Pleural empyema

Case report:

A 48 year old an alcoholic patient was treated for ten days because of a pneumonia with doxycycline (div. Trademark) and was initially entfiebert after a few days. After that, however, again to 39.5 � C fever had set with clear breath-dependent pain dorsolateral right. The temperature curve showed a continuous course with minor variations in temperature between morning and evening measurements. Moreover, again appeared purulent sputum. The physical examination of the sick-acting and fully oriented patients showed a body temperature of 39 � C, a respiratory rate of 23 / min, decreased breath excursion through the right lung and a significant weakening of the knocking sound dorsolateral on the right lung with reversed breathing sound.

Diagnosis:

The history and the collected clinical findings indicate a paramagnetic or postpneumonisches empyema of the right lung. A chest radiograph confirmed this suspicion with an extensive pleural effusion in the right lung. In blood, there is a leukocytosis of 20,000 / ul with marked left shift, the CRP value is increased by 65 mg / l. A thoracentesis yields a purulent pleural effusion.

Pathogenesis:

Pleural empyema caused mostly parapneumonisch or postpneumonisch under pneumonia. Not infrequently, this is suboptimal antibiotic treatment of pneumonia cause for the spread of inflammation to the pleura. Often it is these Pleuraempyemen to mixed infections of aerobic bacteria such as staphylococci, pneumococci, Klebsiella, and anaerobic streptococci and Bacteroides species.

Therapy:

The most important therapeutic measure with a pleural empyema is the drainage and irrigation with a double lumen catheter or two Sp�lkathetern which are placed deliberately both apical as well as caudal in the pleural space. Until a few days on the defervescence also antibiotic therapy is made, which should take place on the basis of resistance testing. Because of the mentioned frequent mixed infection should be a combination of clindamycin (SOBELIN) and a parenteral cephalosporin [eg Cefotiam (SPIZEF) or CefuroximCEFUROXIM be inter alia)] used. Alternative therapies make the combination of aminopenicillins with beta-lactamase inhibitors such as Ampicillin plus sulbactam (UNACID) or amoxicillin plus clavulanic acid (Augmentin). The rinsing must be performed occasionally for a few weeks until the elimination of purulent secretion and gradual fibrosis of pleural. With early rinsing surgical decortication is rarely necessary and should be considered only a few months after treatment completion.