Empyema

EMPYEMA child

Last Updated December 20th, 2021

Introduction

Formation of pus indicates the presence of an infection, often bacterial in origin. Pus is the by-product of an immune response to the infection. It is a thick, opaque fluid that is usually white or yellowish in colour, although it can sometimes be greenish or blood-tinged as well. When bacteria invade your skin or a certain tissue, white blood cells congregate at the site in order to fight the infection. As a consequence of wear and toxins released by the bacteria, these immune cells die in large numbers and, along with the neutralized bacteria, become part of the debris that forms a collection of pus at the site. You may have observed pus-filled pimples on your skin. Pus can also collect at a deeper level within the tissues to form abscesses. Alternatively, it could give rise to a condition known as ‘empyema’.

 

What Is Empyema?

EMPYEMA pusTechnically, empyema is the name for any condition in which pus accumulates within a pre-existing anatomical cavity. Such a buildup of pus in the pleural cavity of the chest is known as a pleural empyema, pyothorax or empyema thoracis. Most often, such an empyema develops as a result of a lung infection such as pneumonia, tuberculosis or even an abscess in the lung. It could also arise as a result of infection in other adjacent sites.

As pus accumulates, it begins to exert pressure on the lungs which are then unable to expand and contract normally. As a result, it becomes difficult for the person to breathe. Unlike a pustule on the skin which may drain spontaneously, an empyema will need to be artificially drained by a trained medical professional and under anesthetic. Otherwise, it can give rise to further complications and even lead to death in the absence of timely medical intervention.

Examination of the pus drained from an empyema often reveals a mixture of aerobic and anaerobic bacteria, with the most common culprits being Staphylococcus aureus and Streptococcus pneumoniae. Possible candidates also include some species of Bacteroides, Peptostreptococcus, Klebsiella, and Pseudomonas, among others.

 

How Does A Pleural Empyema Develop?

Our lungs function by constantly expanding and contracting when we inhale and exhale. In order to ease the friction produced by this action, the pleural membranes form a cushioning layer between the lungs and the chest wall. There are two such membranes, namely, the visceral pleura and the parietal pleura. The space between them contains a small quantity of lubricating fluid. The pleural space, or the gap between the two pleural membranes, is very small and only becomes expanded in the event of diseases which cause an excessive accumulation of fluid or even air in this space.

EMPYEMA childAn empyema develops in three successive stages. Pleural effusion is the immediate pre-requisite for empyema. A pleural effusion is the abnormal accumulation of fluid between the pleural membranes and this can occur as a complication of lung infection or inflammation of the pleural membranes. It tends to develop over anywhere between 2 to 5 days following the onset of pneumonia. It could also occur as a result of any condition, such as heart failure, kidney failure or cancer, that interferes with the normal balance between production and absorption of pleural fluid. This first stage is called the exudative stage.

Normally, the pleural space is relatively dry and the pleural fluid sterile, but when excessive fluid accumulates in this space, bacteria find ideal conditions in which to multiply. The resultant immune response causes the formation of pus. This pus is generally viscous and opaque in quality. This is the second stage, known as the fibrinopurulent stage.

As the condition worsens, it enters the final phase or organization stage. Here, fibroblasts in the pleural membranes begin to form a thick, proteinaceous layer called a pleural peel, which is inflexible and prevents the lungs from expanding and deflating normally.

 

What Are The Causative Factors?

There are several scenarios that could potentially give rise to an effusion. To give some examples, infection, inflammation or even cancer in the lungs or nearby sites could give rise to a pleural effusion. Medications, surgery, or injury could also be responsible. A fuller list of possible causes appears below:

  • Viral or bacterial infection as in the case of tuberculosis, influenza or pneumonia. Bacterial pneumonia accounts for as many as 70% of cases of empyema.
  • Lung abscess.
  • Bronchitis.
  • Bronchiectasis.
  • Chronic Obstructive Pulmonary Disease.
  • A chronic inflammatory illness such as systemic lupus erythematosus or rheumatoid arthritis.
  • Cancer of the lungs, breasts or other adjacent tissues or organs.
  • Tumors in the pleural membranes.
  • Pulmonary embolism or clots in the blood vessels of the lungs.
  • Sickle cell anemia.
  • Liver cirrhosis.
  • Heart failure.
  • Kidney disorders.
  • Diabetes.
  • Septicemia.
  • In as many as 30% of cases, prior surgery has been noted as the cause of empyema. This could even include minor procedures such as thoracentesis for the treatment of pleural effusion.
  • Exposure to substances such as asbestos and ammonia through inhalation.
  • Trauma to the chest region such as fracture of the ribs or trauma from surgical procedures.
  • Leakage of air into the space between the pleural membranes from a hole in the lung. This is known as pneumothorax.
  • Taking chemotherapy or radiation therapy.
  • Side effects of certain medications.
  • Having a weak immune system.
  • Alcoholism.

 

What Are The Identifying Features And Symptoms?

EMPYEMA lungsSince the pleural membranes are supplied with nerve endings, an empyema can be painful. The main symptom is the inability to breathe normally as the lungs struggle to expand against the rigid rib cage with the added pressure of the empyema acting upon them. As a result, the patient may feel weak, lose appetite and even lose weight. A fuller list of symptoms appears below:

  • Shortness of breath.
  • Pain in the chest which worsens during inhalation and coughing.
  • Fever.
  • Headache.
  • Sweating.
  • Dry cough.
  • Loss of appetite.
  • Weight loss.

 

What Are The Possible Complications?

If the buildup of scar tissue and pleural peel continues, the patient could suffer a condition known as lung entrapment. Infection from the pleural space could also spill over into the bloodstream and give rise to a potentially fatal condition known as sepsis. This requires immediate medical attention as it could quickly escalate and cause organ failure and death from hypovolemic shock.

 

How Is A Pleural Empyema Diagnosed And Treated?

Normally, a physician will suspect empyema when pneumonia fails to respond to treatment.

The only treatment for empyema includes administering antibiotics and draining the fluid from the pleural cavity. The most commonly prescribed antibiotics for this condition include metronidazole, penicillin, and cefuroxime. In addition to these, medicines to bring down the body temperature caused due to infection and high fever is also prescribed. The draining of pus from the pleural cavity is done with the help of a process known as thoracostomy. In this technique, a plastic tube is inserted between the two ribs and with the help of a suction mechanism the pus is drained out of the lungs.

The only way to prevent the onset of empyema is to effectively treat underlying lung/gallbladder/pelvic infection. One must take the complete prescribed dosage of the antibiotics in order to ensure that the infections don’t keep occurring again and again. It is important to build immunity naturally and stay away from substance abuse. Signs of chest infection, congestion, and pain, especially among children and immunocompromised individuals, should not be ignored.

 

Dos and Don'ts

Dos
  • Seek immediate medical help for pneumonia or other lung infections. It is important to get tested for all the possible complications for the same.
  • Be wary of dehydration. Manage fluid and nutrient intake of the patient.
  • Complete the full antibiotic dosage prescribed to treat the underlying bacterial infection.
Don'ts
  • Indulge in substance abuse of drugs and/or alcohol as it drastically compromises an individual’s immunity.
  • Ignore symptoms of sepsis that can follow a severe lung infection such as palpitations and low blood pressure (90/60).

 

 

 

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9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
avocado benefits
Avocado: 15 reasons why this fruit should be a staple in your diet Did you know that the word avocado literally means "testicles". Don't get grossed out as this power-packed fruit…
biotin for hair
Biotin: One-stop-shop for shiny hair and an active body! What is common to bananas, eggs, sweet potatoes, and liver? These are delicious and rich in biotin ;…
Hydroquinone: Is it the best topical treatment for hyperpigmentation? Darkening of the skin due to high melanin levels is called hyperpigmentation.  Hydroquinone interferes with melanin production thus treating…
Oxalates: How healthy greens can sometimes be bad news for your kidneys Oxalates are compounds present in a majority of healthy foods. However, at times an overconsumption of these could…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
beta hcg test
Beta hCG Test A Beta hCG test measures the level of human gonadotropin hormones present in the blood that is primarliy…
malarial antigen test
Malaria Antigen Test A malaria antigen test is a rapid diagnostic test (RDT) that can detect malarial antigens (proteins) in your…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
sleep deprivation
Don’t let your sleep deficit grow into memory loss or heart attack Why is sleep important for us? How could sleep deprivation harm you? We bet you didn't know about…
oral hygiene tips
6 shocking consequences of bad oral hygiene (and how to avoid them) Did you know bad breath is not just turning off, but also harms your body in ways you…
ashwagandha brain
Ashwagandha: The best-kept secret of Ayurveda now revealed! Ashwagandha literally means "smell of horse". Don't get bogged down by that one tiny detail because this ayurveduic…
Salt dangers
Sodium chloride: The wonders and dangers of the simple table salt Sodium chloride is a salt containing sodium and chlorine ions at a 1:1 ratio. It is edible and…
Bromelain: 11 reasons why you should start adding pineapple to your pizza! If you didn't love pineapples already, here are some of the top health benefits that bromelain can bring…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
How can berberine supplements help you live longer and healthier? Berberine is a turmeric look-alike herbal extract that is credited with numerous health benefits ranging from diabetes cure…
Experts reveal the safest ways to perform an enema at home The idea of pushing some up your rectal area might make you queasy but an enema could actually…
Inhale oxygen, exhale worries: The top breathing exercises and how to perform them Performing the breathing exercise is like becoming mindful of how you breathe.  Here is a list of breathing…
glucose-tolerance
Oral Glucose Tolerance Test – GTT Glucose tolerance test (or Oral GTT) is used to detect the onset of diabetes or prediabetes conditions. It…
Strep throat pain
Anti-Streptolysin-O Test The ASO or Anti-Streptolysin-O is a blood test designed to check for the presence of streptococcus bacterial infection…
cystatin C
Cystatin C Test Cystatin C is a specific single-chain protein that is found in body fluids and is a biomarker for…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
yoga health benefits
How to practice yoga for astounding health benefits Can a 5000-year-old system be the ultimate body healer? Did you know yoga can make you smarter and…
aspartame or sugar
Aspartame – Hidden truths about this storm in a teacup Aspartame, the artificial sweetener, has gone under the scanner on several occasions for allegedly doing more harm than…
DHEA wrinkles
DHEA: Now get unbelievable age defiance with this wonder hormone! DHEA is known popularly as the age-defying hormone. This supplement is widely used to slow down aging and…
Oil of Oregano: The one-stop essential oil you’ve been looking for Are you plagued by a weak immune system? High body inflammation accompanied by pain and infections? Why not…
Shilajit: A miracle Himalayan herb for an active and happy life The Himalayas contain more wonders than you thought. Shilajit is a miracle herb that is widely used in…
The complete “what to eat” guide for gluten intolerance Does eating breads and pastas often makes you nauseous? Gluten intolerance is a common reason why you might…
Exercises or diet? Find out the healthiest way to gain weight Tired of being called skinny all the time? Looking for healthy ways to beef up? Why not try…
Is it possible to achieve full body detox with Master Cleanse? Master cleanse is a diet consisting of a lemonade based beverage, a salt water drink and a herbal…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
How seitan proved to be a blessing in disguise for vegans worldwide Can only meat-eaters enjoy delicious juicy steaks and burgers? With seitan, the best meat substitute available today,even vegans…
shakeology woman
Meal replacement or protein drink? Learn all about Shakeology and its claims Shakeology from Beachbody claims to be the most suitable shake that can aid in weight loss, regulate blood…
anoscopy
Anoscopy Anoscopy is an invasive diagnostic procedure where a small device known as anoscope will be inserted in the…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
leptospira Igm test
Leptospira-IgM Test A Leptospira-IgM test is a blood test which is carried out to detect anti-Leptospira IgM antibody. Leptospirosis is…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
piles
Best treatment for piles in Bangalore All you need to know about piles and piles treatment in Bangalore - the types of treatment available,…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
The Shepherd's diet
Facts about the Shepherd’s diet Kristina Wilds promoted Shepherd's diet, a Christian-based diet that highlights Jesus Christ's diet as mentioned in the Bible.
gallbladder diet tomato
Gallbladder surgery :Tips on post-operative care and diet What to eat post a gallbladder surgery? What are the key things to avoid if you had a…

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