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.

Facts

  • The name of this disease has been derived from the Greek word “empyein” which roughly translates to “producing pus”.

Facts

  • Staphylococcus Aureas is the number one cause of empyema infections in adults , constituting roughly 90% of all cases of lung infections in children and infants.
  • Empyema is not restricted only to the lungs. This has been observed in the gallbladder and in the pelvic region as well.

Facts

  • In a majority of cases, empyema occurs as a complication of pneumonia. This disease kills more than 5 million children every year globally.
  • In this condition, the pus accumulates between the two layers of the pleural cavity namely parietal layer and visceral layer.

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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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Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
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…
Optavia diet
The features of an Optavia diet The Optavia diet endorses pre-packaged meals and snacks called "fuelings" that are tasty, low in calorie, and incorporates…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
Jackfruit: Slice your way into higher immunity, better digestion, & more… Native to the South East Asia, the jackfruit is a fruit brimming with thousands of health benefits. Discover…
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 to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
Epley maneuver: Why is this the best protection from the symptoms of vertigo? Epley maneuver is an exercise that can treat the symptoms of benign paroxysmal positional vertigo (BPPV).  It was…
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…
Atkins diet weight loss
Atkins Diet: The right steps to carb control that can help you lose those pounds fast The Atkins diet is a high fat, low-carb diet with proven weight loss benefits that is flexible enough…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
chloride test
Chloride Test A chloride test of the blood checks the level of chloride in body, an important factor governing the…
Agave nectar: The bitter truth about this sweetener revealed Agave nectar is considered to be sweeter than the normal table sugar and even contains higher amounts of…
Coconut sugar: What is it and is it healthier than table sugar? In the long list of things that the wonderful coconut gives us, coconut sugar is another remarkable addition.…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
These are the top foods to increase your hemoglobin count It is important to add iron-rich foods into your diet in order to increase hemoglobin. Deficiency of hemoglobin could…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
ANTIPHOSPHOLIPIDANTIBODY(APL)_IgG
Antiphospholipid (APL) antibody-IgG The Antiphospholipid Antibody testing is a blood test used to determine an autoimmune disorder called Antiphospholipid syndrome linked…
valproic acid test
Valproic Acid Test Valproic acid test is performed to generally check for psychiatric and even neurological conditions such as bipolar disease…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
antihepatitis core antigent
Anti-Hepatitis B Core Antigen (AHBc) Total Anti-hepatitis B core antigen (AHBC ) is a blood examination and the only serological marker of infectious blood…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
hidden benefits walking
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…
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…
acne removal tips
Anatomy of acne: 7 instant steps to kiss those zits goodbye Blackheads, whiteheads, or pimples-call them what you may. Acne is never good news.Did you know some of the…