comensal da cavidade oral humana, que pode causar infecções sistêmicas graves. Apesar de serem raros os casos descritos em pediatria, têm sido cada vez mais descritas infecções torácicas complicadas em adultos. Esse microrganismo também tem a capacidade de formar abcessos e empiemas, que precisam de intervenções terapêuticas diferentes, quando comparados a pneumonias complicadas causadas por outros agentes.

Iatrogenic pleural empyema caused by Propionibacterium acnes

Propionibacterium acnes is one of the commensals living on the human skin and glands, implicated mainly in acnes, but seldom in deep infection. Pleural empyema is rarely complicated with closed thoracostomy. We experienced 1 case of empyema caused by P. acnes after pleural biopsy and closed thoracostomy through a percutaneous pigtail catheter. A 79-year-old man was admitted for cough, purulent sputum and shortness of breath. Three weeks ago, closed thoracostomy and pleural biopsy were performed to confirm a diagnosis for his recurrent pleural effusion. He had increased amount of right pleural effusion. Through the pigtail catheter, pleural effusion was removed. Gram-positive rods were observed in Gram stain, but not cultured. By 16S rRNA analysis, P. acnes was confirmed as the pathogen. His empyema was repeatedly treated with antibiotics, fibrolysis and irrigation. Pleural decortication was recommended. We report the first case of empyema with P. acnes in Korea, possibly complicated with closed thoracostomy procedures.

Thinking on whether the BPF patients treated by open window thoracostomy after pulmonary resection / 中华胸心血管外科杂志

Objective Introduce the experience of open window thoracostomy in the treatment of bronchopleural fistula after pulmonary resection.To explore which patients are currently suitable for open window thoracostomy , how to deal with them after open window thoracostomy, and how to treat patients without window drainage.Methods In 2017, the thoracic surgery department of Shanghai Pulmonary Hospital completed 13,341 thoracic surgeries, including 10 cases of open window thoracos-tomy, and patients with BPF after other pulmonary resection were treated with conservative thoracic closed drainage .Thoracic closed drainage therapy is often accompanied by thoracic irrigation.From January 2004 to December 2017, 21 cases of chronic refractory abscess treated with autologous musculocutaneous flap implantation after pulmonary resection and open window drain-age were summarized.The treatment of chronic refractory abscess after 14 years of diagnosis was divided into three stages.The first stage is opening the abscess cavity stage, namely opening the window drainage.The second stage is elimination of abscess cavity and closure of bronchial pleural fistula.The third stage is autologous musculocutaneous flap transplantation or displace-ment to fill the abscess cavity stage.Results Compared with before open window, the 10 patients with open window thoracos-tomy showed obvious improvement in thoracic and pulmonary infection, without perioperative death.Other patients with BPF af-ter pulmonary resection without open window thoracostomy died in 2 of conservative thoracic closed drainage .From January 2004 to December 2017, 19 patients(19/21) were successfully treated with autologous musculocutaneous flap implantation af-ter pulmonary resection and open window thoracostomy, without recurrence of empyema and necrosis of skin flap, and 2 cases (2/21) were not cured due to large bronchial fistula, and local recurrence of empyema, without perioperative death.Conclu-sion Most patients with BPF after pulmonary resection are treated with closed thoracic drainage , especially those with lower lo-bectomy and with pleural irrigation.Most patients can be cured.If patients with upper lobe, middle and upper lobectomy or pneumonectomy, accompanied by BPF, chest infection and poor drainage, it is easy to develop intrapulmonary infection sprea-ding.We should do open window thoracostomy as soon as possible.The removal of the residual cavity by filling musculocutane-ous flap after open window thoracostomy is a great improvement compared with the transthoracic reconstruction .

Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion / Cirurgia torácica vídeoassistida antes e depois de drenagem torácica em crianças com derrame parapneumônico complicado

Abstract Objectives To evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage. Methods The medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Patients were divided into two groups: in group 1, videothoracoscopic surgery was performed as the initial procedure; in group 2, videothoracoscopic surgery was performed after previous chest tube drainage. Results Videothoracoscopic surgery was effective in 73 children (92.4%); the other six (7.6%) needed another procedure. Sixty patients (75.9%) were submitted directly to videothoracoscopic surgery (group 1) and 19 (24%) primarily underwent chest tube drainage (group 2). Primary videothoracoscopic surgery was associated with a decrease of hospital stay (p = 0.05), time to resolution (p = 0.024), and time with a chest tube (p < 0.001). However, there was no difference between the groups regarding the time until fever resolution, time with a chest tube, and the hospital stay after videothoracoscopic surgery. No differences were observed between groups regarding the need for further surgery and the presence of complications. Conclusions Videothoracoscopic surgery is a highly effective procedure for treating children with complicated parapneumonic pleural effusion. When videothoracoscopic surgery is indicated in the presence of loculations (stage II or fibrinopurulent), no difference were observed in time of clinical improvement and hospital stay among the patients with or without chest tube drainage before videothoracoscopic surgery.

Resumo Objetivos Avaliar a eficácia da cirurgia torácica videoassistida no tratamento de derrame pleural parapneumônico complicado e determinar se há diferença no resultado da cirurgia torácica videoassistida realizada antes ou depois da drenagem torácica. Métodos Analisamos retrospectivamente prontuários médicos de 79 crianças (idade média de 35 meses) submetidas a cirurgia torácica videoassistida de janeiro de 2000 a dezembro de 2011. O mesmo algoritmo de tratamento foi utilizado no manejo de todos os pacientes. Os pacientes foram divididos em dois grupos: o Grupo 1 foi submetido a cirurgia torácica videoassistida como procedimento inicial; o Grupo 2 foi submetido a cirurgia torácica videoassistida após drenagem torácica prévia. Resultados A cirurgia torácica videoassistida foi eficaz em 73 crianças (92,4%); as outras seis (7,6%) necessitaram outro procedimento. Sessenta pacientes (75,9%) foram diretamente submetidos a cirurgia torácica videoassistida (Grupo 1) e 19 (24%) foram primeiramente submetidos a drenagem torácica (Grupo 2). A cirurgia torácica videoassistida primária foi associada à redução do tempo de internação (p = 0,05), do tempo para resolução (p = 0,024) e do tempo com o tubo torácico (p < 0,001). Contudo, não houve diferença entre os grupos a respeito do tempo até que não tivessem mais febre, do tempo com o tubo torácico e do tempo de internação após a cirurgia torácica videoassistida. Não foram observadas diferenças entre os grupos com relação à necessidade de cirurgia adicional e à presença de complicações. Conclusões A cirurgia torácica videoassistida é um procedimento altamente eficaz para tratar crianças com derrame pleural parapneumônico complicado. Quando a cirurgia torácica vídeoassistida é indicada na presença de loculações (fase II ou fibrinopurulenta) não há diferença no tempo de melhora clínica e no tempo de internação entre os pacientes com ou sem drenagem torácica antes da cirurgia torácica videoassistida.

Autologous myocutaneous flap implantation for chronic refractory empyema: 26 cases report / 中华胸心血管外科杂志

Objective To summarize experience in the treatment of chronic refractory empyema with autologous myocutaneous flap implantation.Methods From January 2004 to December 2017,26 patients had been treated with autologous myocutaneous flap implantation in Shanghai Pulmonary Hospital for chronic refractory empyema.Among them,24 were men and 2 were women.The mediam age was 50.1 years(14-74 years).21 of them had medical histories of lung resection because of basic diseases(most of which accepted surgeries in other hospitals).Complications appeared after surgeries.15 of them had bronchopleural fistula while windowing,which could not be cured by conservative treatments such as drainage.Then we performed open-window thoracostomy and long-time dressing.6 of 21 had experienced pneumonectomy.Other 5 patients did not have primary operational histories.They experienced dressing by windowing because of chronic refractory empyema after the in effective conservative treatments like drainage without pulmonary re-expansion.Results No respiratory complications occurred in these patients.The catheters were successfully removed within 5 days and the patients were discharged within 3-6 weeks after the operations.The median follow-up period was 9 months.24 cases were successful with no recurrence of empyema or flap necrosis,the other 2 cases underwent recurrence of empyema.Conclusion The application of autologous myocutaneous flaps for the treatment of chronic refractory empyema is an effective and continuously improving method.

Ventana torácica y anestesia local en la supuración pleural / Thoracic window and local anesthesia in pleural suppuration

Introducción: la colección purulenta en la cavidad pleural es causa de complicaciones, por procesos infecciosos pulmonares, y de alta mortalidad. Con frecuencia se trata de enfermos con deterioro del estado general, situación que se agrava en enfermos de edades geriátricas. Objetivo: mostrar la experiencia en el uso de la toracostomía con resección costal y anestesia local en el Hospital Universitario Manuel Fajardo para la atención de enfermos con empiema pleural. Métodos: se estudiaron 24 pacientes con empiema pleural atendidos desde enero de 1998 hasta octubre de 2015, con edad avanzada y estado físico precario en el Hospital Universitario Manuel Fajardo a los que se les realizó una ventana pleurocutánea con anestesia local. Resultados: La edad promedio fue de edad 72 años; 75 por ciento presentó enfermedades asociadas. La relación hombre/mujer fue de 3 a 1. La causa más frecuente fue el derrame paraneumónico infestado, 100 por ciento tuvo antecedentes de pleurostomía. Hubo cultivo negativo en 20,8 por ciento pacientes. Los gérmenes más frecuentes fueron el estreptococo, estafilococo y gérmenes gramnegativos. Las costillas resecadas fueron los arcos costales anteriores sexto y séptimo y el tiempo promedio de cierre de las ventanas fue de 8 meses, sin mortalidad quirúrgica. Conclusión: la ventana torácica pleurocutánea es un procedimiento quirúrgico de baja mortalidad, ideal para solucionar una cavidad pleural tabicada con gran utilidad en enfermos de edades geriátricas y con estado físico precario, por la factibilidad de realizarla con anestesia local(AU)

Introduction: pleural cavity purulent collection causes high mortality and complications in lung infections processes. It often comes to patients with deterioration of general condition, a situation muchworsened in patients of geriatric age. Objective: to show the experience in using costal thoracostomy and local anesthesia in care for elderly patients with pleural empyema and poor physical condition. Methods: study carried out in 24 patients with pleural empyema, advanced age and poor physical condition cared for from January 1998 to October 2015 at Comandante Manuel Fajardo University Hospital and who also underwent pleurocutaneous window with local anesthesia. Results: average age was 72 years. The male/female ratio was 3 to 1. 75 percent of the patients presented associated diseases. The most frequent cause was infested parapneumonic effusion. There was pleurostomy history in 100 percent of the cases, negative culture in 20.8 percent, while the most common germs were streptococcus, staphylococcus and gram-negative bacteria. The resected ribs were the sixth and seventh previous costal arches. El average windows closing time was 8 months. There was no surgical mortality. Conclusion: pleurocutaneous thoracic window is a surgical procedure with low mortality, ideal to settle a pleural cavity tabicada with great utility in patients at geriatric age and in precarious physical condition, from the feasibility of being performing under local anesthesia(AU)

Paquipleuritis y empiema loculado izquierdo secundario a neumonía adquirida en la comunidad en adolescente / Pachypleuritis and left loculated empyema secondary to community-acquired pneumonia in adolescents

La neumonía es una de las principales causas de mortalidad en las Américas, entre el 20 a 40% evolucionan a derrame pleural, sólo 0,6-2% evolucionan a empiema pleural. El empiema crónico se asocia a engrosamiento pleural, puede ser total o abarcar el parénquima pulmonar (paquipleuritis). Presentamos paciente adolescente, con neumonía al que se le realizó toracentesis con resultado de gram y cultivo positivo para Esta lococos sp, sin citoquímica, fue tratado como derrame pleural simple con diferentes antibióticos por 17 días sin mejoría. Posteriormente en hospital especializado, se realizó toracentesis guiada por ultrasonido que reportó masa heterogénea tabicada, se realizó decorticación de empiema loculado gigante izquierdo y liberación de atrapamiento pulmonar. Se dio alta médica con persistencia de paquipleuritis residual que resolvió espontáneamente a los seis meses. En la neumonía con derrame pleural es importante durante el tratamiento, correlacionar; clínica, citoquímica, pH, estudios de imagen y respuesta a los antibióticos.

Pneumonia is a leading cause of mortality in America, between 20-40% progresses to pleural e usion, only 0.6-2% evolve to pleural empyema. Chronic empyema associated with pleural thickening, can be total or cover the lung parenchyma (pleural thickening). Here we report a clinical case about an adolescent patient with pneumonia who had a thoracentesis with gram positive and positive culture for Staphylococcus sp, without cytochemical, it was treated as a simple pleural e usion with di erent antibiotics for 17 days without patient's improvement. Later on a specialized hospital, he had an ultrasound guided thoracentesis which reported that a partitioned heterogeneous mass was held. Decortication of giant loculated empyema and lung entrapment release was made. He was discharged with persistent residual pleural thickening which resolved spontaneously within six months. In pneumonia with pleural e usion, it is important during treatment to correlate clinical facts cytochemical, pH, imaging and response to antibiotics.

Pneumonia due to Rhodococcus equi in a non-Hodgkin's lymphoma patient: case report

The authors reported a lung infection by Rhodococcus equi in a 25 years-old male patient admitted to hospital with cough, dyspnea, fever, and previous diagnosis of pleural effusion. R. equi was isolated from pleural fluid and the patient acquired nosocomial infection by Acinetobacter baumannii, isolated from chest drain. The patient was treated with antibiotics. During hospitalization, he was diagnosed with non-Hodgkin lymphoma of precursor T-cell lymphoblastic lymphoma subtype in biopsy of pleura. After undergoing surgery for pulmonary decortication for drain empyema, the patient died due to septicemia(AU)

Los autores informan de una infección pulmonar por Rhodococcus equi en un paciente masculino de 25 años que fuera hospitalizado con tos seca, disnea, fiebre y diagnóstico previo de derrame pleural. R. equi se aisló del líquido pleural y el paciente adquiere una infección nosocomial con Acinetobacter baumannii aisladas de un drenaje torácico. El paciente recibió tratamiento con antibióticos y, durante la hospitalización, fue diagnosticado linfoma no Hodgkin subtipo de linfoma linfoblástico de precursoras de células T en la biopsia pleural. Después de la cirugía para decorticación pulmonar para la fuga de empiema, el paciente falleció debido a una septicemia(AU)

Seudotumor pulmonar inflamatorio. Presentación de caso / Inflammatory pulmonary pseudo tumor. Presentation of a case

El seudotumor inflamatorio es un proceso no neoplásico poco frecuente, caracterizado por un crecimiento irregular de células inflamatorias. Puede originarse en cualquier lugar del organismo y, en la mayoría de los casos, presenta un asentamiento local único y de características benignas. Se presentó el caso de un varón de 51 años, en el que se manifestó el seudotumor inflamatorio de forma nodular en el pulmón derecho, con evolución a un empiema pleural.

The inflammatory pseudo tumor is a few frequent non neoplastic process, characterized by an irregular increase of inflammatory cells. It can be originated in any place of the organism, and in most of the cases it has only one local settlement with benign characteristics. We presented the case of a male patient, aged 51 years who had the inflammatory pseudo tumor of nodular form in the right lung, with evolution to a pleural empyema.

Evaluation of serial C-reactive protein measurements after surgical treatment of pleural empyema

OBJECTIVE: Serial C-reactive protein measurements have been used to diagnose and monitor the response to therapy in patients with pneumonia and other infectious diseases. Nonetheless, the role of C-reactive protein measurement after surgical treatment for pleural empyema is not well defined. The aim of this study is to describe the behavior of C-reactive protein levels after the surgical treatment of pleural empyema and to correlate this parameter with the patient's prognosis. METHODS: We retrospectively analyzed the records of patients with pleural empyema treated by either chest-tube drainage or surgery from January 2006 to December 2008. C-reactive protein levels were recorded preoperatively and 2 and 7 days postoperatively. The clinical outcome was binary: success or failure (mortality or the need for repeated pleural intervention). RESULTS: The study group comprised fifty-two patients. The median C-reactive protein values were as follows: 146 mg/L (pre-operative), 134 mg/L (post-operative day 2), and 116 mg/L (post-operative day 7). There was a trend toward a decrease in these values during the first week after surgery, but this difference was only statistically significant on day 7 after surgery. Over the first week after surgery, the C-reactive protein values decreased similarly in both groups (successful and failed treatment). No correlation between the preoperative C-reactive protein level and the clinical outcome was found. CONCLUSIONS: We observed that, in contrast to other medical conditions, C-reactive protein levels fall slowly during the first postoperative week in patients who have undergone surgical treatment for pleural empyema. No correlation between the perioperative C-reactive protein level and the clinical outcome was observed.

Empiema causado por Salmonella typhimurium / Pleural empyema caused by Salmonella typhimurium: a case report

Salmonella species are commonly associated with acute gastroenteritis due to ingestion of contaminated food or water. Extraintestinal infections are less frequent, and most of them occur in immunocompromised patients. We report a case of pleural empyema caused by Salmonella typhimurium, without previous diarrhea or fever. The patient evolved favorably after receiving adequate treatment.

El género Salmonella se caracteriza por causar infecciones en el tracto gastrointestinal, debido a la ingesta de alimentos o agua contaminada. También puede causar, con menor frecuencia, infecciones localizadas en diferentes órganos; esto se asocia con inmunodepresión. En este caso se describe un paciente con infección pleuropulmonar por Salmonella typhimurium, que no reportó antecedentes de diarrea previa. Evolucionó favorablemente con tratamiento adecuado.

Empiema pleural causado por tricomonas: caso clínico / Pleural empyema caused by trichomonas: case report

Pleural empyema formation is one of the potential complications of lower respiratory tract infections and it is characterized by bacterial organisms seen on gram stain or the aspiration of pus on thoracentesis. Very rarely empyema can be caused by trichomonas species, of which Trichomonas Tenax appears to be the most common cause. In this article we report the case of a 51-year-old man who developed a pleural empyema caused by trichomonas, and review the available literature of this rare infection of unknown incidence and uncertain pathogenetic significance. Our patient was treated with metronidazole, however complete cure was not achieved and pulmonary decortication was necessary for the successful outcome. As far as we know, this is the first case of pleural empyema caused by trichomonas reported in Chile.

La formación de un empiema pleural es una de las potenciales complicaciones de las infecciones de la vía aérea inferior, y se caracteriza por la observación de bacterias en la tinción de Gram, o la aspiración de pus en la toracocentesis. Muy infrecuentemente el empiema puede ser causado por alguna de las especies de tricomonas, de las cuales Trichomonas Tenax parece ser la causa más común. En este artículo, reportamos el caso de un hombre de 51 años que desarrolló un empiema pleural causado por tricomonas, y revisamos la literatura disponible de esta rara infección, de incidencia desconocida, y significancia patogénica incierta. Nuestro paciente fue tratado con metronidazol, observándose sólo una respuesta parcial, necesitándose decorticación pulmonar para una recuperación completa. Hasta donde sabemos, este es el primer caso de empiema pleural causado por tricomonas reportado en Chile.

Delftia acidovorans Isolated from the Drainage in an Immunocompetent Patient with Empyema / 결핵및호흡기질환

Delftia acidovorans is a gram-negative motile rod found ubiquitously in soil and in water. Confirmed isolation from clinical infections is rare, and has been documented mostly in immunocompromised patients or those with indwelling catheters. A 53-year-old man was referred for the evaluation of a huge mass-like lesion found incidentally by chest X-ray. The lesion occupied more than half of the right lung and was diagnosed as a large loculated pleural effusion by CT scan. Bloody pus was drained through a percutaneous catheter, and D. acidovorans, identified by the Vitek GN card and confirmed by amplification of 16S ribosomal RNA and sequencing analysis, was isolated repeatedly from the drained pus. The patient was treated with imipenem/cilastatin to which the organism was sensitive. This is a rare report of chronic empyema associated with D. acidovorans in the respiratory system of an immunocompetent patient.

Open thoracotomy and decortication for chronic empyema

OBJECTIVES: Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for videothoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS: From March 1992 to June 2006, 85 patients diagnosed with empyema were treated at Santo Tomás Hospital by the first author. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Thirty-three patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS: Twenty-seven patients (81.8 percent) were male and the average age of the study group was 34 years. The etiology was pneumonia in 26 patients (78.8 percent) and trauma in 7 (21.2 percent). The duration of symptoms and signs before definitive treatment averaged 37 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. Surgery lasted an average of 139 min. There were 3 (9 percent) complications with no mortality. The post-operative length of stay averaged 10 days. There were no recurrences of empyema. CONCLUSIONS: Open thoracotomy and decortication can be achieved with low morbidity and mortality. Long-term functional results are especially promising. We suggest that the validation of other surgical approaches should be based on comparative, prospective and controlled studies.