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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Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
Tissue Transglutaminase Antibody (tTG) Test Transglutaminase is an enzyme present in our body and is involved in protein metabolism. A tTg test is…
Chlorella: Therapeutic powers of the billion-year-old algae now within your reach Chlorella - A billion year old nutrient-rich algae that can potentially ward off cancers and high cholesterol; the…
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…
tonometry
Tonometry Tonometry uses a device called tonometer to measure the pressure inside the eye. This pressure is depends upon…
dhea adrenal
Androstenedione Test Androstenedione is produced by the adrenal gland, the test of the levels of Androstenedione helps in the evaluation…
GM Diet: The fastest way to lose weight or yet another hoax diet? General Motors started this trend of extreme dieting for 7 straight days to ensure its employees were able…
How can Kegels help you overcome weak pelvic muscles & incontinence? Kegel exercises are pelvic floor strengthening exercises that can help you overcome incontinence issues that rise out of…
rosacea-treatment--before-_-after
The best and safest ways to treat rosacea Rosacea is a skin disease that is characterized by reddish hives and rashes on the face. Read more…
about mediterranean diet
Why you should be adopting a Mediterranean style of diet today Ever wondered why the Mediterranean diet is so healthy? One simple solution to lowering risk of several deadliest…
CERULOPLASMIN- triple marker
Triple Marker Test A triple marker test is an important prenatal test that is performed to detect the presence of chromosomal…
working mom with kids
Practical Motherhood Tips for Working Women Check out these effective tips for working mothers to manage motherhood and work life. Raise your children easily…
kidney stones
Kidney stones Kidney stones are solid substances made up of crystals. They can be of various sizes. Treatment depend on…
Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
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…
BRAT Diet: What is the right way to follow this diarrhea-relieving diet? BRAT diet, a simple diet consisting of just bananas, rice, applesauce, and toast, can help you combat the…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…

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