Clinical characteristics and outcomes of empyema thoracis in 117 patients: a comparative analysis of tuberculous vs. non-tuberculous aetiologies.
BACKGROUND
Empyema thoracis remains a major problem in developing countries. Clinical outcomes in tuberculous empyema are generally believed to be worse than in non-tuberculous aetiologies because of the presence of concomitant fibrocavitary parenchymal disease, frequent bronchopleural fistulae and poor general condition of patients. We performed a prospective study over a 2-year period with the objective of comparing the clinical characteristics and outcomes of patients with tuberculous vs. non-tuberculous empyema.


METHODS
Prospective study of all cases of non-surgical thoracic empyema seen at a tertiary care centre in North India over a 2-year period. A comparative analysis of clinical characteristics, treatment modalities and outcomes of patients with tuberculous vs. non-tuberculous empyema was carried out. Factors associated with poor outcomes were analysed using multivariate logistic regression.


RESULTS
One hundred and seventeen cases of empyema were seen in the study period of which 95 had non-tuberculous and 41 had tuberculous empyema. Malnutrition and bronchopleural fistulae (BPF) were more common and duration of symptoms longer in the tuberculous empyema group. Time to resolution of fever, duration of pleural drainage and pleural thickening >2 cm were significantly greater as well. Eight (10.5%) patients with non-tuberculous empyema and four (9.8%) with tuberculous empyema succumbed. Presence of a BPF was significantly associated with poor outcomes on multivariate logistic regression analysis.


CONCLUSIONS
Tuberculous empyema remains a common cause of thoracic empyema in India though it ranked second amongst all causes of empyema after community acquired lung infections in this study. Tuberculous empyema is associated with longer duration of symptoms, greater duration of pleural drainage and more residual pleural fibrosis.
Malhotra
P
P
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. dranshupuneet@yahoo.co.in
Aggarwal
A N
AN
Agarwal
R
R
Ray
P
P
Gupta
D
D
Jindal
S K
SK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001983:Bronchial Fistula / Q000150:complications / Q000453:epidemiology; D004322:Drainage; D016724:Empyema, Pleural / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D004654:Empyema, Tuberculous / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005402:Fistula / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000150:complications / Q000453:epidemiology; D010994:Pleura / Q000473:pathology; D010995:Pleural Diseases / Q000150:complications / Q000453:epidemiology; D010996:Pleural Effusion / Q000382:microbiology; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D000890:Anti-Infective Agents