title: [Parapneumonic pleural effusions: Epidemiology, diagnosis, classification and management].
abstract: Parapneumonic pleural effusions represent the main cause of pleural infections. Their incidence is constantly increasing. Although by definition they are considered to be a "parapneumonic" phenomenon, the microbial epidemiology of these effusions differs from pneumonia with a higher prevalence of anaerobic bacteria. The first thoracentesis is the most important diagnostic stage because it allows for a distinction between complicated and non-complicated parapneumonic effusions. Only complicated parapneumonic effusions need to be drained. Therapeutic evacuation modalities include repeated therapeutic thoracentesis, chest tube drainage or thoracic surgery. The choice of the first-line evacuation treatment is still controversial and there are few prospective controlled studies. The effectiveness of fibrinolytic agents is not established except when they are combined with DNase. Antibiotics are mandatory; they should be initiated as quickly as possible and should be active against anaerobic bacteria except for in the context of pneumococcal infections. There are few data on the use of chest physiotherapy, which remains widely used. Mortality is still high and is influenced by underlying comorbidities.
authors.affiliation: Service de maladies infectieuses et réanimation médicale, hôpital Pontchaillou, université de Rennes 1, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France. Electronic address: julien.letheulle@chu-rennes.fr.
authors.forename: J
authors.initials: J
authors.lastname: Letheulle
authors.affiliation: Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, 35033 Rennes cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Kerjouan
authors.affiliation: Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, 35033 Rennes cedex 9, France.
authors.forename: F
authors.initials: F
authors.lastname: Bénézit
authors.affiliation: Service de chirurgie thoracique, hôpital Pontchaillou, université de Rennes 1, 35033 Rennes cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: De Latour
authors.affiliation: Service de maladies infectieuses et réanimation médicale, hôpital Pontchaillou, université de Rennes 1, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Laboratoire de bactériologie, hôpital Pontchaillou, université de Rennes 1, 35033 Rennes cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Piau
authors.affiliation: Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, 35033 Rennes cedex 9, France.
authors.forename: H
authors.initials: H
authors.lastname: Léna
authors.affiliation: Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, 35033 Rennes cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Desrues
authors.affiliation: Service de maladies infectieuses et réanimation médicale, hôpital Pontchaillou, université de Rennes 1, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Le Tulzo
authors.affiliation: Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, 35033 Rennes cedex 9, France; IRSET UMR 1085, université de Rennes 1, 35043 Rennes cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Jouneau
mesh_terms: D019468:Disease Management; D004322:Drainage / Q000379:methods; D006801:Humans; D010996:Pleural Effusion / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000069258:Thoracentesis / Q000379:methods
keywords: Chest tube drainage; Chirurgie thoracique; Drainage thoracique; Empyème pleural; Parapneumonic pleural effusion; Pleural empyema; Ponction pleurale; Thoracentesis; Thoracic surgery; Épanchement pleural parapneumonique