Empyema

Empyema, pus in the pleural space, usually presents as pneumonia plus pleurisy. In adults hospitalized for pneumonias, empyemas are uncommon while effusions are common. Common pathogens are S. pneumoniae, Streptococcus species, Staph. aureus, and anaerobes.

CASES/YEAR
125,000 (US); 2,500,000 (Global)
CATEGORY
Localized Infections
AGENT TYPE
Mixed
OTHER NAMES
ACUITY
Acute-Severe
INCUBATION
Estimated: days to weeks;
INITIAL SYMPTOMS
Usually presents as pneumonia plus pleurisy; [ABX Guide]
PRECAUTIONS
COMMENTS
In adults hospitalized for pneumonias, empyemas are uncommon (2-3% of pneumonias) while effusions are common (20-40% of pneumonias). Common pathogens are in CAP (S. pneumoniae, Streptococcus species, Staph. aureus, and anaerobes. [ABX Guide] Patients with anaerobic pleuropulmonary infection present with a more chronic pattern (weight loss, fever, and chronic cough) than those presenting with acute bacterial pneumonia. [PPID 7th Ed., p. 919] Lung abscesses are associated with leukocytosis and anemia of chronic disease; Empyema occurs in about 1/3 of lung abscess cases; [PPID, p. 857] Common causes are pneumonias caused by Streptococcus pneumoniae, Staphylococcus aureus, tuberculosis, or aspiration. [Cecil, p. 609] Complications include shock and respiratory failure. [Cohen, p. 266]
DIAGNOSTIC
Chest x-ray, or ultrasound, or CT; Thoracentesis (if > 10 ml free-flowing fluid on lateral decubitus x-ray); Gram stain (Use initial results to guide 1st day of therapy.) and culture; pH of the pleural fluid is < 7.2; [ABX Guide]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • H anemia
  • H leukocytosis
  • R chest pain
  • R cough
  • R dyspnea
  • R sputum production
  • X cystic or cavitary lesions
  • X lung infiltrates
  • X pleural effusions
  • *ARDS
  • *pneumonia
  • *shock
  • *weight loss
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Inhalation
SOURCE
Person-to-Person
RESERVOIR
Human
RISK FACTORS
  • AIDS patients
  • Cancer patients
TREATMENT
Treatment includes drainage and antibiotics. [ABX Guide]
DRUG LINK
REFERENCES FOR CASES/YEAR
1. (US) More than 10 million cases of pneumonia and 1 million hospitalizations every year in the US; [Cecil, 24th Ed, p. 588] Empyemas occur in 2-3% of pneumonias. [ABX Guide] 2.5% X 10 million = 250,000;
2. (Global) Global cases/yr = 20 X US cases/yr.