Pleural fluid investigations for pleural infections
نویسندگان
چکیده
: Over 1.5 million patients are admitted to hospital with pneumonia in the United States each year. Up 50% of them can develop a parapneumonic effusion which is associated higher mortality. The incidence pleural infection continues rise, particularly elderly and those comorbidities. Parapneumonic effusions cover spectrum presentations from free-flowing ‘simple effusion’ septated ‘complicated (CPE) (usually bacterial invasion) ‘empyema’ (presence pus). Pleural defined as either CPE or empyema, usually requires evacuation infected fluid. Laboratory investigations play an essential part diagnosis management infection. A typically neutrophil-rich exudate. Presence bacteria culture fluid defines but conventional methods have low yield. Surrogate markers often employed confirm CPE, including pH (<7.2) glucose (<3.3 mmol/L) elevated lactate dehydrogenase (LDH). Measurement triglyceride chylomicrons (for chylothorax) cholesterol pseudochylothorax) may be needed separate lipid empyema. Tuberculous result hypersensitivity pleuritis lymphocyte predominant adenosine deaminase (ADA) interferon gamma levels. Culture yield mycobacteria low. Caseating granulomas on tissue biopsy considered diagnostic. Common organisms for community-acquired include Streptococcus pneumoniae, anginosus group Staphylococcus aureus. Hospital-acquired infections mortality polymicrobial S. aureus, Enterobacteriaceae anaerobes. Antibiotics fluid, by chest tube drainage, remain mainstay treatment. Intrapleural fibrinolytic deoxyribonuclease therapy, occasionally surgical required.
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ژورنال
عنوان ژورنال: Journal of laboratory and precision medicine
سال: 2021
ISSN: ['2519-9005']
DOI: https://doi.org/10.21037/jlpm-2021-01