A new study, conducted at Changhua Christian Hospital in Taiwan, has shed light on the varied outcomes of bacterial, tuberculous, and fungal pleural infections (empyema), a potentially life-threatening condition. Published in The International Journal of Tuberculosis and Lung Disease, the research emphasises the urgent need for tailored treatment approaches.
Empyema occurs when infected fluid accumulates in the pleural cavity surrounding the lungs. While bacterial causes dominate cases, fungal and tuberculous origins are increasingly observed due to widespread use of antibiotics and immunosuppressive treatments.
Of the 561 patients studied, 87% had bacterial empyema, 8% had tuberculous empyema, and 5% were diagnosed with fungal empyema. All patients had been subject to surgical decortication.
Fungal empyema has poor patient outcomes, with a 30-day mortality rate of 22.2%, compared to 6.5% for bacterial and tuberculous empyema. Fungal cases also exhibited significantly lower two-year survival rates and longer time spent in ICU.
Of the fungal empyema cases, testing revealed that Candida spp. was the most prevalent fungal pathogen with some Aspergillus spp. also seen. The patients with fungal empyema were also more likely to have caught the infection from previous medical interventions, with 26% of fungal empyema cases being iatrogenic in origin, compared to only 4% in bacterial infections.
An earlier paper looking fungal empyema thoracis (FET) in cancer patients showed that FET accounts for 16% of positive pleural cultures in cancer patients, with Candida spp. (58%) and Aspergillus spp. (12%) dominating. There was also a high incidence of iatrogenic causes as most patients had recent invasive surgical procedures (e.g., abdominal or thoracic surgeries) and demonstrated a significant indicator of Candida infections. Cancer-related immunosuppression was also key in FET cases.
Both studies underscore the importance of identifying the infection type early especially as fungal empyema patients are often immunocompromised, due to underlying conditions. Timely intervention (drainage, often surgical as in these cases described) and targeted therapies can significantly improve outcomes for these patients.
While the study provides critical insights, its authors stress the need for multi-center, global studies to validate their findings and address geographic variations in infection management.
You can read the full article here.
Image showing a pleural empyema. Case courtesy of Ian Bickle, Radiopaedia.org, rID: 74921
