Pleuro-pulmonary amoebiasis.

From a retrospective scrutiny of 500 consecutive case records, which related to patients with empyema thoracis, over a 13-year period in a relatively closed community of one and a half million in the south-east region of Scotland (le Roux, 1965), it emerged that, in 50% of patients, empyema was related to non-specific pulmonary infection for which a persisting cause was not found, and that this was the commonest single cause for empyema in this region. Trauma was a rare cause, and amoebic empyema was not encountered. On completion of this survey the opportunity arose to establish a thoracic surgical unit which would serve the Province of Natal in South Africa. The population of this Province is some three million, of whom two million are Africans, half a million are Asiatics, and half a million are of Caucasian stock. Empyema thoracis in the first 200 examples of this disease (80% of which were in relatively young men) seen in this new community was a late and probably iatrogenic complication of traumatic haemothorax in 50%, and in nearly all these patients the trauma was a stab wound. In the remainder the commonest cause of empyema was amoebiasis and in most of these patients the pleural infection was an extension from the liver. The purpose of this paper is to relate the natural history of amoebiasis which has extended into the pleural space or the lung. Extension of amoebiasis from the liver to the lungs and pleura is well documented, and the problems which relate to amoebiasis in clinical practice have been described by Wilmot (1962). Pleuro-pulmonary amoebiasis may, develop as a consequence of: (1) Direct extension (either abruptly by rupture of a liver abscess, or insidiously) from the liver through the diaphragm either (a) to involve the pleura, here promoting the symptoms and signs