55 y/o with no PMH presenting with Strep. pneumo empyema
Dr. Will Greendyke | Morning Report | 02/13/2017
Sensitivity for diagnosing PNA- 4-16%
Specificity for diagnosing PNA- 96-99%
Posted 02/13/17 03:12:01 PM by Adam Faye
Light's Criteria Rule, if at least one of the three criteria is fulfilled, the fluid is defined as an exudate: 1) Pleural Protein : Serum Protein >0.5
2) Pleural fluid LDH > 2/3 ULN for serum LDH
3) Pleural fluid LDH/Serum LDH > 0.6
Pleural fluid glucose <60, pH <7.2 - think complicated parapneumonic effusion/empyema: pH has to be run within an hour - can be falsely low if sits out for a long time. Glucose then becomes a better marker
A pleural fluid glucose level <60 mg/dL(3.33 mmol/L) is most commonly due to TB, parapneumonic effusion, malignant effusion, or rheumatoid disease.
In parapneumonic effusions, a low glucose level implies the need for chest tube drainage.
In malignant effusions, a low glucose level predicts a high yield on cytology, poor result of pleurodesis, and a poorer prognosis.
TB Effusions: Adenosine Deaminase <40 has almost a 100% negative predictive value for TB
Posted 02/13/17 03:16:21 PM by Adam Faye
Patients with diabetes mellitus are at increased risk of empyema secondary to Klebsiella.
MRSA can cause a necrotizing pneumonia; Group A Strep is also associated with a high rate of empyema.
In patients with viral PNA, the major causes of bacterial superinfection and empyema have been S. aureus, S. pneumoniae, and S. pyogenes.