Empyema laboratory findings: Difference between revisions
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{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
Diagnosis is confirmed by [[thoracentesis]]. Aspiration of the purulent fluid is necessary especially when condition is not resolving on antibiotics. The pleural fluid typically has a low pH (<7.20), low glucose (<60 mg/dL), and contains infectious organisms. Although the presence of pus or organisms on gram stain is extremely helpful in making a diagnosis of empyema, a positive bacteria culture from pleural fluid is not needed before diagnosis of empyema is comfirmed.<ref name="pmid3548615">{{cite journal| author=Mavroudis C, Ganzel BL, Cox SK, Polk HC| title=Experimental aerobic-anaerobic thoracic empyema in the guinea pig. | journal=Ann Thorac Surg | year= 1987 | volume= 43 | issue= 3 | pages= 298-302 | pmid=3548615 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3548615 }} </ref><ref name="pmid27527890">{{cite journal| author=Perez VP, Caierão J, Fischer GB, Dias CA, d'Azevedo PA| title=Pleural effusion with negative culture: a challenge for pneumococcal diagnosis in children. | journal=Diagn Microbiol Infect Dis | year= 2016 | volume= 86 | issue= 2 | pages= 200-4 | pmid=27527890 | doi=10.1016/j.diagmicrobio.2016.07.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27527890 }} </ref> | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
Diagnosis is confirmed by [[thoracentesis]] | Diagnosis is confirmed by [[thoracentesis]]. Aspiration of the purulent fluid is necessary especially when condition is not resolving on antibiotics. | ||
The pleural fluid typically has the following features: | |||
*Low pH (<7.20) | |||
*Low glucose (<60 mg/dL) and | |||
*Contains infectious organisms. | |||
Although the presence of pus or organisms on gram stain is extremely helpful in making a diagnosis of empyema, a positive bacteria culture from pleural fluid is not needed before diagnosis of empyema is comfirmed.<ref name="pmid3548615">{{cite journal| author=Mavroudis C, Ganzel BL, Cox SK, Polk HC| title=Experimental aerobic-anaerobic thoracic empyema in the guinea pig. | journal=Ann Thorac Surg | year= 1987 | volume= 43 | issue= 3 | pages= 298-302 | pmid=3548615 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3548615 }} </ref><ref name="pmid27527890">{{cite journal| author=Perez VP, Caierão J, Fischer GB, Dias CA, d'Azevedo PA| title=Pleural effusion with negative culture: a challenge for pneumococcal diagnosis in children. | journal=Diagn Microbiol Infect Dis | year= 2016 | volume= 86 | issue= 2 | pages= 200-4 | pmid=27527890 | doi=10.1016/j.diagmicrobio.2016.07.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27527890 }} </ref> | |||
The '''COMPLES score''' has been developed to differentiate between tuberculous effusions with low pleural pH or glucose and complicated parapneumonic effusions. | |||
The components are: | |||
*pleural fluid adenosine deaminase (ADA) (<46 IU/L [0 points] | |||
*The percentage of mononuclear cells (MNC %), ≥100 IU/L [6 points]), 46-100 IU/L [4 points], MNC % (<10 % [0 points], 10-50 [3 points], >50 [8 points]) | |||
*PH, pH (<7.07 [0 points], 7.07-7.20 [3 points], >7.20 [5 points]), | |||
*Age.age (≥30 [0 points], <30 years [3 points]) | |||
A score of 12 or more points is highly sensitivity and specificity for complicated tuberculous pleural effusion.<ref name="pmid27401009">{{cite journal| author=Corral-Gudino L, García-Zamalloa A, Prada-González C, Bielsa S, Alexis D, Taboada-Gómez J et al.| title=Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions. | journal=Lung | year= 2016 | volume= 194 | issue= 5 | pages= 847-54 | pmid=27401009 | doi=10.1007/s00408-016-9923-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27401009 }} </ref> | |||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
Latest revision as of 17:39, 18 September 2017
|
Empyema Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diagnosis is confirmed by thoracentesis. Aspiration of the purulent fluid is necessary especially when condition is not resolving on antibiotics. The pleural fluid typically has a low pH (<7.20), low glucose (<60 mg/dL), and contains infectious organisms. Although the presence of pus or organisms on gram stain is extremely helpful in making a diagnosis of empyema, a positive bacteria culture from pleural fluid is not needed before diagnosis of empyema is comfirmed.[1][2]
Laboratory Findings
Diagnosis is confirmed by thoracentesis. Aspiration of the purulent fluid is necessary especially when condition is not resolving on antibiotics. The pleural fluid typically has the following features:
- Low pH (<7.20)
- Low glucose (<60 mg/dL) and
- Contains infectious organisms.
Although the presence of pus or organisms on gram stain is extremely helpful in making a diagnosis of empyema, a positive bacteria culture from pleural fluid is not needed before diagnosis of empyema is comfirmed.[1][2]
The COMPLES score has been developed to differentiate between tuberculous effusions with low pleural pH or glucose and complicated parapneumonic effusions.
The components are:
- pleural fluid adenosine deaminase (ADA) (<46 IU/L [0 points]
- The percentage of mononuclear cells (MNC %), ≥100 IU/L [6 points]), 46-100 IU/L [4 points], MNC % (<10 % [0 points], 10-50 [3 points], >50 [8 points])
- PH, pH (<7.07 [0 points], 7.07-7.20 [3 points], >7.20 [5 points]),
- Age.age (≥30 [0 points], <30 years [3 points])
A score of 12 or more points is highly sensitivity and specificity for complicated tuberculous pleural effusion.[3]
References
- ↑ 1.0 1.1 Mavroudis C, Ganzel BL, Cox SK, Polk HC (1987). "Experimental aerobic-anaerobic thoracic empyema in the guinea pig". Ann Thorac Surg. 43 (3): 298–302. PMID 3548615.
- ↑ 2.0 2.1 Perez VP, Caierão J, Fischer GB, Dias CA, d'Azevedo PA (2016). "Pleural effusion with negative culture: a challenge for pneumococcal diagnosis in children". Diagn Microbiol Infect Dis. 86 (2): 200–4. doi:10.1016/j.diagmicrobio.2016.07.022. PMID 27527890.
- ↑ Corral-Gudino L, García-Zamalloa A, Prada-González C, Bielsa S, Alexis D, Taboada-Gómez J; et al. (2016). "Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions". Lung. 194 (5): 847–54. doi:10.1007/s00408-016-9923-y. PMID 27401009.