Related Experiment Videos
[Purulent pleurisy caused by anaerobic bacteria. A retrospective study of 19 cases]
J C Dalphin1, G Capellier, M J Dupont
1Service de Pneumologie, Centre hospitalier régional Saint-Jacques, Besançon.
Abstract:
A retrospective clinical, biological, radiological and evolutive study of 19 cases of pleural empyema caused by anaerobic organisms diagnosed between 1980 and 1986 was carried out. These 19 cases accounted for 30.6 p. 100 of all cases of pleural empyema diagnosed during the same period. A local or general contributory factor was found in all patients; false passage, gastrointestinal pathology and buccal or dental diseases were the most frequent aetiological circumstances. The clinical picture was rather torpid, with a body temperature below 38 degrees C in 42 p. 100 of the cases, which delayed the diagnosis: the mean time interval between onset and diagnosis was 20 days. In nearly one half of the cases, blood stained expectoration was present and air-fluid levels were visualized at standard radiography and computerized tomography, which is the best exploratory method to evaluate the size and appearance of the pleural lesion, to guide percutaneous drainage and later to assess possible sequelae. The predominant anaerobic flora consisted of Gram-positive cocci and Bacteroides spp; in 70 p. 100 of the cases the anaerobic organism(s) was (were) sensitive to penicillin G. The course of the disease was favourable in all patients. Surgery was performed in 3 of the 19 patients on account of chest wall gangrene due to Clostridium perfringens in 1 case and of the presence of multiple fluid pockets making drainage ineffective in 2 cases.
Insights
Anaerobic bacteria caused 30.6% of pleural empyema cases between 1980-1986. Diagnosis was often delayed due to mild symptoms, but all patients recovered with appropriate treatment, often including penicillin G.
Area of Science:
- Infectious Diseases
- Pulmonology
- Microbiology
Background:
- Pleural empyema is a serious infection of the pleural space.
- Anaerobic organisms are an under-recognized cause of pleural empyema.
- Understanding the clinical presentation and microbiology is crucial for effective management.
Purpose of the Study:
- To retrospectively analyze clinical, biological, radiological, and evolutive features of anaerobic pleural empyema.
- To determine the incidence, causative organisms, and treatment outcomes of anaerobic pleural empyema.
- To highlight the diagnostic challenges and optimal management strategies.
Main Methods:
- Retrospective study of 19 patients diagnosed with anaerobic pleural empyema from 1980 to 1986.
- Review of clinical data, microbiological findings, radiological imaging (including CT scans), and treatment outcomes.
- Analysis of etiological factors, clinical presentation, and response to therapy.
Main Results:
- Anaerobic organisms accounted for 30.6% of pleural empyema cases during the study period.
- Common contributing factors included gastrointestinal pathology and dental diseases.
- Delayed diagnosis was frequent due to torpid clinical presentation (fever <38°C in 42%) with a mean diagnostic interval of 20 days.
- Computerized tomography (CT) was essential for lesion evaluation and guiding drainage.
- Predominant flora included Gram-positive cocci and Bacteroides spp., with 70% sensitivity to penicillin G.
- All patients experienced favorable outcomes; surgery was reserved for complex cases.
Conclusions:
- Anaerobic bacteria represent a significant proportion of pleural empyema cases.
- Early diagnosis can be challenging due to subtle clinical signs.
- CT imaging and appropriate antibiotic therapy, often penicillin G, are key to successful management.
- Prompt and effective management leads to favorable outcomes in anaerobic pleural empyema.