ABSTRACT
Introducción: el empiema cerebral en pediatría es una rara infección intracraneal que puede ser secundaria a una meningitis, sinusitis, o por mecanismos como trauma craneal, cirugía neurológica o como resultado de la diseminación hematógena desde un sitio remoto. Objetivo: describir un caso de empiema cerebral causado por Escherichia coli en un lactante. Metodología: presentar un caso clínico, con aislamiento de Escherichia coli fuera del periodo gris de la meningitis. Se realiza una revisión acerca de los factores de riesgo, la etiología y tratamiento del empiema cerebral en niños. Resultados: masculino de 5 meses, sin inmunodeficiencia, cráneo con plagiocefalia; antecedente de otitis de 3 semanas de evolución previo a su ingreso al hospital. El paciente manifestó fiebre, crisis convulsivas y deterioro rostro-caudal. El líquido cefalorraquídeo con pleocitosis e hipoglucorraquia. Las imágenes tomográficas revelaron la presencia de empiema cerebral. Se logró el aislamiento de Escherichia coli en el cultivo, requirió drenaje quirúrgico y antibioticoterapia sistémica por 4 semanas. Conclusiones: el empiema cerebral por Escherichia coli en lactantes después del periodo gris es muy raro. Su tratamiento consiste en la evacuación quirúrgica oportuna, la erradicación del foco infeccioso primario y la administración apropiada de antimicrobianos sistémicos.
Introduction: Brain empyema in children is a rare intracranial infection that may result from meningitis, sinusitis, or mechanisms such as head trauma, neurological surgery or hematogenous spread from a remote site. Objective: To describe a case of brain empyema caused by Escherichia coli in an infant. Methodology: A case report is presented with isolation of Escherichia coli arising after the overlap period of meningitis (1-3 months). A literature review of the risk factors, etiology and treatment of brain empyema in children is conducted. Results: The case report is about a 5 month-old male infant with no history of immunodeficiency, plagiocephalic, and with a 3 week-long history of otitis prior to admission. The patient had fever, seizures and rostro-caudal deterioration, cerebrospinal fluid pleocytosis and hypoglycorrhachia. The tomographic images revealed brain empyema. It was posible to isolate Escherichia coli from culture and surgical drainage was required plus systemic antibiotic therapy for 4 weeks. Conclusions: Brain empyema caused by Escherichia coli in infants after the overlap period are very rare. Treatment consists in prompt surgical evacuation, eradication of the primary infection and proper administration of systemic antimicrobials.
Subject(s)
Humans , Male , Infant , Empyema/diagnosis , Empyema/microbiology , Brain Diseases/diagnosis , Brain Diseases/microbiology , Anti-Bacterial Agents/therapeutic use , Drainage , Empyema/etiology , Empyema/therapy , Brain Diseases/etiology , Brain Diseases/therapy , Escherichia coli/isolation & purification , Risk Factors , Tomography, X-Ray ComputedABSTRACT
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
Subject(s)
Empyema, Pleural/etiology , Empyema/complications , Empyema/diagnosis , Empyema/mortality , Empyema/therapy , Ethiopia , Hospitals, TeachingABSTRACT
Empyema thoracis is a disease that, despite centuries of study, still causes significant morbidity and mortality. The present study was undertaken to study the age-sex profile, symptomatology, microbiologic findings, etiology and the management and treatment outcome in a tertiary care hospital. A prospective study of empyema thoracis was conducted on 40 consecutive patients with empyema thoracis admitted to the tuberculosis and chest diseases ward of a teaching hospital. The demographic data, clinical presentation, microbiological findings, etiology, the clinical course and management were recorded as per a planned pro forma and analyzed. The peak age was in the range of 21-40 years, the male-to-female ratio was 3.4:1.0 and the left pleura was more commonly affected than the right pleura. Risk factors include pulmonary tuberculosis, chronic obstructive pulmonary diseases, smoking, diabetes mellitus and pneumonia. Etiology of empyema was tubercular in 65% cases and nontubercular in 35% cases. Gram-negative organisms were cultured in 11 cases [27.5%]. Two patients received antibiotics with repeated thoracentesis only, intercostal chest tube drainage was required in 38 cases [95%] and more aggressive surgery was performed on 2 patients. The average duration for which the chest tube was kept in the complete expansion cases was 22.3 days. It was concluded that all cases of simple empyema with thin pus and only those cases of simple empyema with thick pus where size of empyema is small should be managed by aspiration/s. Cases failed by the above method, all cases of simple empyema with thick pus and with moderate to large size of empyema and all cases of empyema with bronchopleural fistula should be managed by intercostal drainage tube connected to water seal. It was also observed that all cases of empyema complicated by bronchopleural fistula were difficult to manage and needed major surgery
Subject(s)
Humans , Male , Female , Thoracostomy , Treatment Outcome , Empyema/microbiology , Empyema/therapy , Empyema, Pleural , Empyema, Tuberculous , Cross-Sectional StudiesABSTRACT
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
Subject(s)
Child , Empyema/diagnosis , Empyema/etiology , Empyema/therapy , South Africa , Staphylococcus , Streptococcus pneumoniaeABSTRACT
Os autores descrevem o caso de um homem de 45 anos com empiema crônico adquirido após trauma torácico por arma de fogo. O paciente evoluiu durante doze anos com drenagem espontânea através da parede torácica. Submetido a tratamento cirúrgico, recebeu alta em boas condições clínicas. A partir do caso relatado, é feita uma breve discussão sobre os principais aspectos para o diagnóstico e tratamento do empiema de necessidade.
Subject(s)
Humans , Male , Adult , Empyema/surgery , Empyema/complications , Empyema/diagnosis , Empyema/therapy , Thoracic Injuries , Wounds, GunshotABSTRACT
Objetivo. Evaluar el efecto de la toracoscopia temprana en la evolución de pacientes con empiema posneumónico. Sede Hospital General de Puebla, SSA, ®Dr. Eduardo Vázquez Navarro¼, Puebla, México. Diseño. Ensayo clínico con control histórico. Para el análisis estadístico se usó T de Student, análisis de varianza y chi cuadrada. Material y métodos. De septiembre de 1995 a diciembre de 1998, a los pacientes con empiema posneumónico (EPN) se les realizó toracoscopia en las primeras 48 h del ingreso (TT). Se clasificaron en fases: 1) derrame seroso, 2) líquido purulento libre o tabicado, 3) engrosamiento pleural, pus y pulmón colapsado. Como grupo control: pacientes con EPN de octubre 1993 a agosto 1995, sin toracoscopia (NT); el EPN se clasificó de acuerdo a la evolución clínica: 1) seroso con expansión pulmonar, 2) purulento con expansión pulmonar (sonda de toracostomía), 3) purulento sin expansión pulmonar (toracotomía decorticación). El tratamiento se instituyó de acuerdo a la fase. Resultados. En total 42 pacientes con EPN, (TT 17 y NT 25), fueron similares en sexo, edad, fases del empiema, número de defunciones, resultados de laboratorio, enfermedades asociadas y esquemas antibióticos. La estancia hospitalaria global fue 12.76 ñ 5.36 días para el grupo
Subject(s)
Humans
, Male
, Female
, Adolescent
, Adult
, Empyema/classification
, Empyema/diagnosis
, Empyema/therapy
, Histocytochemistry/methods
, Pleural Effusion/classification
, Pleural Effusion/diagnosis
, Pleural Effusion/therapy
, Thoracoscopy
, Thoracostomy
, Data Interpretation, Statistical
ABSTRACT
Patología frecuente en nuestro medio, que se debe principalmente a infecciones pulmonares por Staphylococcus, Streptococcus, o Haemophilus; suele presentarse en menores de 6 años y se caracteriza por: fiebre, tos, dolor torácico, insuficiencia respiratoria, hipoventilación parcial o total de un hemitórax y percusión mate; suele cursar con leucocitosis a expensas de neutrofilia radiografía de tórax con opacidad marginal o total de un hemitórax. Requiere de manejo antibiótico, punción evacuadora o colocación de una sonda pleural y en ocasiones tratamiento quirúrgico
Subject(s)
Humans , Child , Clinical Laboratory Techniques , Diagnosis, Differential , Empyema/drug therapy , Empyema/etiology , Empyema/physiopathology , Empyema/therapy , Pleural Effusion/diagnosis , Pleural Effusion/etiologyABSTRACT
Realizamos una revisión sobre los empiemas pleurales ingresados en un hospital general en un período de 10 años. Se establece su frecuencia e incidencia con respecto a los egresos del hospital en el mismo período. Se obtienen informes sobre costos aproximados para la institución. Se obtuvo información sobre múltiples parámetros como: ficha patronímica, clínica, estudios realizados, tratamientos médicos y quirúrgicos. Se estableció también la mortalidad del grupo; realizando algunas propuestas para mejorar los resultados obtenidos
Subject(s)
Humans , Animals , Male , Female , Adolescent , Adult , Middle Aged , Empyema , Empyema/diagnosis , Empyema/etiology , Empyema/therapyABSTRACT
Sobre la base de las posibilidades diagnósticas y terapéuticas de la toracoscopía clásica de visión directa, se adaptó la tecnología de la colecistectomía laparoscópica al diagnóstico y tratamiento de las enfermedades del tórax. Se denominó al método Endocirugía Toracoscópica controlada por video y fue efectuado en 16 pacientes. En 10 derrames pleurales sin diagnóstico etiológico previo tuvo el 100%de acierto. En un cáncer de pulmón contribuyó a la estadificación y en otro al diagnóstico de estirpe. Fue terapéutica en 3 empiemas y en 1 hemoneumotórax traumático. No existieron complicaciones de consideración. Sus posibles alcances, que solo depurarán el tiempo y la experiencia, se reúnen en un protocolo destacando la excelente visión, cómoda instrumentación y rápida recuperación postoperatoria que se suman a las ventajas funcionales postoperatorias de la toracoscopía clásica. Esta modalidad, deberá ser desarrollada por grupos con experiencia en cirugía torácica
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thoracic Surgery/methods , Endoscopy , Pleural Effusion/therapy , Thoracoscopy , Drainage , Empyema/surgery , Empyema/therapy , Endoscopy/adverse effects , Endoscopy/instrumentation , Hemothorax/surgery , Lung Neoplasms/diagnosis , Pneumothorax/surgery , Pleural Effusion/diagnosis , Thoracoscopy/instrumentationABSTRACT
A deiscência da sutura do coto brônquico é uma grave complicaçäo da penumonectomia. O empiema e a fístula brônquica que se desenvolvem nestes doentes säo de difícil tratamento. A conduta para o controle destas fístulas é um desafio terapêutico apesar do grande número de técnicas propostas. A incidência é baixa, 2,7% a 6,8% das penumonectomias, porém sua mortalidade chega a 50%. Neste trabalho apresentamos 1 caso de fístula brônquica e analisamos os diversos procedimentos operatórios, preconizados para o seu tratamento
Subject(s)
Humans , Aged , Male , Pleural Diseases/surgery , Bronchial Fistula/surgery , Fistula/surgery , Pneumonectomy/adverse effects , Pleural Diseases/etiology , Drainage , Empyema/complications , Empyema/therapy , Bronchial Fistula/complications , Bronchial Fistula/etiology , Bronchial Fistula/mortality , Fistula/etiology , Lung Neoplasms/surgery , ReoperationABSTRACT
El amplio uso de los drenajes pleurales en las diversas patologías del tórax (neumotórax, hemotórax, síndrome de ocupación pleural, etc.) implica el buen conocimiento de los sistemas de drenaje aspirativos y no aspirativos. Sus complicaciones están dadas por la infección, la obstrucción, la hemorragia y la filtración. Para un buen manejo del drenaje pleural es importante capacitar al personal, mantener el sistema bajo asepsia rigurosa y si el procedimiento no funciona, cambiar todo el sistema, incluído el tubo de drenaje pleural
Subject(s)
Humans , Drainage , Pleural Diseases/therapy , Empyema/therapy , Hemopneumothorax/therapy , Pleura/injuries , Chylothorax/therapySubject(s)
Humans , Male , Female , Mediastinal Neoplasms , Respiratory Tract Diseases , Asthma/diagnosis , Asthma/physiopathology , Asthma/therapy , Disease Outbreaks/classification , Empyema , Empyema/diagnosis , Empyema/therapy , Lung Diseases, Obstructive/prevention & control , Lung Diseases, Obstructive/therapy , Pneumonia/diagnosis , Pneumonia/therapy , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/therapy , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/therapySubject(s)
Humans , Male , Female , Empyema , Empyema/diagnosis , Empyema/history , Empyema/surgery , Empyema/therapyABSTRACT
Un estudio retrospectivo de 47 pacientes con derrame pleural para neumonico y empiema estudiados en el Hospital General de Medellin, Colombia, durante un periodo de cuatro anos mostro que los ninos menores de dos anos son el grupo mas frecuentemente afectados (57%). Los sintomas clinicos de presentacion mas frecuentes fueron: fiebre (100%), taquipnea (93%), disnea y tos (85%). El derrame pleural ocurrio como una enfermedad predominantemente unilateral. Entre los hallazgos radiologicos, los neumatoceles no se observaron estar asociados con un germen en especial. Se presentaron 20 pacientes con empiema (42%) y los germenes mas comunmente aislados fueron el staphilococo aureus y el haemophilus influenzae. Veintisiete pacientes (57%) presentaron derrame paraneumonico y se identifico organismo especifico tan solo en el 18%. Los derrames para neumonicos se trataron sin sonda a torax en el 66% de los pacientes, mientras que fue necesario la colocacion de sonda de torax en el 80% de los pacientes con empiema
Subject(s)
Infant , Child, Preschool , Child , Humans , Male , Female , Empyema , Pleural Effusion , Colombia , Empyema/diagnosis , Empyema/therapy , Haemophilus influenzae/pathogenicity , Pleural Effusion , Pleural Effusion/complications , Pleural Effusion/diagnosis , Pleural Effusion/epidemiology , Pleural Effusion/surgery , Pleural Effusion/therapy , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/therapy , Staphylococcus aureus/pathogenicity , Thoracostomy/methodsABSTRACT
O diagnóstico do empiema pleural, numa fase inicial da doença, é de fundamental importância para uma boa evoluçäo, evitando-se, destarte, as complicaçöes quando se faz o diagnóstico tardiamente. Nos derrames pleurais näo complicados (pH > 7,20, glicose > 50 mg% e DHL < 1.000 UI/I) näo há indicaçäo de drenagem e o tratamento, basicamente, é o da pneumonia. Em relaçäo aos complicados (pH < 7,20, glicose < 50 mg% e DHL > 1.000 UI/I) e septaçöes múltiplas a drenagem será aberta ou fechada se agudo ou crônico, respectivamente. A descorticaçäo pulmonar precoce está indicada no tratamento de volumoso espaço pleural residual e em algumas situaçöes em que o pulmäo ocupar o espaço pleural após a descorticaçäo. Na dúvida, realizar drenagem aberta. No espaço pleural residual menor, alguns tipos de mioplastia däo ótimos resultados
Subject(s)
Humans , Empyema/diagnosis , Drainage , Empyema/therapySubject(s)
Humans , Infant , Empyema/microbiology , Escherichia coli Infections/microbiology , Pneumonia/microbiology , Amikacin/therapeutic use , Cephalexin/therapeutic use , Cephalothin/therapeutic use , Combined Modality Therapy , Drainage , Empyema/complications , Empyema/therapy , Escherichia coli Infections/therapy , Pneumonia/complications , Pneumonia/therapyABSTRACT
Os autores apresentam um caso de Empiema Pleural com manifestaçöes clínicas pouco exuberantes, evoluçäo radiológica atípica, evoluçäo radiológica atípica, no qual foi impossível determinar a causa. O exame radiológico de admissäo evidenciava um pequeno derrame pleural esquerdo que evoluiu rapidamente para derrame pleural bilateral e posteriormente para empiema pleural loculado a direita caracterizando um comportamento näo comumente observado na literatura. Destacam a importância da ultrasonografia de tórax para distinguir com precisäo a natureza sólida ou cística das opacidades pleurais, bem como a necessidade de intervençäo cirúrgica precoce, de antibioticoterapia correta e fisioterapia respiratória, no intuito de evitar a ocorrência de grave perda funcional e possibilitar uma boa evoluçäo, como no caso apresentado