Elevated Pleural Fluid pH in Proteus mirabilis Empyema

Pine, Jeffrey R.; Hollman, Jay

doi:10.1378/chest.84.1.109

Cited by 35 publications

(22 citation statements)

References 8 publications

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“…When those criteria are not met, the patient’s clinical presentation associated with a pH of <7.20 is suggestive of pleural infection [33]. In pleural infections with multiple loculations [28] and/or a Proteus mirabilis infection [39], the possibility of aspirating fluid from a compartment that has a pH of >7.20 should not exclude a complicated parapneumonic effusion, which may also be supported by increased pleural LDH (>1,000 IU/l) and low glucose (<35 mg/dl) [34, 38]. …”

Section: Pleural Fluid Microbiologic Analysismentioning

confidence: 99%

Diagnostic Work-Up of Pleural Effusions

Froudarakis¹

2008

Respiration

116

112

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A wide range of diseases may be the cause of an accumulation of fluid in the pleural space. Pleural effusion is a major diagnostic problem, since the pleura is an inner cavity with no direct access. The aim of this review is to provide a practical approach to the investigation of the patient presenting with pleural effusion. This should help to accurately diagnose pleural effusion and keep time-consuming, but necessary, invasive investigations to the minimum.

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Section: Pleural Fluid Microbiologic Analysismentioning

confidence: 99%

Diagnostic Work-Up of Pleural Effusions

Froudarakis¹

2008

Respiration

116

112

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“…It should also be kept in mind that the pleural fluid pH may not be useful in patients with systemic pH alterations (e.g. in systemic acidosis) [22] and in infections due to Proteus spp., which can induce a local metabolic alkalosis [29]. A properly measured pleural fluid pH is a useful indicator for tube thoracostomy.…”

Section: Pleural Fluid Chemical Analysismentioning

confidence: 99%

Parapneumonic effusion and empyema

Hamm

Light²

1997

Eur Respir J

232

150

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Parapneumonic effusions account for about one third of all pleural effusions. Approximately 40% of patients with pneumonia develop a concomitant effusion, which is associated with an increased morbidity and mortality.In order to select the most appropriate therapy for the individual patient, the effusion should be categorized as being in the exudative, fibropurulent, or organizational stage, and all necessary information should be compiled to decide whether the effusion is likely to take an uncomplicated or a complicated course. There is a considerable variation in the aggressiveness and course of parapneumonic effusions, and, therefore, the spectrum of the appropriate therapy may vary from a conservative approach in uncomplicated effusions to aggressive surgical intervention in advanced multiloculated empyemas. This review discusses current diagnostic and therapeutic options and offers guidelines for treating the various stages of parapneumonic effusions and empyemas. Eur Respir J 1997; 10: 1150-1156 Definitions "Pleurisy" (syn. pleuritis) is best defined as an inflammatory process of the pleura, which can be caused either by a variety of infectious microorganisms or by other inflammatory mechanisms. It is usually associated with localized chest pain that is synchronous with the respiratory cycle and is often manifested as a pleural rub on auscultation. It may induce an exudative pleural effusion. The pain and the rub sometimes subside when an effusion develops.A "parapneumonic effusion" is an accumulation of exudative pleural fluid associated with an ipsilateral pulmonary infection."Uncomplicated parapneumonic effusions" are not infected and do not usually need tube thoracostomy."Complicated parapneumonic effusions" are usually associated with the pleural invasion of the infectious agent and require tube thoracostomy and sometimes decortication for their resolution.An effusion is called an "empyema" when the concentration of leucocytes becomes macroscopically evident as a thick and turbid fluid (pus). In more than 50% of cases, it is of parapneumonic origin. Other common causes include surgical procedures (mainly thoracic surgery), traumas and oesophageal perforation. PathophysiologyParapneumonic effusions and empyemas usually develop along the following lines. The pleuritis sicca stageThe inflammatory process of the pulmonary parenchyma extends to the visceral pleura, causing a local pleuritic reaction. This leads to a pleural rub and the characteristic pleuritic chest pain, which originates from the sensitive innervation of the adjacent parietal pleura. A significant number of patients with pneumonia report pleuritic chest pain without developing a pleural effusion [1], suggesting that the involvement of the pleura may be limited to this stage in many cases of pneumonia. The exudative stageThe ongoing inflammatory process leads to a mediator-induced increased permeability of local tissue and of regional capillaries. The subsequent accumulation of fluid in the pleural space is probably the combined ...

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“…Proteus spp.) with enzymatic activity that can elevate fluid pH, for instance by cleaving urea into ammonia [11]. During the fibrinopurulent stage the pleural space becomes increasingly infected.…”

Section: Pathogenesismentioning

confidence: 99%

“…ACCP category 1 (table 1) effusions may be observed without a diagnostic aspiration, as the risk of a complicated course is remote [11]. All other cases require at least a diagnostic pleural aspiration before this decision can be made: only category 2 effusions may be observed without formal drainage.…”

Section: Managementmentioning

confidence: 99%

Parapneumonic Pleural Effusion and Empyema

Koegelenberg¹,

Diacon

Bolliger³

2008

Respiration

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At least 40% of all patients with pneumonia will have an associated pleural effusion, although a minority will require an intervention for a complicated parapneumonic effusion or empyema. All patients require medical management with antibiotics. Empyema and large or loculated effusions need to be formally drained, as well as parapneumonic effusions with a pH <7.20, glucose <3.4 mmol/l (60 mg/dl) or positive microbial stain and/or culture. Drainage is most frequently achieved with tube thoracostomy. The use of fibrinolytics remains controversial, although evidence suggests a role for the early use in complicated, loculated parapneumonic effusions and empyema, particularly in poor surgical candidates and in centres with inadequate surgical facilities. Early thoracoscopy is an alternative to thrombolytics, although its role is even less well defined than fibrinolytics. Local expertise and availability are likely to dictate the initial choice between tube thoracostomy (with or without fibrinolytics) and thoracoscopy. Open surgical intervention is sometimes required to control pleural sepsis or to restore chest mechanics. This review gives an overview of parapneumonic effusion and empyema, focusing on recent developments and controversies.

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Elevated Pleural Fluid pH in Proteus mirabilis Empyema

Cited by 35 publications

References 8 publications

Diagnostic Work-Up of Pleural Effusions

Diagnostic Work-Up of Pleural Effusions

Parapneumonic effusion and empyema

Parapneumonic Pleural Effusion and Empyema

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