532 results match your criteria Parapneumonic Pleural Effusions and Empyema Thoracis


pulmonary abscess and pleural space infection in an immunocompetent patient.

BMJ Case Rep 2021 May 24;14(5). Epub 2021 May 24.

Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

A 34-year-old woman is admitted to the hospital with dyspnoea, dry cough and left-sided flank pain. Her urinary test was positive and CT imaging demonstrated multifocal pneumonia with pulmonary abscesses. Although she had initial clinical improvement on appropriate antibiotic therapy, her hospital course was complicated by worsening flank pain, hypoxemia and leucocytosis, prompting clinical re-evaluation and assessment for development of complications involving the pleural space. Read More

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Incidence trends of parapneumonic pleural effusions/empyema in children 2009 to 2018 from health insurance data: Only temporal reduction after the introduction of PCV13.

Vaccine 2021 Jun 15;39(26):3516-3519. Epub 2021 May 15.

Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany. Electronic address:

Background: Recently, emergence of a higher proportion of serotype 3 in children with parapneumonic pleural effusion/empyema (PPE/PE) were observed in Germany despite general immunization with 13-valent pneumococcal conjugate vaccine (PCV13) since 2009. The impact of PCV13 on the overall incidence of PPE/PE in children is unclear.

Methods: Annual incidence of PPE/PE in children were determined using secondary health care data for 2009-2018, provided by the Barmer statutory health insurer, serving about 11% of the German population. Read More

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Contrast-enhanced ultrasound of pediatric lungs.

Pediatr Radiol 2021 May 12. Epub 2021 May 12.

Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA.

In addition to radiography, ultrasound (US) has long proved to be a valuable imaging modality to evaluate the pediatric lung and pleural cavity. Its many inherent advantages, including real-time performance, high spatial resolution, lack of ionizing radiation and lack of need for sedation make it preferable over other imaging modalities such as CT. Since the introduction of ultrasound contrast agents (UCAs), contrast-enhanced ultrasound (CEUS) has become a valuable complementary US technique, with many well-established uses in adults and evolving uses in children. Read More

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Medical thoracoscopy treatment for pleural infections: a systematic review and meta-analysis.

BMC Pulm Med 2021 Apr 20;21(1):127. Epub 2021 Apr 20.

Clinical Epidemiology and Medical Statistics Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.

Background: Complicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy is a safe and minimally invasive endoscopic technique prescribed to treat severe pleural infections. However, only a few studies evaluated its success rate. Read More

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Pleural empyema in children - benefits of primary thoracoscopic treatment.

Wideochir Inne Tech Maloinwazyjne 2021 Mar 26;16(1):264-272. Epub 2020 Nov 26.

Department of Children Developmental Defects Surgery and Traumatology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland.

Introduction: Pleural empyema is the condition of the pleural cavity when initially sterile pleural effusion has become infected. In the majority of cases, it is of parapneumonic origin. Parapneumonic effusions and pleural empyemata usually continuously progress in severity. Read More

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Conservative and surgical modalities in the management of paediatric parapneumonic effusion and empyema: a protocol for a living systematic review and network meta-analysis.

BMJ Open 2021 03 24;11(3):e045010. Epub 2021 Mar 24.

Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.

Introduction: Parapneumonic effusion and empyema are common complications of paediatric pneumonia. Acceptable treatment modalities for large parapneumonic effusions include antibiotics alone or in conjunction with surgical interventions. Clear guidelines on the best treatment approach are lacking and mostly based on evidence prior to widespread pneumococcal conjugate 13-valent vaccination (PCV-13). Read More

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Diagnosis of pleural empyema/parapneumonic effusion by next-generation sequencing.

Infect Dis (Lond) 2021 Jun 9;53(6):450-459. Epub 2021 Mar 9.

Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Japan.

Background: Although a microbiological diagnosis of pleural infection is clinically important, it is often complicated by prior antibiotic treatment and/or difficulties with culturing some bacterial species. Therefore, we aimed to identify probable causative bacteria in pleural empyema/parapneumonic effusions by combining 16S ribosomal RNA (rRNA) gene amplification and next-generation sequencing (NGS).

Methods: Pleural fluids were collected from 19 patients with infectious effusions and nine patients with non-infectious malignant effusions. Read More

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Role of medical thoracoscopy in the treatment of complicated parapneumonic effusions.

Lung India 2021 Mar-Apr;38(2):149-153

Department of Pharmacology, Narayana Hrudayalaya Foundations, Bengaluru, Karnataka, India.

Objective: The role of medical thoracoscopy in the treatment of pleural infections is increasingly being recognized. This study was done to assess the role of medical thoracoscopy in the management of carefully selected subset of patients with complicated parapneumonic effusions (PPEs).

Materials And Methods: We analyzed retrospective data of 164 thoracoscopic procedures performed at our center on patients with complicated PPE in the past 10 years. Read More

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Empyema thoracis presented as giant back abscess.

Radiol Case Rep 2021 May 24;16(5):1061-1064. Epub 2021 Feb 24.

Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extrapulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the organizing/late stage. Read More

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Endothelial Cell Protein C Receptor Deficiency Attenuates induced Pleural Fibrosis.

Am J Respir Cell Mol Biol 2021 04;64(4):477-491

Department of Cellular and Molecular Biology.

is the leading cause of hospital community-acquired pneumonia. Patients with pneumococcal pneumonia may develop complicated parapneumonic effusions or empyema that can lead to pleural organization and subsequent fibrosis. The pathogenesis of pleural organization and scarification involves complex interactions between the components of the immune system, coagulation, and fibrinolysis. Read More

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NOX1 Promotes Mesothelial-Mesenchymal Transition through Modulation of Reactive Oxygen Species-mediated Signaling.

Am J Respir Cell Mol Biol 2021 04;64(4):492-503

Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, Texas.

Pleural organization may occur after empyema or complicated parapneumonic effusion and can result in restrictive lung disease with pleural fibrosis (PF). Pleural mesothelial cells (PMCs) may contribute to PF through acquisition of a profibrotic phenotype, mesothelial-mesenchymal transition (MesoMT), which is characterized by increased expression of α-SMA (α-smooth muscle actin) and other myofibroblast markers. Although MesoMT has been implicated in the pathogenesis of PF, the role of the reactive oxygen species and the NOX (nicotinamide adenine dinucleotide phosphate oxidase) family in pleural remodeling remains unclear. Read More

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[Successful treatment of a stage III pleural empyema following a COVID-19 infection].

Chirurg 2021 Feb 29;92(2):134-136. Epub 2021 Jan 29.

Division of Thoracic Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, SW3 6NP, London, Großbritannien.

Parapneumonic pleural effusion is a common complication of pneumonia and can progress to empyema. Pleural empyema is a life-threatening infection, which can be treated with antibiotics and interventional drainage but in later stages often requires surgery. Here we describe the first case of pleural empyema following a COVID-19 infection with no respiratory failure in a previously healthy and athletic patient. Read More

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February 2021

Pleural cytokines MIF and MIP-3α as novel biomarkers for complicated parapneumonic effusions and empyema.

Sci Rep 2021 Jan 19;11(1):1763. Epub 2021 Jan 19.

Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan.

Patients with complicated parapneumonic effusion (CPPE)/empyema have high morbidity and mortality, particularly when adequate management is delayed. We aimed to investigate novel dysregulated cytokines that can be used as biomarkers for infectious pleural effusions, especially for CPPE/empyema. Expression of 40 cytokines in parapneumonic effusions (PPE) was screened in the discovery phase, involving 63 patients, using a multiplex immunobead-based assay. Read More

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January 2021

Potential diagnostic value of pleural fluid cytokines levels for tuberculous pleural effusion.

Sci Rep 2021 Jan 12;11(1):660. Epub 2021 Jan 12.

Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Patients with tuberculous pleural effusion (TPE) or malignant pleural effusions (MPE) frequently have similar pleural fluid profiles. New biomarkers for the differential diagnosis of TPE are required. We determined whether cytokine profiles in the PE of patients could aid the differential diagnosis of TPE. Read More

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January 2021

Small-bore catheter is more than an alternative to the ordinary chest tube for pleural drainage.

Lung India 2021 Jan-Feb;38(1):31-35

King Fahad Specialist Hospital, Buraydah, Qassim, Saudi Arabia; Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt.

Background: Pleural collection is a common medical problem. For decades, the chest tube of different designs was the commonly used toll for pleural drainage. Over the past few years, small-bore catheter (SBC) has gained more popularity. Read More

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January 2021

Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema.

Pediatr Infect Dis J 2021 Jun;40(6):544-549

Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany.

Background: Parapneumonic pleural effusion and pleural empyema (PPE/PE) are complications of community-acquired pneumonia. The objective of this study was to analyze prehospital antibiotic therapy (PH-ABT) of children with PPE/PE and investigate its effects on clinical outcome and pathogen detection.

Methods: Prospective nationwide active surveillance in Germany between October 2010 and June 2018. Read More

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Epidemiology of pleural empyema in English hospitals and the impact of influenza.

Eur Respir J 2020 Dec 17. Epub 2020 Dec 17.

Bristol Academic Respiratory Unit, Learning and Research Centre, Southmead Hospital, Bristol, United Kingdom.

Pleural empyema represents a significant healthcare burden due to extended hospital admissions and potential requirement for surgical intervention. This study aimed to assess changes in incidence and management of pleural empyema in England over the last 10 years and the potential impact of influenza on rates.Hospital Episode Statistics (HES) data was used to identify patients admitted to English hospitals with pleural empyema between 2008 and 2018. Read More

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December 2020

Management of Pleural Infection.

Pulm Ther 2021 Jun 9;7(1):59-74. Epub 2020 Dec 9.

Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Pleural infection is a millennia-spanning condition that has proved challenging to treat over many years. Fourteen percent of cases of pneumonia are reported to present with a pleural effusion on chest X-ray (CXR), which rises to 44% on ultrasound but many will resolve with prompt antibiotic therapy. To guide treatment, parapneumonic effusions have been separated into distinct categories according to their biochemical, microbiological and radiological characteristics. Read More

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Proteus empyema as a rare complication from an infected renal cyst, a case report.

BMC Pulm Med 2020 Nov 27;20(1):314. Epub 2020 Nov 27.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, USA.

Background: The most commonly isolated organisms in a parapneumonic effusion include S. pneumoniae, H. influenzae, and S. Read More

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November 2020

Loculated empyema in a neonate successfully treated with chest tube thoracostomy and antibiotics.

Respir Med Case Rep 2020 4;31:101274. Epub 2020 Nov 4.

Department of Pediatrics, Ospital ng Makati Sampaguita cor Gumamela St, Pembo, Makati NCR, 1218, Philippines.

Empyema thoracis, defined as the accumulation of pus in the pleural space, is a rare entity in the neonatal period. There are very few cases described in the medical literature and there are still no treatment protocols in the management of empyema in neonates. In older infants and children, intrapleural fibrinolytics and surgery are often utilized since treatment of complicated parapneumonic effusions with chest tube and antibiotics alone often fail due to the viscous fluid and presence of loculations. Read More

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November 2020

Two vs. three weeks of treatment with amoxicillin-clavulanate for stabilized community-acquired complicated parapneumonic effusions. A preliminary non-inferiority, double-blind, randomized, controlled trial.

Pleura Peritoneum 2020 Mar 26;5(1):20190027. Epub 2020 Feb 26.

Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain.

Background: The optimal duration of antibiotic treatment for complicated parapneumonic effusions (CPPEs) has not been properly defined. Our aim was to compare the efficacy of amoxicillin-clavulanate for 2 vs. 3 weeks in patients with CPPE (i. Read More

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Complicated pneumonia in children.

Lancet 2020 09;396(10253):786-798

Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK. Electronic address:

Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Read More

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September 2020

Metabolomic profiling of parapneumonic effusion reveals a regulatory role of dipeptides in interleukin-8 production in neutrophil-like cells.

Anal Chim Acta 2020 Sep 11;1128:238-250. Epub 2020 Jul 11.

Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Bacterial pneumonia is a lethal condition, and approximately 40% of bacterial pneumonia patients experience parapneumonic effusion (PPE). Based on the severity of inflammation, PPEs can be categorized as early-stage uncomplicated PPE (UPPE), advanced-stage complicated PPE (CPPE) and, most seriously, thoracic empyema. Appropriate antibiotic treatment at the early stage of PPE can prevent PPE progression and reduce mortality, indicating that understanding PPE generation and components can help researchers develop corresponding treatment strategies for PPE. Read More

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September 2020

[Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP) - Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)].

Pneumologie 2020 Aug 21;74(8):515-544. Epub 2020 Aug 21.

Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen.

The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Read More

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Pediatric parapneumonic effusion before and after national pneumococcal vaccination programs in Taiwan.

J Formos Med Assoc 2020 Nov 31;119(11):1608-1618. Epub 2020 Jul 31.

Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei City, 10002, Taiwan. Electronic address:

Background: Reports on the effectiveness of pneumococcal conjugate vaccines (PCVs) on pediatric parapneumonic effusion are limited. We report the changes in cases and etiologies of pediatric parapneumonic effusion in a children's hospital before and after national PCV13 vaccination programs.

Methods: We screened medical records of children 0-18 years admitted to the National Taiwan University Hospital with diagnoses of lobar pneumonia and parapneumonic effusion between 2008 and 2017. Read More

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November 2020

Clinical efficacy and bleeding outcomes of tissue plasminogen activator and dornase alfa in pleural space infection with once daily concurrent administration: a retrospective cohort study.

BMC Res Notes 2020 Aug 3;13(1):368. Epub 2020 Aug 3.

Department of Medicine-Division of Pulmonary Medicine, Jamaica Hospital Medical Center, Jamaica, NY, 11418, USA.

Objective: The use of intrapleural tissue plasminogen activator (tPA) and dornase alfa (DNase) is common in the management of pleural space infection. We review our experience with the efficacy and safety of this therapy. We performed a single center, retrospective study of consecutive patients with complicated parapneumonic effusion or empyema who received tPA/DNase therapy. Read More

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Image-guided catheter drainage in loculated pleural space collections, effectiveness, and complications.

Lung India 2020 Jul-Aug;37(4):316-322

Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar, Jammu and Kashmir, India.

Introduction: Image-guided drainage is an established technique with a multitude of applications. The indications, techniques, and management of image-guided catheter drainage, however, continue to evolve. Image-guided drainage alone is sometimes sufficient for the treatment of a collection, but it can also act as an adjunct or temporizing measure before definitive surgical treatment. Read More

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Intrapleural Fibrinolytic Therapy in Loculated Pleural Effusions.

Authors:
M S Barthwal

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

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Surgical Pulmonary and Pleural Diseases in Children: Lung Malformations, Empyema, and Spontaneous Pneumothorax.

Adv Pediatr 2020 08 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.

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