CAUSES OF EMPYEMA/PYOTHORAX

Empyema can develop after having pneumonia. Many different types of bacteria may cause pneumonia, but the two most common are Streptococcus pneumoniae and Staphylococcus aureus. Occasionally, empyema may happen after surgery in chest. Medical instruments can transfer bacteria into pleural cavity.

The pleural space naturally has some fluid, but infection can cause fluid to build up faster than it can be absorbed. The fluid then becomes infected with the bacteria that caused the pneumonia or infection. The infected fluid thickens. It can cause the lining of lungs and chest cavity to stick together and form pockets. This is called an empyema.Lungs may not be able to inflate completely, which can lead to breathing difficulties.

The biggest risk factor for empyema is having pneumonia. Empyema occurs most frequently in children and older adults. However, it is fairly uncommon. In one study, it occurred in less than 1 percent of children with pneumonia.

Having the following conditions can also increase our chances of empyema after pneumonia:

• Bronchiectasis
• Chronic obstructive pulmonary disease (COPD)
• Rheumatoid arthritis
• Alcoholism
• Diabetes
• Weakened immune system
• Surgery or recent trauma
• Lung abscess

Empyema can be simple or complex.

Simple empyema

Simple empyema occurs in the early stages of the illness. A person has this type if the pus is free-flowing. The symptoms of simple empyema include:

• Shortness of breath
• Dry cough
• Fever
• sweating
• chest pain when breathing that may be described as stabbing
• Headache
• Confusion
• Loss of appetite

Complex empyema

Complex empyema occurs in the later stage of the illness. In complex empyema, the inflammation is more severe.Scar tissue may form and divide the chest cavity into smaller cavities.This is called loculation, and it is more difficult to treat.

If the infection continues to get worse, it can lead to the formation of a thick peel over the pleura, called a pleural peel. This peel prevents the lung from expanding. Surgery is required to fix it.

Other symptoms in complex empyema include:

• Difficulty breathing
• Decreased breath sounds
• Weight loss
• Chest pain

COMPLICATION OF EMPYEMA/PYOTHORAX

In rare instances, a case of complex empyema can lead to more severe complications. These include sepsis and a collapsed lung, also called a pneumothorax. The symptoms of sepsis include:

• High fever
• Chills
• Rapid breathing
• Fast heart rate
• Low blood pressure

A collapsed lung can cause sudden, sharp chest pain and shortness of breath that gets worse when coughing or breathing.

• Chest X-rays and CT scans will show whether or not there is fluid in the pleural space.
• An ultrasound of the chest will show the amount of fluid and its exact location.
• Blood tests can help check our white blood cell count, look for the C-reactive protein, and identify the bacteria causing the infection. White cell count can be elevated when one have an infection.
• During a thoracentesis, a needle is inserted through the back of our ribcage into the pleural space to take a sample of fluid. The fluid is then analyzed under a microscope to look for bacteria, protein, and other cells.