Thoracic Empyema in HIV-Infected Patients: Results
Antibiotic therapy and cavity drainage with closed thoracostomy commenced immediately. Success was measured by clinical and radiologic (or CT) status improvement within a 24- to 48-hr period. Drainage was maintained until the daily fluid yield dropped to <50 mL and improvement in the chest radiograph was evident. Indication for intrapleural thrombolytics (streptokinase [SK]) was persistent fluid collection that had been inadequately drained by thoracostomy tubes. SK (250,000 U/d) was instilled into the pleural cavity until a complete radiologic recovery was detected. antibiotics online
Results are expressed as mean±SD (or range) and percentages. Either the Student’s test or the nonparametric K-Wallis test, as needed, was used for quantitative variables; and either the X2 or Fisher test was used for qualitative variables. The correlation of continuous variables was determined by simple regression. A p value <0.05 was considered to be a significant difference.
Twenty-three HIV-infected patients were diagnosed as having empyema during the period of study. The group included 22 men and one woman, with an average age of 28.7±5.3 years (range, 21 to 43 years). All of them were injection-drug users (IDUs), and 10 (43%) fulfilled criteria for an AIDS diagnosis when they manifested empyema. Empyema was the primary cause for medical consultation in 15 patients (65%) and in 11 of them (48%), the diagnosis of HIV infection was established during hospitalization. In 12 cases, the diagnosis of HIV infection was prior to hospitalization, with a range from 1 to 8 years (average, 4.1 ±2.4 years). Community-acquired infections were manifest in 21 patients and 2 were due to nosocomial infections.
The chest findings and characteristics of pleural fluid are described in Table 1. The pleural fluid had a purulent aspect in 12 cases and none were fetid. Eleven samples were nonpurulent: nine were serofibrinous and two were bloody. In six patients, there was evidence of thrombophlebitis and in five of them, a diagnosis of endocarditis was established. The predominant factor leading to infection was parenteral drug abuse (91%) and in five cases, associated factors coexisted (alcoholism [three]; airway instrumentation [one]; and severe malnutrition [one]). All the patients had symptoms attributable to their empyema, with fever and chest pains being the most common symptoms (96%). Other symptoms included dyspnea (53.5%), hemoptysis (35%), cough (39%), and septic shock (9%).
Table 1—Chest Radiographs and Characteristics of Pleural Fluid
|(n=23)||(n=10)||(n = 13)|
|Loculated effusion||14 (61%)||6 (60%)||8 (62%)|
|Consolidation||21 (91%)||10 (100%)||11 (85%)|
|CV||9 (39%)||4 (40%)||5 (38%)|
|Pyopneumothorax||6 (26%)||4 (40%)||2 (15%)|
|LDH, UI/L||6,813± 10,632||5,430 ±6,566||7,613±1,271|
|Leukocytes, cells/mm||72,926± 181,573||41,005± 102,072||85,139±215,120|