Chest Infections

SESSION TITLE: Chest Infections Posters

SESSION TYPE: Original Investigation Posters
PRESENTED ON: October 18-21, 2020

EMPYEMA THORACIS: A COMPARATIVE ANALYSIS OF TB AND NON-TB ETIOLOGY AND

THEIR OUTCOMES
PRAPULLA CHANDRA DAVULURI

PURPOSE:
1. To study the tuberculous and non-tuberculous patterns in the etiology of Empyema.
2. To compare the age, sex distribution among tuberculous and non-tubercluous groups.
3. To know the effect of early intervention, prognosis, treatment modalities and outcomes in tuberculous and non-tuberculous
empyema.
METHODS: A prospective study of empyema thoracis was conducted on 52 consecutive patients with empyema thoracis
admitted to the tuberculosis and chest diseases ward of a teaching hospital over one-and-a-half-year period with the objective of
comparing the etiology, clinical profiles and outcomes of patients. The demographic data, clinical presentation, microbiological
findings, etiology, the clinical course and management were recorded as per a planned pro forma and analyzed.
RESULTS: Out of 52 cases, 30 (57.7%) cases were of non TB etiology where as TB constitute 42.3%. Gram negative organisms
28.8% cases, Gm+ve 15.3%. In TB empyema mean age of presentation was 35.8 years & 44.46 yrs in non TB. Average duration of
symptom presentation in TB & non TB empyema are 40.35 & 21.13 days respectively. Mean duration of intercostal tube drainage
in TB was 33.55 days vs 18.36 days in non TB empyema. Bronchopleural fistula present in 54.54% of tuberculous versus 20% of
non-tuberculous empyema. Good lung expansion with minimal pleural thickening seen in 25(83.33%) cases of non TB cases but
only 59% cases of TB empyema had good resolution.
CONCLUSIONS: Empyema continues to be prevalent in our country particularly in the lower socioeconomic strata due to the
delay in seeking medical care, inappropriate antibiotics and dosages and duration of antibiotic treatment. Pleural fluid

CHEST INFECTIONS
biochemical parameters would also vary depending on the stage of empyema, severity and previous antibiotic therapy.
Management of primary empyema continues to be controversial in terms of duration of antibiotic therapy and the indications for
and timing of surgery. There is a need for randomized controlled trials for strict guidelines on the management of empyema
Tuberculous empyema differs from non-tuberculous empyema in the age profile, Clinical presentation, management issues, and
has a significantly poorer outcome. All cases of empyema with bronchopleural fistula should be managed by intercostal drainage
tube connected to water seal. It was also observed that all cases of empyema complicated by bronchopleural fistula were difficult to
manage and needed major surgery.
CLINICAL IMPLICATIONS: Tuberculous empyema remains a significant cause of empyema thoracis in India. Further studies
are needed to evaluate the role of rapid diagnostic tools like CBNAAT with reliable sensitivity and specificity in the diagnostic
algorithm for the early diagnosis of tuberculous empyema which would help in planning the treatment of empyema.
DISCLOSURES: No relevant relationships by PRAPULLA CHANDRA DAVULURI, source¼Web Response
DOI: http://dx.doi.org/10.1016/j.chest.2020.08.348
Copyright ª 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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