alexa Fungal empyema thoracis: an emerging clinical entity.


Journal of Pulmonary & Respiratory Medicine

Author(s): Ko SC, Chen KY, Hsueh PR, Luh KT, Yang PC

Abstract Share this page

Abstract STUDY OBJECTIVES: To analyze the clinical spectra, pathogenesis, treatment, outcome, and prognostic factors of fungal empyema thoracis. DESIGN: The medical records of patients with positive fungal cultures from pleural effusions were retrospectively analyzed. SETTING: A university-based tertiary care hospital in Taipei, Taiwan. PATIENTS AND METHODS: From January 1990 through December 1997, patients diagnosed with fungal empyema were included in this study. The criteria for diagnosis of fungal empyema thoracis were as follows: (1) isolation of a fungal species from the pleural effusion; (2) significant signs of infection, such as fever (body temperature > 38.3 degrees C) and leukocytosis (white blood cell > 10,000/microL); and (3) isolation of the same mold species from pleural effusion on more than one occasion, or from pleural effusion and other specimens such as blood, sputum, or surgical wounds that showed evidence of tissue invasion. RESULTS: Sixty-seven patients with fungal empyema thoracis were included. Their mean age was 54 years (range, 2 weeks to 93 years), and 64\% (43 patients) were men. Fifty-seven patients (85\%) had various underlying diseases, and 18 (27\%) had more than one immunocompromising condition. A total of 73 fungal isolates were recovered from pleural effusion; the most commonly encountered were Candida species (47 isolates, 64\%), Torulopsis glabrata (13 isolates, 18\%), and Aspergillus species (9 isolates, 12\%). Candida albicans (28 isolates) was the most common Candida species, followed by Candida tropicalis (13 isolates). Six patients (9\%) had two fungal strains isolated, and 16 (24\%) had concomitant bacterial empyema thoracis. Eighteen patients (27\%) had concurrent fungemia. Most (56 patients, 84\%) cases of fungal empyema thoracis were nosocomial, and many case (43 patients, 64\%) were acquired in ICUs. Abdominal disease (20 patients, 30\%), especially previous abdominal surgery and GI perforation (12\% and 10\%, respectively), was the most common cause of fungal empyema thoracis, followed by bronchopulmonary infection (15 patients, 22\%) and chest surgery (12 patients, 18\%). Forty-nine patients (73\%) received systemic antifungal therapy, and 38 (57\%) underwent closed drainage therapy. Eleven patients (16\%) underwent pleural irrigation with normal saline solution, povidone-iodine solution, or antifungal agents. Six patients (9\%) finally received decortication. All patients receiving surgery or pleural irrigation with antifungal agents survived. Despite the aforementioned management, the crude mortality was high (73\%). Multivariate analysis showed a significantly increased risk of death in immunocompromised patients (relative risk, 1.58; p < 0.005) and those with respiratory failure (relative risk, 2.31; p < 0.001). Systemic antifungal therapy was associated with a significantly lower risk of death (relative risk, 0.69; p < 0.05). CONCLUSION: These data imply an increasing incidence of fungal empyema thoracis in recent years and the necessity for aggressive treatment of patients with this disease.
This article was published in Chest and referenced in Journal of Pulmonary & Respiratory Medicine

Relevant Expert PPTs

Relevant Speaker PPTs

  • Shoude Jin
    Mechanisms of Chronic obstructive pulmonary disease and airway smooth muscle remodeling: the potential roles of Abhd2
    PDF Version
  • Alsayed Alnahal
    Urinary netrin-1 predict early ischemic acute kidney injury after cardiopulmonary bypass
    PPT Version | PDF Version
  • Ping Yang
    Chronic obstructive pulmonary disease (COPD) complicating early-stage lung cancer (LC)
    PDF Version
  • Gunilla Lindqvist
    Chronic obstructive pulmonary disease: A study of the relationship between patients’ feeling of guilt due to their belief of the disease being self inflicted
    PDF Version
  • Roger Mark Engel
    The effect of including manual therapy in the management of mild chronic obstructive pulmonary disease – a randomized controlled trial
    PDF Version
  • Rupal Patel Mansukhani
    Correlation of Medication Therapy in Chronic Obstructive Pulmonary Disease(COPD) Patients with 30-day Readmission Rates
    PPT Version | PDF Version
  • Hadeel Faisal Gad
    In-vitro analysis of cytokines responses of visceral leishmaniasis and pulmonary tuberculosis patients to homologous and heterologous antigen stimulation
    PPT Version | PDF Version
  • Xin Wang
    IL17 Pathway Involves Moderating Pulmonary Hypertension, a common complication of COPD, in Statins Therapy in Smoking Rats
    PPT Version | PDF Version

Recommended Conferences

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version