Archive for February 25, 2014

Community-acquired staphylococcal pneumonia.

J Bras Pneumol. 2008 Sep;34(9):683-9.

Santos JW1, Nascimento DZ, Guerra VA, Rigo Vda S, Michel GT, Dalcin TC.

Pulmonology Department, Santa Maria University Hospital of the Federal University of Santa Maria, Santa Maria, Brazil. jwasb@terra.com.br

Abstract

OBJECTIVE:

Staphylococcal pneumonia typically presents high rates of morbidity and mortality. It typically occurs in cases of influenza (airborne transmission) or during episodes of bacteremia (blood-borne transmission).

METHODS:

A retrospective and descriptive study was conducted in patients admitted to our hospital between January of 1992 and December of 2003. All of he patients included had been diagnosed with community-acquired pneumonia caused by Staphylococcus aureus. All were older than 14 years of age, and none were intravenous drug users.

RESULTS:

Community-acquired pneumonia was identified in 332 cases, of which 24 (7.3%) were identified as cases of staphylococcal pneumonia. Age ranged from 14 to 89 years. Fifteen patients were male, and nine were female. Twelve patients met the criteria for severe pneumonia. Chest X-rays showed unilateral consolidation in 14 cases, bilateral consolidation in 10, pleural effusion in 15, rapid radiological progression of pulmonary lesions in 14, cavitation in 6 and pneumothorax in 1. Most of the patients presented comorbidities, of which diabetes mellitus was the most common. Twelve patients presented complications such as empyema and septic shock. Four patients died, translating to a mortality rate of 16.6% in our sample.

CONCLUSIONS:

The clinical presentation of pneumonia caused by S. aureus is similar to that of pneumonia caused by other etiological agents. Radiological findings, epidemiological data and risk factors provide important clues to the diagnosis. These factors are important for clinical suspicion, since S. aureus is not typically addressed in empirical treatment.

PDF

http://www.scielo.br/pdf/jbpneu/v34n9/en_v34n9a08.pdf

February 25, 2014 at 8:20 am

Empyema thoracis.

Clin Med Insights Circ Respir Pulm Med. 2010 Jun 17;4:1-8.

Ahmed AE1, Yacoub TE.

Department of Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.

Abstract

Epmyema thoracis is associated with high mortality ranging between 6% to 24%. The incidence of empyema is increasing in both children and adults; the cause of this surge is unknown.

Most cases of empyema complicate community- or hospital-acquired pneumonia but a proportion results from iatrogenic causes or develops without pneumonia.

Parapneumonic effusions (PPE) develop in about one half of the patients hospitalized with pneumonia and their presence cause a four-fold increase in mortality.

Three stages in the natural course of empyema have long been described: the exudative, fibrinopurulent, and organizing phases.

Clinically, PPE are classified as simple PPE, complicated PPE, and frank empyema. Simple PPE are transudates with a pH > 7.20 whereas complicated PPE are exudates with glucose level <2.2 mmol/l and pH < 7.20.

Two guidelines statements on the management of PPE in adults have been published by the American College of Chest Physicians (ACCP) and the British Thoracic Society (BTS). Although they differ in their approach on how to manage PPE, they agree on drainage of the pleural space in complicated PPE and frank empyema.

They also recommend the use of intrapleural fibrinolysis and surgical intervention in those who do not show improvement, but the level of evidence for the use of intrapleural fibrinolysis is not high highlighting the need for more research in this area.

A recently published large randomized trial has shown no survival advantage with the use of intrapleural streptokinase in patients with pleural infection. However, streptokinase enhances drainage of infected pleural fluid and may still be used in patients with large collection of infected pleural fluid causing breathlessness or ventilatory failure.

There is emerging evidence that the combination of intrapleural tPA/DNase is significantly superior to tPA or DNase alone, or placebo in improving pleural fluid drainage in patients with pleural space infection. A guideline statement on the management of PPE in children has been published by the BTS.

It recommends the use of antibiotics in all patients with PPE in addition to either video-assisted thoracoscopic surgery (VATS) or tube thoracostomy and intrapleural fibrinolysis. Prospective randomized trials have shown that intrapleural fibrinolysis is as effective as VATS for the treatment of childhood empyema and is a more economic treatment and therefore, should be the primary treatment of choice.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998927/pdf/ccrpm-2010-001.pdf

February 25, 2014 at 8:18 am


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