Infective Pleural Effusions-A Comprehensive Narrative Review Article

• Published in: Clinics and practice Vol. 14; no. 3; pp. 870 - 881
• Main Authors: Abdulelah, Mohammad, Abu Hishmeh, Mohammad
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 16.05.2024; MDPI
• Subjects: Clinical medicine; Drug resistance; empyema; Epidemiology; Etiology; exudative pleural effusion; infectious pleural effusions; Pathophysiology; Patients; pleural disease; pleural infections; Pneumonia; Review; Streptococcus infections; Ultrasonic imaging; United States > US; empyema; intrapleural enzyme therapy; pneumonia; parapneumonic effusion; pleural infections; infectious pleural effusions; pleural disease; exudative pleural effusion
• ISSN: 2039-7275; 2039-7283; 2039-7283
• DOI: 10.3390/clinpract14030068

Infective pleural effusions are mainly represented by parapneumonic effusions and empyema. These conditions are a spectrum of pleural diseases that are commonly encountered and carry significant mortality and morbidity rates reaching upwards of 50%. The causative etiology is usually an underlying bacterial pneumonia with the subsequent seeding of the infectious culprit and inflammatory agents to the pleural space leading to an inflammatory response and fibrin deposition. Radiographical evaluation through a CT scan or ultrasound yields high specificity and sensitivity, with features such as septations or pleural thickening indicating worse outcomes. Although microbiological yields from pleural studies are around 56% only, fluid analysis assists in both diagnosis and prognosis by evaluating pH, glucose, and other biomarkers such as lactate dehydrogenase. Management centers around antibiotic therapy for 2-6 weeks and the drainage of the infected pleural space when the effusion is complicated through tube thoracostomies or surgical intervention. Intrapleural enzymatic therapy, used to increase drainage, significantly decreases treatment failure rates, length of hospital stay, and surgical referrals but carries a risk of pleural hemorrhage. This comprehensive review article aims to define and delineate the progression of parapneumonic effusions and empyema as well as discuss pathophysiology, diagnostic, and treatment modalities with aims of broadening the generalist's understanding of such complex disease by reviewing the most recent and relevant high-quality evidence.