Empyema - Empyema

Japanese: 膿胸 - のうきょう（英語表記）Empyema

What is the disease?

Pleura ( Good job ) Infection in the chest cavity Purulent ( Infancy ) It is a collection of fluids.

What is the cause?

Pneumonia and Lung abscess ( Hello everyone ) The disease often develops when bacteria invade the pleural cavity and cause the disease. Bacillus ( Kankin ) , Streptococcus milleri, Anaerobic bacteria ( Research ) etc. are quite frequent.

It is more likely to occur in elderly people who are bedridden, as bacteria in the mouth can easily flow into the lungs.

The cause is pulmonary tuberculosis ( Haikekaku ) In this case, it is tuberculous empyema, and pus may accumulate over years, resulting in a condition known as chronic empyema.

How symptoms manifest

Fever, chest pain (characterized by worsening with deep breathing or coughing), cough ( cough ) Symptoms include: When pus in the thoracic cavity leaks into the lungs, purulent phlegm is coughed up. When a large amount of pus accumulates, the patient begins to feel difficulty breathing.

Chronic empyema may be asymptomatic for years.

Testing and diagnosis

Chest X-ray showed pleural effusion, Thoracentesis ( Air Force ) If purulent pleural fluid is collected by needle insertion, empyema is diagnosed. However, in chronic empyema, the fluid is not purulent and is brown in color.

The causative organism is determined by culturing the collected pleural fluid.

Blood tests reveal increased inflammatory signs such as increased white blood cells, high CRP levels, and accelerated erythrocyte sedimentation rate.

Treatment methods

A strong antibiotic called carbapenem is administered, and clindamycin, an antibiotic with excellent antibacterial properties against anaerobic bacteria, may also be used in combination.

In the treatment of empyema, it is important to remove purulent pleural fluid from the pleural cavity while administering systemic antibiotics. A tube is placed in the pleural cavity to continuously drain the fluid. The pleural cavity may be irrigated with saline or antibiotics such as aminoglycosides may be injected.

With these treatments, most cases are cured within 2 to 3 weeks.

Chronic empyema is difficult to cure with medical treatment alone, and many patients require surgical treatment. Decortication ( Art ) Or, thoracoplasty is performed to reduce and close the empyema cavity.

What to do if you notice an illness

If you experience chest pain that worsens with deep breathing or coughing, and you also have a fever, you should see an internal medicine doctor as soon as possible. If an elderly bedridden person complains of fever or chest pain, a family member should take the patient to the hospital.

Jiro Okimoto

Empyema
Empyema
(Infectious Diseases)

What are the symptoms?

What is empyema? Pleura ( Good job ) This is a condition in which the pleura becomes inflamed and pus-like fluid accumulates in the pleura. It is characterized by occurring following bacterial pneumonia or intrathoracic surgery.

Depending on the duration, empyema is classified as acute empyema (less than 3 months) or chronic empyema (more than 3 months). Also, depending on the type of bacteria, Tuberculous ( Results ) The most common causative bacteria is Staphylococcus aureus, followed by Streptococcus pneumoniae, Klebsiella, and Gram-negative bacteria. Negative bacilli ( Infection control ) In rare cases, malignant B lymphoma may develop from empyema.

How symptoms manifest

In acute cases Chills ( Mom ) High fever accompanied by cough ( cough ) The main symptoms are chest pain and difficulty breathing. In severe cases, blood pressure drops and sepsis may occur, leading to shock.

Testing and diagnosis

The diagnosis was made on chest X-ray, which showed pleural effusion. Thoracic cavity ( Airport ) of puncture ( Warrior ) If the fluid collected (by needle insertion) is purulent, the diagnosis is confirmed as empyema.

Pleural fluid should always be tested for bacteria and cultured for tuberculosis bacteria. Even in cases of bacterial empyema, bacteria may not be detected. Chest CT scans are also very useful for determining how much and where the purulent fluid is.

In the case of tuberculous empyema, the condition progresses chronically, and many patients have a history of tuberculous pleurisy, and the pleural fluid may not be purulent but may be brown in color. Also, tuberculosis bacteria are often not identified.

It is said that 44% of cases of empyema are accompanied by underlying diseases such as diabetes, liver disease, congestive heart failure, and obstructive pulmonary disease, and that it is related to alcohol dependence and smoking.

Treatment methods

Both systemic antibiotics that are sensitive to the causative bacteria and chest drainage (drainage through a tube) are required, and antibiotics are given intravenously, usually broad-spectrum penicillins or second-generation cephalosporins, often in combination with aminoglycosides.

The tube used for chest drainage is as thick as possible to eliminate blockage of purulent pleural fluid. Antibiotics are injected directly through the tube, and saline is used to wash the pleural cavity.

Chronic empyema is difficult to treat, so pleuropulmonary resections and other procedures are required to remove the empyema from the lungs. expansion ( Bocho ) Surgical treatment is also performed to achieve this.

What to do if you notice an illness

You will need to visit a hospital that has a tuberculosis specialist or respiratory disease specialist (especially a National Hospital Organization respiratory specialist hospital) and consult with them.

どんな病気か

　胸膜(きょうまく)の感染症により、胸腔内に膿性(のうせい)の液体がたまったものです。

原因は何か

　肺炎や肺膿瘍(はいのうよう)が胸膜に広がり、細菌が胸腔内に侵入して発症することが多く、起炎菌としては、黄色ブドウ球菌、肺炎桿菌(かんきん)、ストレプトコッカスミレリ、嫌気性菌(けんきせいきん)などが頻度の高いものです。

　高齢で寝たきりの人に発症しやすく、口腔内の細菌が肺内に流れ込みやすいのがその理由です。

　原因が肺結核(はいけっかく)の場合は結核性膿胸であり、年余にわたって膿がたまり、慢性膿胸と呼ばれる病態を示すことがあります。

症状の現れ方

　発熱、胸痛（深呼吸や咳で増悪するのが特徴）、咳(せき)などの症状が現れます。胸腔内の膿が肺内にもれると、膿性痰が吐き出されます。膿が大量にたまってくると呼吸困難を自覚するようになります。

　慢性膿胸では、年余にわたって無症状のこともあります。

検査と診断

　胸部X線検査で胸水がたまった像を認め、胸腔穿刺(きょうくうせんし)（針を刺す）により膿性の胸水が採取されれば膿胸と診断されます。しかし、慢性膿胸では胸水も膿性ではなく、褐色を示します。

　採取された胸水の培養により、起炎菌が決定されます。

　血液検査では、白血球増加、CRP高値、赤沈促進などの炎症所見の亢進が認められます。

治療の方法

　カルバペネムという強力な抗菌薬が投与されます。また、クリンダマイシンという嫌気性菌に優れた抗菌力をもつ抗菌薬が併用されることもあります。

　膿胸の治療では、全身的な抗菌薬の投与と同時に、胸腔内の膿性胸水を排除することが重要です。胸腔内にチューブを留置し、持続的に排液します。胸腔内を生理食塩水で洗浄したり、アミノグリコシドなどの抗菌薬を注入することもあります。

　これらの治療により、多くは2～3週間で治癒します。

　慢性膿胸では、内科的治療のみでは治癒させることが困難であり、多くの患者さんでは外科的治療が必要になります。基質化して厚くなった胸膜の剥皮術(はくひじゅつ)や、膿胸腔を縮小、閉鎖するための胸郭形成術が行われます。

病気に気づいたらどうする

　深呼吸や咳で増悪する胸痛を自覚し、発熱もあれば、早めに内科を受診します。高齢で寝たきりの人が発熱や胸痛を訴えた場合は、家族の方は患者さんを病院に連れていったほうがよいでしょう。

沖本　二郎

膿胸
のうきょう
Empyema
(感染症)

どんな症状か

　膿胸とは、胸膜(きょうまく)が炎症を起こし胸膜内に膿状の液体（うみ）がたまった状態をいいます。細菌性肺炎、胸腔内手術後に続いて起こるのが特色です。

　期間によって急性膿胸（3カ月未満）、慢性膿胸（3カ月以上）に分けられます。また、菌の種類によって結核性(けっかくせい)、化膿性、真菌性膿胸に分けられます。原因となる細菌はブドウ球菌が最も多く、ほかには肺炎球菌、クレブシエラ、グラム陰性桿菌(いんせいかんきん)があります。まれに膿胸から悪性Bリンパ腫が発症します。