Empyema: symptoms, causes and treatment

Definition

What is an empyema?

Empyema is a medical term that describes the collection of pus in the cavity around the lung. This condition can form if a bacterial infection is not treated, or if the body fails to respond to treatment and recovers completely. Empyema is a complication of pneumonia.

This term generally refers to a pocket of pus that develops in the pleural space, which is the thin space that is located on the outside of the lungs and the inside of the chest cavity.

How common is this condition?

This is not a common condition as most bacterial infections have been treated with antibiotics prior to this stage. Empyema is a serious condition. Affected patients may die or require further surgery in the first year after developing this condition.

Signs and symptoms

What are the signs and symptoms of an empyema?

The symptoms of this condition are similar to those of pneumonia in that the two conditions are closely related. Quoted from the website of the UK public health service program, the NHS, the signs and symptoms caused by empyema are:

• Fever and night sweats
• Not energized
• Difficulty breathing
• Lose weight
• Chest pain
• Coughing up phlegm containing pus

Symptoms that arise as a result of this condition usually last for a long time. The study cited in an article on the National Center for Biotechnology Information website states that empyema patients generally come to the hospital after 15 days of symptoms.

When should you see a doctor?

You should contact your doctor when you experience symptoms of empyema. The signs of this condition are similar to those of pneumonia, but it can be more dangerous and serious.

Cause

What causes empyema?

The lungs and the inside of the chest cavity are covered by a smooth lining known as the pleura. These layers are separated by a thin space (pleural space) which is filled with a small amount of lubricant called pleural fluid.

Pleural fluid can sometimes accumulate and become infected, forming pus. This infected pleural fluid can cause the pleural area to fuse and create a pocket of pus (empyema).

Empyema is a condition that can worsen, creating more pockets of pus with thick deposits lining the outer lining of the lungs. This condition prevents the lungs from developing properly.

A common cause of empyema is pneumonia with a bacterial infection that causes inflammation of the lungs. About 20% of patients with pneumonia will develop a condition that can cause this condition. Empyema is a condition that can form when pneumonia fails to treat.

The cause of emphyema due to pneumonia depends on whether the infection is acquired from the community or the hospital. Empyema due to community-acquired pneumonia (community-acquired pneumonia) generally caused by bacteria Streptococcus.

Meanwhile, empyema is due to a type of pneumonia that is acquired in the hospital (hospital-acquired pneumonia) generally caused by Staphylococcus aureus , (methicillin-resistant S. aureus (MRSA)) and Pseudomonas.

Empyema caused by fungi is rarer and has a high mortality rate. The most common fungi that cause empyema are species Candida.

In addition, other causes of empyema are:

• Bronchiectasis, which is a long-term condition in which the airways of the lungs become abnormally dilated.
• Blood clots or other blockages. This condition can prevent blood flow to the lungs, causing some lung tissue to die.
• Surgery on the chest
• Endoscopy. Empyema is a rare complication of endoscopy.
• Serious chest injury
• Infection elsewhere in the body that spreads via the bloodstream.
• Infections caused by inhaled food because you have trouble swallowing.
• Tuberculosis

Risk factors

What factors increase my risk of developing empyema?

Empyema is a condition that is closely related to pneumonia. People who are at high risk of developing pneumonia also have a high risk of developing this condition. In addition, other factors that can also increase the risk of empyema are:

• Diabetes mellitus
• Drug abuse through intravenous (vein)
• Have a weak immune system
• Have acid reflux
• Drinking too much alcohol

Empyema is a condition that is not related to age. Both parents and children can experience this condition.

Treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How to diagnose this condition?

Empyema is a condition that may occur when a person with severe pneumonia does not improve despite treatment for pneumonia. Later symptoms also began to appear.

The following are some of the tests your doctor may order to diagnose empyema:

• Sputum test. If you have a cough with phlegm, a sputum sample is taken to be examined under a microscope. In this procedure, the doctor can determine the type of bacteria causing the infection so that they are able to provide the right antibiotic.
• Blood test. A blood sample may also be asked to count your white blood cell count and other possible infections.
• Chest X-ray. This procedure allows the doctor to detect a pleural effusion, which is a buildup of fluid in the pleural cavity.
• Ultrasound. This procedure is performed after the doctor suspects a pleural effusion during a chest X-ray. An ultrasound test allows a more detailed depiction of the fluid buildup.
• CT scan. This procedure is performed as a mandatory follow-up examination for patients with empyema.

What are the treatment options for empyema?

Treatment for this condition is usually a combination of drugs and surgery. The following is a series of medications that can treat empyema:

Antibiotics

Some people only need antibiotics that are given directly into a vein through an IV. However, they may have to stay in the hospital for a long time.

Suction of fluids in the chest

Some people may need antibiotics and aspiration of the chest fluid. The suction procedure is performed by inserting an elastic plastic tube that is inserted through the chest wall and directed to the affected area to drain the fluid.

The area where the tube is inserted will be given an anesthetic. The patient will also be given a light sedative before the procedure.

The chest tube will usually remain in place until an X-ray or ultrasound shows all fluid has been drained from the chest and the lungs can fully expand.

You may need to stay in the hospital until the tube is removed. However, some people may be able to return home with the chest tube still in place. Later, the health worker will show how to manage this condition at home.

Operation

Surgery may be needed if the condition does not improve. The surgical procedure is to make an incision in the chest to reach the lungs and remove the thick lining that lines the lungs, so that the organ can expand properly again.

Stoma

Fluid aspiration or chest drainage procedures may not be suitable for everyone. Some people may choose to make a hole in the chest known as a stoma.

A special bag is placed over the stoma to collect fluid that leaks from this condition. However, this treatment option is rarely used.

If you have any questions, consult your doctor for the best solution to your problem.