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Paper Topic:


Running Head : Empyema


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Empyema is a disease causing pus and fluid , from the infected tissue , to collect in a body cavity . The word Empyema is derived from the Greek word empyein , which means pus-producing (suppurate . Empyema is commonly used to refer to pus collection around the lung (pleural cavity , known as Empyema Thoracic . However , similar collection can also get collected in gall bladder or the pelvic cavity . Although , there are a number of causes of Empyema , frequently it is a complication

of pneumonia


According to the American Thoracic Society , Empyema is described in three stages : -

1 . Exudative (acute ) stage : - A thin fluid containing few cellular elements is collected in the pleural cavity . The fluid is due to pleural inflammation that increases permeability of mesothelial cells

2 . Fibrinopurulent (transitional ) stage : - In this stage , organisms invade the pleural space . Inflammation progresses with polymorphonuclear (PMN ) leukocyte invasion . Proteins and fibrinous material also accumulates

3 . Organizing (chronic ) stage : - Activity of fibroblasts adhere the visceral and parietal pleura . Loculations are also formed . Progression of this stage leads to indistinguishable pleural layers . Pleural place is filled with pus containing protein-rich fluid with the inflammatory cells (Gupta and Shilpa , 2005

The most common cause of empyema is pneumonia . The inflammatory responses are triggered due to this pneumonia . Inflammation causes the permeability of mesothelial cells to increase . And this increase in permeability causes albumin and proteins to collect in the spaces

Inflammation also stimulates the mesothelial cells to secrete chemokines and to attract neutrophils . Neutrophils are normally not found in the pleural space and only present due to response of an inflammation (Tobler , 2004

Causes and Symptoms

Empyema thoracis can be caused by a number of different organisms including bacteria , fungi , and amebas , in connection with pneumonia chest wounds , chest surgery , lung abscesses , or a ruptured esophagus The following bacteria are the most common bacteria causing empyema These bacteria includes : Streptococcus pneumoniae , Haemophilus influenzae and Staphylococcus aureus . Disease organisms arriving the pleural cavity , infects tissues covering the lung . The cavity is filled with dead tissue cells , pus and tissue fluid , as a response of the body to fight of these organisms (Frey , 2002

Signs and Symptoms

Sign and symptoms of empyema depend on its location . In empyema thoracis , patients usually exhibit symptoms of pneumonia , including fever , cough , fatigue , shortness of breath , and chest pain ' Later patients are dehydrated cough up blood , and exhibit very high fever Coma is also seen . Thoracic empyema can be life-threatening if not treated in time . Large collection of pus , from the infected tissue ruptures airways . Infection can spread to heart , or even to brain , as the bacteria travels through the bloodstreams . In pelvic empyema , large amount of foul-smelling pus is produces rapidly . The pus is replaced even if drained . Intense pain of abdomen , high fever , and the rigidity of muscles , characterizes Empyema of gallbladder (Frey , 2002


Diagnosis can be made using a stethoscope . The sounds of breathing will be...

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