Nocardia nova causing empyema necessitatis afterlung re-transplantation: a case report

Abstract: We report herein a case of thoracic infection due to Nocardia nova following lung re-transplantation performed for emphysema related to alpha-1-antitrypsin deficiency. The infection extended from the lung into the pleural space, thoracic wall, and mediastinum, presenting as pericarditis and empyema necessitatis. Nocardia nova was identified by 16S ribosomal deoxyribonucleic acid (rDNA) sequencing and phylogenetic analysis. According to a literature search of PubMed, LILACS and MEDLINE databases, we describe herein the first case of empyema necessitatis caused by N. nova species in a transplanted patient.

Thoracic neuroblastoma presenting as recurrent empyema.

Neuroblastoma is the most common intra-abdominal and extracranial solid tumour in children, accounting for 7%–8% of all childhood cancers. It is a malignant tumour of the autonomic nervous system derived from the neural crest. Most children with neuroblastoma have distant metastatic disease at the time of diagnosis. Pulmonary metastasis at the time of diagnosis is rare, and rarer is the presence of associated pleural effusion. We present the case of a child with recurrent empyema, who was diagnosed to have a thoracic neuroblastoma.

Concurrent Salmonella mycotic abdominal aneurysm and empyema thoracis: a rare coincidence

To present a case of Salmonella bacteremia with a rare metastatic focus. Clinical Presentation and Intervention: A 61-year-old male presented with a suicide attempt after ingestion of half a bottle of toilet cleaner. He had a medical history of intravenous drug abuse and major depression. Persistent Salmonella enteritidisbacteremia occurred during his hospitalization, and a search for the primary source of infection disclosed a mycotic abdominal aortic aneurysm. A suppurative lesion was also noted over the left pleural space, and Salmonella empyema was confirmed after thoracentesis. He underwent video-assisted thoracoscopic surgery and endovascular repair of the abdominal aortic aneurysm and was placed on long-term antibiotics, without recurrence. S. enteritidis involvement of the cardiovascular system is a rare coincidence and results in significant morbidity and mortality. In addition, the phenomenon of secondary metastatic infective foci involving the pleural space has an even lower frequency than that of cardiovascular involvement. Therefore, a high index of suspicion and prompt treatment from the treating physicians are strongly recommended

Empiema cerebral por Escherichia coli en un lactante de 5 meses: reporte de caso y revisión del tema / Brain empyema due to Escherichia coli in a 5 month-old infant: a case report and literature review

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.

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

Liver Abscess and Empyema due to Lactococcus lactis cremoris

Lactococcus lactis cremoris infections are very rare in humans. We experienced liver abscess and empyema due to L. lactis cremoris in an immunocompetent adult. A 42-yr-old man was admitted with fever and abdominal pain. Abdominal computed tomography (CT) revealed a liver abscess and chest CT showed loculated pleural effusion consistent with empyema. L. lactis cremoris was isolated from culture of the abscess material and blood. The patient was treated with pus drainage from liver abscess, video-assisted thoracoscopic decortications for empyema, and antibiotics including cefotaxime and levofloxacin. The patient was completely recovered with the treatment. To our knowledge, this is the first report of a L. lactis cremoris infection in Korea.

Intracranial abscess and empyema from ENT origin

Intracranial abscess and empyemas from ENT infection are rare. The aim of our study was to recall the treatment and therapeutic results. It was a retrospective study from 1995 to 2006 concerning. 23 patients who had brain abscesses secondary to an ENT infection. The infections origin was otological in 56% of cases, sinusal in 44%. Bacterias were identified in 40% of cases. All patients benefited a medical treatment to basis of at least 2 antibiotics a long length going from 20 days to 3 less by intravenous way. Nine patients benefited neurosurgery with an ENT treatment surgical. Nine patients had alone neurosurgery and 5 cases had an ENT surgery alone. The treatment consists in excision or single punction of the abscess. 72% are alive and well. We have no dead. The classical intracranial hypertension associated to high fever is usually truncated. The diagnosis is more precocious thanks to the progress of the medical imagery. Multibacterial infections are frequent. Treatment is medical and surgical. Recovery requires a specific surgical treatment of the ENT infection in more than 60% of cases. An adapted treatment permits a recovery without after effects in at least the half of cases

Diagnostic role of closed pleural biopsy in the investigation of exudative pleural effusions.

Closed pleural biopsy is known to be diagnostic in approximately 75% of pleural effusion undiagnosed by thoracocentesis or pleural fluid evaluation. The purpose of this study was to determine the efficacy of closed pleural biopsy in a teaching hospital, Eastern India. The study was undertaken in all patients with exudative pleural effusion who were admitted in the department of chest medicine, Burdwan Medical College and Hospital, Burdwan, during the period from January 2001 to December 2005. Abram's needle was used for closed pleural biopsy in every case. One hundred and thirty-three pleural biopsies were performed with the needle. Twenty-three cases were excluded due to obtaining no pleural tissue. Specific diagnoses were obtained in 64 cases giving a diagnostic yield of 48.12%. Of these 17 revealed malignancy, 37 tuberculosis, and 10 empyema. A non-specific diagnosis was obtained in 46 cases (34.58%). By closed pleural biopsy 48.12% of undiagnosed exudative pleural effusions could be diagnosed which shows that closed pleural biopsy is still of value as a diagnostic procedure, and should be carried out prior to invasive procedures such as thoracoscopy or open pleural biopsy.

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

Empiema de necessidade doze anos após trauma torácico por arma de fogo / Empyema necessitatis twelve years after thoracic trauma for gunshot wounds

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.

La toracoscopia temprana en el empiema poneumónico / Early thoracoscopy in post-pnemonic empyema

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

Empiema en niños: diagnóstico y tratamiento / Empyema in children: Treatment and diagnosis

El empiema es una de las complicaciones más frecuentes de las neumonías bacterianas causadas por Haemophilus influenzae y Staphylococcus aureus, sobre todo en lactantes y escolares. El correcto diagnóstico y clasificación, de acuerdo con el estadio en que se encuentre ya sea exudativo, fibrinopurulento u organizado; son fundamentales para determinar el tratamiento antibiótico y de drenaje adecuados

Empiema pleural: diagnóstico de situación en el Hospital de Clínicas / Pleural empyema: diagnosis of situation at the hospital de Clinicas

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

Leiomyosarcoma of gallbladder: a case report.

A case of leiomyosarcoma of gallbladder, a rare tumor in hepatobiliary region, is reported. The present case differs from previously reported cases in its presentation with empyema of gallbladder and multiple intrahepatic cholangiolytic abscesses. Curative surgery could not be undertaken on account of poor condition of patient, and invasion of tumor into liver and adjacent organs.

La ecografía en la lesion torácica / Ultrasonography in thoracic lesions

Hace más de 20 años se comenzó a utilizar la ecografía en tórax. Pocos estudios se describieron desde entonces. Esta breve experiencia tiende a su difusión y debate. Se estudiaron 50 pacientes de ambos sexos, de 50,5 años de promedio, en un período de 8 meses. Se utilizaron transductores de 3,75 MHz; evaluándose lesiones pleurales, pulmonares y mediastinales. Es el método más fidedigno para la diferenciación entre lesiones sólidas y líquidas, buena guía en procedimientos invasivos

Group A beta-hemolytic streptococcal type M11 sepsis and empyema: a case report.

A case of serious suppurative disease caused by GABHS in a previously well 2-month-old Thai female presenting with clinical features of sepsis and right pleural effusion was reported. Treatment was initially with cloxacillin and a right side intercostal drainage. When subsequent cultures of blood and pleural fluid grew GABHS; intravenous penicillin was substituted. She made an uneventful recovery. Typing of the GABHS revealed non typable T-antigen and M-protein 11 GABHS, although very sensitive to penicillin, can cause severe and rapidly progressive disease in a very young infant. This is the first case of GABHS type M11 causing pleural effusion and sepsis in an infant ever reported in Thailand. Epidemiologic study might be indicated if an epidemic should occur.