Pearls from Dr. Will Greendyke

55 y/o with no PMH presenting with Strep. pneumo empyema


  • Egophony:

    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. 

    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

  • Empyema:
    1. Patients with diabetes mellitus are at increased risk of empyema secondary to Klebsiella. 
    2. MRSA can cause a necrotizing pneumonia; Group A Strep is also associated with a high rate of empyema. 
    3. In patients with viral PNA, the major causes of bacterial superinfection and empyema have been S. aureus, S. pneumoniae, and S. pyogenes.

    Posted 02/13/17 03:17:47 PM by Adam Faye

  • Empyema Management with Chest Tube; tPA + DNase to help breakup loculations

    Posted 02/13/17 03:19:59 PM by Adam Faye

  • 46yoM p/w 2 weeks of fevers after trip to DR. Also with recent tick exposure, found to have anaplasmosis


  • DDx for fever in returning traveler (from DR) w/o localizing symptoms: Vector borne - Zika, Chikungunya, malaria (more likely in traveler from Asia or Africa), dengue.  Others - TB, acute HIV, non-infectious causes. 

    Posted 07/11/17 09:23:05 AM by Emily Miller

  • Ixodes tick (deer tick) - vector for anaplasma, Lyme, Babesia.  Very small tick, bites often missed by patients.

    Posted 07/11/17 09:23:51 AM by Emily Miller

  • Doxycycline will treat most tick borne illnesses (Anaplasma, Lyme, RMSF), but NOT Babesia.  Treatment options for Babesia are Clindamycin/quinine or Atovaqone/azithromycin.

    Posted 07/11/17 09:25:24 AM by Emily Miller

  • 21yoF w/ sore throat and fusobacterium bacteremia with Lemierre's syndrome




    63 yo M w well controlled HIV, recent admission for PNA, p/w acute diarrhea and hypotension


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