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J Assoc Physicians India 2020 Jun;68(6):32-34

Professor and Head, Department of Pulmonary Medicine, Dr D Y Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra.

About 36% to 57% of bacterial pneumonias develop parapneumonic effusion. When the chest tube is correctly positioned as evidenced by postero-anterior and lateral chest radiographs and there is a significant amount of pleural fluid, the major reasons for failed drainage are multiple pleural space loculations or tube obstruction by thick and viscous fluid. The various modalities of treatment available for loculated pleural effusion are: saline flushes, placing one or more catheters in loculi under image guidance, video assisted thoracoscopic surgery (VATS), standard thoracotomy with drainage of empyema and decortication. Read More

Adv Pediatr 2020 Aug 14;67:145-169. Epub 2020 May 14.

Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, 600 Highland Avenue, H4/740 CSC, Madison, WI 53792-7375, USA.

Int J Infect Dis 2020 Jun 14. Epub 2020 Jun 14.

Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, Spain; Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga, Red de Investigación Translacional en Infectología Pediátrica (RITIP), Málaga, Spain; Infectología Pediátrica e Inmunodeficiencias, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, Spain.

Introduction: Community-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP.

Method: From 2011-2016 a partially retrospective and prospective and descriptive study was carried out on healthy paediatric patients (3 months - 14 years old) with CAP, who required hospital admission. Read More

Pulm Med 2020 20;2020:7175451. Epub 2020 May 20.

Rocky Mountain Radiologists, 1873 S. Bellaire St, #420. Denver, CO 80222, USA.

Introduction: Complicated parapneumonic effusions (CPE) are distinguished from uncomplicated parapneumonic effusions (UPE) by the ability to resolve without drainage. Determinants include pleural pH, pleural glucose, and pleural LDH, along with microbiologic cultures. Inflammation mediated by neutrophil chemotactic cytokines leads to fibrinous loculation of an effusion, and the degree of this inflammation may lead to a CPE. Read More

Ann Am Thorac Soc 2020 May 18. Epub 2020 May 18.

Beth Israel Deaconess Medical Center, 1859, Division of Thoracic Surgery and Interventional Pulmonology, Boston, Massachusetts, United States;

Rationale: Pleural infection is a frequent diagnosis encountered in clinical practice associated with high morbidity and mortality. Limited evidence exists regarding the optimal treatment. Although both early medical thoracoscopy (MT) and tube thoracostomy with intrapleural instillation of tissue plasminogen activator (tPA) and human recombinant deoxyribonuclease (DNase) are acceptable treatment for patients with complicated pleural infection, there is a lack of comparative data between these modes of management. Read More

Case Rep Infect Dis 2020 12;2020:7301617. Epub 2020 Feb 12.

Department of Pediatrics, Central Michigan University Health, Saginaw, MI 48602, USA.

Community-Acquired Pneumonia (CAP) is a common reason for hospitalization of a pediatric patient. We report a 20-month-old female admitted for suspected CAP. History included a week-long cough, fever, dyspnea, single occurrence of seizure-like activity, and a sick contact. Read More

Am J Respir Crit Care Med 2020 Jun;201(12):1545-1553

Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom.

Parapneumonic effusions have a wide clinical spectrum. The majority settle with conservative management but some progress to complex collections requiring intervention. For decades, physicians have relied on pleural fluid pH to determine the need for chest tube drainage despite a lack of prospective validation and no ability to predict the requirement for fibrinolytics or thoracic surgery. Read More

BMC Infect Dis 2020 Feb 1;20(1):99. Epub 2020 Feb 1.

Clinic of Pulmonary Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.

Background: The identification of the pathogens in pleural effusion has mainly relied on conventional bacterial culture or single species polymerase chain reaction (PCR), both with relatively low sensitivity. We investigated the efficacy of a commercially available multiplex bacterial PCR assay developed for pneumonia to identify the pathogens involved in pleural infection, particularly empyema.

Methods: A prospective, monocentric, observational study including 194 patients with pleural effusion. Read More

World J Crit Care Med 2019 Oct 16;8(6):99-105. Epub 2019 Oct 16.

Intensive Care Unit, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny 93000, France.

Background: () is a gram-negative intracellular bacillus composed of sixteen different serogroups. It is mostly known to cause pneumonia in individuals with known risk factors as immunocompromised status, tobacco use, chronic organ failure or age older than 50 years. Although parapneumonic pleural effusion is frequent in legionellosis, pleural empyema is very uncommon. Read More

Pediatr Pulmonol 2020 02 18;55(2):484-489. Epub 2019 Nov 18.

Basic Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Objective: To evaluate culture-independent procedures (immunochromatography and quantitative polymerase chain reaction [qPCR]) in the detection and susceptibility of Streptococcus pneumoniae directly from culture-negative pleural fluid (PF) in children.

Method: Detection of S. pneumoniae in PF of children with parapneumonic effusion and/or empyema by using two culture-independent methods: an immunochromatographic membrane test (IMT) which identifies the pneumococcal C antigen, and a real-time PCR test to detect pneumococcal genes lytA and pbp2b, a marker of susceptibility of β-lactam agents, in PF samples. Read More

Vaccine 2020 01 14;38(3):570-577. Epub 2019 Nov 14.

Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany. Electronic address:

Introduction: Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs).

Methods: In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped. Read More

Cochrane Database Syst Rev 2019 10 30;2019(10). Epub 2019 Oct 30.

Southern Adelaide Local Health Network (SALHN), Respiratory and Sleep Services, Bedford Park, South Australia, Australia, 5041.

Background: Pleural infection, including parapneumonic effusions and thoracic empyema, may complicate lower respiratory tract infections. Standard treatment of these collections in adults involves antibiotic therapy, effective drainage of infected fluid and surgical intervention if conservative management fails. Intrapleural fibrinolytic agents such as streptokinase and alteplase have been hypothesised to improve fluid drainage in complicated parapneumonic effusions and empyema and therefore improve treatment outcomes and prevent the need for thoracic surgical intervention. Read More

Medicine (Baltimore) 2019 Oct;98(43):e17397

Respiratory Medicine, Sir Charles Gairdner Hospital.

Background: Community-acquired pneumonia (CAP) is a major global disease. Parapneumonic effusions often complicate CAP and range from uninfected (simple) to infected (complicated) parapneumonic effusions and empyema (pus). CAP patients who have a pleural effusion at presentation are more likely to require hospitalization, have a longer length of stay and higher mortality than those without an effusion. Read More

BMC Pulm Med 2019 Jun 18;19(1):108. Epub 2019 Jun 18.

Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.

Background: We previously demonstrated that the pleural levels of proteins (neutrophil gelatinase-associated lipocalin/NGAL, calprotectin, bactericidal permeability-increasing/BPI, azurocidin 1/AZU-1) were valuable markers for identifying complicated PPE (CPPE). Herein, this study was performed to evaluate whether these proteins are useful as serological markers for identifying CPPE and empyema.

Methods: A total of 137 participates were enrolled in this study. Read More

Neoplasma 2019 Sep 3;66(5):839-846. Epub 2019 Jun 3.

Center for Experimental Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Overexpression of Sonic hedgehog (Shh) is associated with progression of several cancers. The expression of Shh in non-small cell lung cancer (NSCLC) has been reported with inconsistent results. Lung adenocarcinoma (LAC) and lung squamous cell carcinoma (LSCC) are two major subtypes of NSCLC, which have different genetic genotypes and clinical therapeutic options. Read More

J Clin Med 2019 05 16;8(5). Epub 2019 May 16.

Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, CH⁻8032 Zurich, Switzerland.

Parapneumonic effusion or pleural empyema (PPE/PE) is a frequent complication of community-acquired pneumonia (CAP) in children. Different management approaches exist for this condition. We evaluated a 14-day treatment with amoxicillin (AMX) with/without clavulanic acid (AMC) confirmed or modified by microbiological findings from pleural tap. Read More

Artif Cells Nanomed Biotechnol 2019 Dec;47(1):1924-1931

a Department of Respiratory, Daping Hospital, Army Medical Center of PLA,   Chongqing , PR China.

Aims: The study aimed to investigate the clinical characteristics of patients with pleural effusion (PE), and explore the effective indicators for definite diagnosis of tuberculous pleural effusion (TBPE).

Methods: The adult patients with the presence of PE were enrolled. All the patients received pleural fluid Mycobacterium tuberculosis DNA detection, ADA activity measure and blood T-SPOT. Read More

Respir Med Case Rep 2019 17;27:100848. Epub 2019 Apr 17.

Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town and Red Cross War Memorial Children's Hospital, South Africa.

One third of the world's population is estimated to be infected with . Tuberculosis (TB) is endemic in many sub-Saharan African counties. The burden is further made worse by the HIV scourge. Read More

JCI Insight 2019 04 18;5. Epub 2019 Apr 18.

Departments of Cellular and Molecular Biology.

Background: Current dosing of intrapleural fibrinolytic therapy (IPFT) in adults with complicated parapneumonic effusion (CPE) / empyema is empiric, as dose-escalation trials have not previously been conducted. We hypothesized that LTI-01 (scuPA), which is relatively resistant to PA inhibitor-1 (PAI-1), would be well-tolerated.

Methods: This was an open-label, dose-escalation trial of LTI-01 IPFT at 50,000-800,000 IU daily for up to 3 days in adults with loculated CPE/empyema and failed pleural drainage. Read More

Med Clin North Am 2019 May;103(3):475-485

Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, The Vanderbilt Clinic, 1301 Medical Center Drive, B-817 The Vanderbilt Clinic, Nashville, TN 37232-5735, USA. Electronic address:

Pleural effusions are a common clinical problem for the primary care physician. Over the past 10 years, there has been a paradigm shift in the field due to emergence of new evidence, which includes the ubiquitous use of thoracic ultrasound, the reemergence of pleuroscopy as a diagnostic and therapeutic modality, the widespread use of indwelling pleural catheters for malignant pleural effusions, and the evidence-based approach to management of complex parapneumonic effusions. This review focuses on these advancements with an emphasis on practical clinical application. Read More

Medicine (Baltimore) 2019 Mar;98(13):e15003

Division of Allergy/Pulmonary/Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.

Pleural effusions are a common medical problem not only for pulmonologists but also for general physicians, often needing thoracentesis for a definite diagnosis. However, thoracentesis cannot always reveal malignant cells or microbiological evidence.In this context, we prospectively enrolled a total of 289 patients with pleural effusions due to diverse etiologies: parapneumonic effusion (PPE) (63), empyema (22), tuberculous pleural effusion (TBPE) (54), malignant pleural effusion (MPE) (140), or chronic renal failure (CRF)/congestive heart failure (CHF) (10). Read More

Respirol Case Rep 2019 Apr 13;7(3):e00408. Epub 2019 Feb 13.

Department of Respiratory Medicine Sir Charles Gairdner Hospital Perth Western Australia Australia.

Pleural infection managed with intrapleural therapy using a combination of 10 mg of tissue plasminogen activator (tPA) and 5 mg of deoxyribonuclease (DNase) has been shown in randomized and open-label studies to successfully treat >90% of patients without resorting to surgery. Potential bleeding risks, although low, and costs associated with tPA remain important concerns. No phase I studies exist for intrapleural tPA therapy and the lowest effective dose has not been established. Read More

Cureus 2018 Feb 21;10(2):e2214. Epub 2018 Feb 21.

Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.

Background Complicated parapneumonic effusions empyema (CPEE) is fairly common and associated with increased morbidity and mortality. The Multicenter Intrapleural Sepsis Trial 2 (MIST 2) established the combination of intrapleural deoxyribonuclease (DNase) and tissue plasminogen activator (tPA) as an effective treatment for CPEE, thereby avoiding surgery and decreasing the length of hospitalization. MIST 2, however, used a labor-intensive protocol with some risk of bleeding. Read More

Tuberculosis (Edinb) 2019 01 15;114:24-29. Epub 2018 Nov 15.

Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Banacha 1A, 02-097, Warsaw, Poland. Electronic address:

The diagnostic value of pleural fluid biomarkers in tuberculous pleurisy (TP) is firmly established. However, it is less clear whether patients' age affects the diagnostic accuracy of TP biomarkers. The aim of the study was to assess the impact of age, on the predictive value of ADA, IFN-γ, IP-10 and Fas ligand in patients with pleural effusion. Read More

BMJ Case Rep 2019 Jan 31;12(1). Epub 2019 Jan 31.

Internal Medicine, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain.

Infections caused by fusobacteria have a wide clinical spectrum, and in certain patients, they can lead to severe systemic illness. We report the case of an immunocompromised young woman who presented with severe pneumonia complicated by parapneumonic pleural effusion, despite wide-spectrum antibiotic treatment. was isolated in the samples obtained after thoracentesis was performed. Read More

J Emerg Med 2019 Apr 10;56(4):421-425. Epub 2019 Jan 10.

Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore.

Background: Point-of-care ultrasonography (POCUS) is increasingly used for both diagnostic and guided procedures. Increasingly, POCUS has been used for identification of pneumonia and to assist in the differentiation of pleural effusions, as well as to guide thoracentesis. As such, there is a need for training with ideally high-fidelity lung ultrasound phantoms to ensure ultrasound proficiency and procedural competency. Read More

Respiration 2019;97(6):508-517. Epub 2019 Jan 9.

Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.

Background: Data regarding community-acquired pneumonia (CAP) identified on chest computed tomography (CT) but not on chest radiography (CR) are limited.

Objectives: The present study aimed to investigate the clinical and radiological features of these patients.

Methods: We retrospectively compared the clinical characteristics, etiological agents, treatment outcomes, and CT findings between CAP patients with negative CR and positive CT findings (negative CR group) and those with positive CR as well as CT findings (control group). Read More

J Thorac Dis 2018 Nov;10(Suppl 31):S3696-S3703

Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Background: The efficacy of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has recently been proven. Till today, very few works evaluated the role of uniportal-VATS (U-VATS) approach in the treatment of pleural empyema even if it currently represents the most innovative and less invasive thoracoscopic approach. We report our experience with U-VATS in the treatment of pleural empyema. Read More

BMC Pulm Med 2018 Nov 23;18(1):176. Epub 2018 Nov 23.

Department of Internal Medicine, Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.

Background: We aimed to determine the presepsin concentration in pleural fluid from patients with pleural effusions of different aetiologies and to compare its diagnostic value with that of pleural fluid C-reactive protein (CRP) and procalcitonin (PCT).

Methods: We enrolled 132 patients with pleural effusion who underwent diagnostic evaluation, and we classified them into six categories: empyema, parapneumonic effusion, tuberculous effusion, malignant effusion, paramalignant effusion, and transudate effusion. Additionally, all pleural effusions were categorised as infectious or non-infectious effusions. Read More

Praxis (Bern 1994) 2018 Nov;107(23):1283-1287

1 Innere Medizin, Rankweil, Österreich.

Pneumonia: Does Ultrasound Replace Chest X-Ray? Abstract. Pneumonic lung consolidations are characterized by typical changes in terms of sonomorphology: echopoor lesions with blurred margins, bronchoaerograms, regular vascularization, and parapneumonic effusions. Pneumonias may be first discovered at bedside. Read More

J Pediatric Infect Dis Soc 2019 Nov;8(5):474-477

Université Paris Est, IMRB-GRC GEMINI, Créteil, France.

We describe here changes in the bacterial causes of pleural empyema before and after implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) program in France (2009-2017). For 220 (39.3%) of 560 children, a bacterial cause was found. Read More

Clin Microbiol Infect 2019 Jul 3;25(7):857-864. Epub 2018 Nov 3.

Department of Paediatrics, University Hospital of Würzburg, Würzburg, Germany.

Objectives: Parapneumonic pleural effusions/empyema (PPE/PE) are severe complications of community-acquired pneumonia. We investigated the bacterial aetiology and incidence of paediatric PPE/PE in Germany after the introduction of universal pneumococcal conjugate vaccine (PCV) immunization for infants.

Methods: Children <18 years of age hospitalized with pneumonia-associated PPE/PE necessitating pleural drainage or persisting >7 days were reported to the German Surveillance Unit for Rare Diseases in Childhood between October 2010 and June 2017. Read More

Panminerva Med 2019 Sep 31;61(3):326-343. Epub 2018 Oct 31.

Division of Pneumology, Spedali Civili di Brescia, Brescia, Italy.

Diseases of the pleura and pleural space are common and present a significant contribution to the workload of respiratory physicians, with most cases resulting from congestive heart failure, pneumonia, and cancer. Although the radiographic and ultrasonographic detection of pleural abnormalities may be obvious, the determination of a specific diagnosis can often represent a challenge. Invasive procedures such as pleural drainage, ultrasound/CT-guided pleural biopsy or medical thoracoscopy can be useful in determining specific diagnosis of pleural diseases. Read More

Chest 2018 09;154(3):471-473

Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address:

Indian J Pediatr 2019 Feb 4;86(2):140-147. Epub 2018 Sep 4.

Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.

Objective: To identify predictors of complicated parapneumonic effusion (CPE)/empyema in patients of community acquired pneumonia (CAP) by using clinical and simple laboratory variables like hemoglobin (Hb), serum C-reactive protein (CRP), serum albumin (SA) levels and total leukocyte counts (TLC).

Methods: This prospective case-control study was conducted after institutional ethical approval. Subjects between ages of 2-59 mo with World Health Organization (WHO) defined CAP with written, informed parental consent were included. Read More

Clin Lab 2018 Jul;64(7):1269-1277

Background: Parapneumonic effusions usually occur secondary to an infection and produce pus (empyema) that accumulates in the pleural space. We aimed to evaluate the prevalence of anerobes in patients with empyema and to assess their resistance patterns for seven antimicrobials.

Methods: Pleural fluid specimens from 236 patients were inoculated on Schaedler agar. Read More

Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2018 Jul;39(1):131-141

University Infectious Diseases Clinic, Medical Faculty, Skopje, Republic of Macedonia.

Cleve Clin J Med 2018 08;85(8):609-611

Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.

Lung 2018 10 11;196(5):623-629. Epub 2018 Aug 11.

Baptist Hospital of Miami, Miami, FL, USA.

Purpose: Complicated parapneumonic effusions and empyema are a leading cause of morbidity in the United States with over 1 million admissions annually and a mortality rate that remains high in spite of recent advances in diagnosis and treatment. The identification of high risk patients is crucial for improved management and the provision of cost-effective care. The RAPID score is a scoring system comprised of the following variables: renal function, age, purulence, infection source, and dietary factors and has been shown to predict outcomes in patients with pleural space infections. Read More

Pneumologie 2018 Dec 2;72(12):843-850. Epub 2018 Aug 2.

Thoraxzentrum Ruhrgebiet, Klinik für Thoraxchirurgie, Evangelisches Krankenhaus Herne, Herne.

Objectives:  Evaluation of a standardised management for the treatment of patients with parapneumonic empyema.

Methods:  A retrospective 10-year single-centre analysis of all patients with parapneumonic empyema undergoing a standardised thoracoscopic treatment approach. We describe referral and age patterns, microbiological results, overall and stage-dependent success rates, conversion rates, 30-day and in-hospital mortality. Read More

Clin Respir J 2018 Aug;12(8):2309-2320

Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, United Kingdom.

Objectives: Pleural infection is a condition commonly encountered by the respiratory physician. This review aims to provide the reader with an update on the most recent data regarding the epidemiology, microbiology, and the management of pleural infection.

Data Source: Medline was searched for articles related to pleural infection using the terms "pleural infection," "empyema," and "parapneumonic. Read More

Ann Thorac Cardiovasc Surg 2018 10 2;24(5):263-264. Epub 2018 Jul 2.

Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki, Japan.

Pediatr Radiol 2018 09 27;48(10):1410-1416. Epub 2018 Jun 27.

Department of Paediatric Radiology, Children's Hospital for Wales, Heath Park, Cardiff, UK, CF14 4XW.

Background: Chest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion.

Objective: To evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital. Read More

Ci Ji Yi Xue Za Zhi 2018 Apr-Jun;30(2):97-101

Department of Preventive Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.

Objectives: It is not always possible to move critically ill patients to the operating or endoscopy room for a pleuroscopy. Bedside pleuroscopy is indicated for these patients. The aim of this study was to investigate the safety and complications of bedside pleuroscopy in an Intensive Care Unit (ICU). Read More

Expert Rev Respir Med 2018 06 20;12(6):521-535. Epub 2018 May 20.

a Pneumology Service , Complejo Hospitalario Universitario de Santiago , Santiago de Compostela , SPAIN.

Introduction: The management of infected pleural effusion is complex. Therapeutic resolution requires determining the following: appropriate antibiotic regimen, the need for pleural drainage, the optimal drainage tube size, and the need for intrapleural therapy or surgery. Areas covered: An updating of the latest advances in the management of parapneumonic pleural effusion based on the best evidence available is provided. Read More

Clin Respir J 2018 May;12(5):1779-1786

Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.

Tuberculosis (TB) is the leading infectious cause of death worldwide, and the commonest cause of death in people living with HIV. Globally, pleural TB remains one of the most frequent causes of pleural exudates, particularly in TB-endemic areas and in the HIV positive population. Most TB pleural effusions are exudates with high adenosine deaminase (ADA), lymphocyte-rich, straw-coloured and free flowing, with a low yield on mycobacterial culture. Read More

Thorac Cardiovasc Surg 2018 11 1;66(8):697-700. Epub 2018 Apr 1.

Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Hospital, Medical Research Institution, Busan, the Republic of Korea.

Background: In patients with parapneumonic empyema, decortication is usually preferred to ensure functional lung re-expansion. However, there could be patients exhibiting incomplete postoperative lung expansion and inadequate drainage despite decortication. Therefore, we evaluated factors affecting postoperative lung expansion in patients undergoing decortication. Read More

Curr Opin Pulm Med 2018 07;24(4):367-373

Centre for Respiratory Health, University of Western Australia, Perth.

Purpose Of Review: Pleural infection remains an important pulmonary disease, causing significant morbidity and mortality. There is a resurgence of disease burden despite introduction of antibiotics and pneumococcal vaccines. A revisit of the pathogenesis and update on intervention may improve the care of pleural infection. Read More

Children (Basel) 2018 Mar 3;5(3). Epub 2018 Mar 3.

Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa, ON K1H 8L1, Canada.

Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Read More