Something Doesn’t Smell Right: When a Patient With Empyema Isn’t Responding to Guideline-Based Management

Abstract

A 10-month-old girl presented with 5 days of fever and cough to our emergency department. She was diagnosed with an upper respiratory infection and discharged from the hospital without antibiotics. She returned 3 days later in severe respiratory distress. Her past medical history was significant for an admission at 3 months of age for community-acquired pneumonia. She had no other medical problems and was fully vaccinated for her age. Her parents denied any sick contacts, and there was no family history of immunodeficiency.

Mixed anaerobic thoracic empyema: the first report of Filifactor alocis causing extra-oral disease

“…It is known to be motile, oxidase-positive, urease-negative and catalase-variable. Though known as an established pathogen in periodontal disease, it has rarely been isolated in extra-oral invasive disease; to date 15 cases of extra-oral invasive disease have been described, four of which have been thoracic empyemas [4], [5], [6], [7], [8], [9], [10], [11], [12]. In most cases, extra-oral Camplobacter rectus infections have been polymicrobial, and the associated pathogens included Actinomyces spp., Streptococcus intermedius , Eubacterium spp ., Porphyromonas spp.…”

Campylobacter rectus Infection Leads to Lung Abscess: A Case Report and Literature Review

“… Tooth extraction for dental caries 8 days Cavernous sinus thrombosis Blood culture (+); 16S rRNA gene sequencing Not assessed – Vancomycin, clindamycin, piperacillin/tazobactam Recovery [ 14 ] 12 2016 M 15Y/O. Keep cats and dogs 13 days Otitis media 16S rRNA gene sequencing Not assessed 25 days Cefditoren-pivoxil, prulifloxacin, ceftriaxone, ampicillin, amoxicillin Recovery [ 15 ] 13 2016 F 10 months None 5 days Empyema thoracis Pleural fluid culture Not assessed 6 weeks Drainage, vancomycin, Ceftriaxone, Piperacillin-tazobactam, ampicillin-sulbactam, amoxicillin-clavulanate Recovery [ 16 ] 14 2016 M 75Y/O. Diabete, impaired renal function, periodontitis 1 week Empyema thoracis 16S rRNA gene sequencing Not assessed 2months Drainage, sulbactam-ampicillin, garenoxacin, levofloxacin Recovery [ 17 ] 15 2017 M 66Y/O.…”

From Bedside to the Bench—A Call for Novel Approaches to Prognostic Evaluation and Treatment of Empyema

“…Advanced stage empyema is considered a risk factor for failure of IPFT ( Himelman and Callen, 1986 ); ( Moulton et al, 1995 ; Temes et al, 1996 ). Patients that present with extensive loculation, lung abscess, and pleural thickening are more likely to fail IPFT ( Davies et al, 1999 ; Thommi et al, 2007 ; Chen et al, 2016 ; Khemasuwan et al, 2018 ) and require surgical intervention ( Davies et al, 1999 ; Maskell et al, 2005 ; Thommi et al, 2007 ). On the other hand, a randomized, double blinded trial demonstrated that Alteplase (25 mg/100 ml, 1 h clamp, suction after second hour, daily up to 3 days) was both more effective than placebo (95 and 12%, respectively) and safe ( Thommi et al, 2012 ).…”