Empyema and Parapneumonic Effusions

Paul G. Auwaerter, M.D.
Empyema and Parapneumonic Effusions is a topic covered in the Johns Hopkins ABX Guide.

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PATHOGENS

  • S. pneumoniae and other streptococci (50%)
    • Streptococcus intermedius complex ([previously S. milleri], S. anginosus, S. constellatus) now dominates in community-acquired cases.
  • S. aureus including MRSA (10%)
  • Anaerobes (20%)
  • Gram-negative bacilli (GNB, 10%)
  • Noscomial: Gram-negative bacilli and S. aureus (MRSA)
  • Rare causes:
    • Mycobacterium tuberculosis
    • Enterococcus 
    • Actinomyces 
    • Other: viruses are a highly unusual cause except for influenza complicated by bacterial superinfection
      • Fungi: rare except immunocompromised hosts
        • Aspergillus 
        • Cryptococcus 
      • Parasites:
        • Echinococcus 
        • Entamoeba histolytica 
        • Paragonimus westermani 
  • Major causes in CAP: S. pneumoniae, streptococcal species, S. aureus and anaerobic bacteria (polymicrobial).
    • Fulminant course in healthy host: usually MRSA, especially if following influenza as a bacterial superinfection.

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PATHOGENS

  • S. pneumoniae and other streptococci (50%)
    • Streptococcus intermedius complex ([previously S. milleri], S. anginosus, S. constellatus) now dominates in community-acquired cases.
  • S. aureus including MRSA (10%)
  • Anaerobes (20%)
  • Gram-negative bacilli (GNB, 10%)
  • Noscomial: Gram-negative bacilli and S. aureus (MRSA)
  • Rare causes:
    • Mycobacterium tuberculosis
    • Enterococcus 
    • Actinomyces 
    • Other: viruses are a highly unusual cause except for influenza complicated by bacterial superinfection
      • Fungi: rare except immunocompromised hosts
        • Aspergillus 
        • Cryptococcus 
      • Parasites:
        • Echinococcus 
        • Entamoeba histolytica 
        • Paragonimus westermani 
  • Major causes in CAP: S. pneumoniae, streptococcal species, S. aureus and anaerobic bacteria (polymicrobial).
    • Fulminant course in healthy host: usually MRSA, especially if following influenza as a bacterial superinfection.

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