title: [Pyopneumothorax caused by Salmonella choleraesuis: a case report and review of the literature].
abstract: OBJECTIVE
  To improve understanding of the clinical features, diagnosis and treatment of pyopneumothorax caused by Salmonella choleraesuis.
  
  
  METHODS
  One case of pyopneumothorax caused by Salmonella choleraesuis diagnosed and treated in our hospital in 2010 was reported and the related literatures were reviewed. As of May 2011, the literature review was carried out with "Salmonella choleraesuis" and "thoracic empyema" as the search terms in Wanfang Med Online and Pubmed Database.
  
  
  RESULTS
  A 43-year-old Chinese woman presenting with fever and chest pain for 4 days was admitted to our hospital. A CT scan of the chest revealed a massive shadow with mixed density in the right hemithorax, from the top of thorax to diaphragmatic surface, and there was air inside or surrounding the mass irregularly but without an air-fluid level. Blood culture and bronchial secretion culture by bronchoscope both showed some serotypes of Salmonella strains. At first intravenous antibiotic therapy (piperacillin-tazobactam, ceftazidime, and then imipenem-cilastatin) was ineffective. Open chest surgery was performed, and chest tube placed. Salmonella choleraesuis was isolated from the drained pleural fluid. Chest tube drainage remained in place for more than 6 weeks, and with prolonged antibiotic therapy, which contributed to a good outcome. Literature review found no related reports in Wanfang Med Online, while 3 literatures were found in Pubmed, including 2 of case report and 1 of retrospective study. Among 973 patients with empyema thoracis in the retrospective study, 12 of these patients, including 9 men and 3 women, were infected with Salmonella species. The median age was 49 years, and 10 patients were immunocompromised, including malignancy, liver cirrhosis, and diabetes mellitus. Seven patients were infected with Salmonella choleraesuis, and 4 (57%) of them died.
  
  
  CONCLUSIONS
  Pyopneumothorax or thoracic empyema is a rare complication of Salmonella choleraesuis infection. Higher rates of death were noted in this disease. Salmonella choleraesuis infection is even more serious in adult patients with underlying diseases. Early diagnosis, appropriate antimicrobial drug therapy, and aggressive drainage are necessary to improve the outcome of patients with pyopneumothorax or thoracic empyema due to Salmonella choleraesuis.
authors.affiliation: Department of Respiratory Medicine, Zhejiang Chinese Medical University, Hangzhou, China. jkzjuedu@163.com
authors.forename: Li-bin
authors.initials: LB
authors.lastname: Jiang
authors.forename: Yi-hao
authors.initials: YH
authors.lastname: Zhu
authors.forename: Yu-feng
authors.initials: YF
authors.lastname: Yao
authors.forename: Jun
authors.initials: J
authors.lastname: Xu
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000328:Adult; D016724:Empyema, Pleural / Q000382:microbiology*; D005260:Female; D006801:Humans; D011030:Pneumothorax / Q000382:microbiology*; D012476:Salmonella arizonae