Fungal empyema: an uncommon disease with high mortality

Fungal infections have increased in the last few decades as a result of the use of broad-spectrum antibiotics and the growing number of immunocompromised patients (pts), which have led to changes in the saprophytic microorganisms usually isolated. Fungal empyema (FE) is still a rare entity, with a mortality rate of 70%. Retrospective analysis of fungal pleural effusions diagnosed in our hospital between 2015 and 2018. Aseptic sampling of pleural fluid was performed by thoracentesis, chest drainage (CT) or video-assisted thoracoscopic surgery (VATS). Seventeen fungal isolates were obtained from 15 pts (12 males, mean age 60±19 y). It presented with nonspecific symptoms (respiratory failure, dyspnea and fever). Three-months mortality rate of 53% and high length of stay (50±16 days). Twelve yeasts (3 non-Candida albicans), 3 Aspergillus species, 1 Saccharomyces cerevisiae and 1 Trichosporon asahii were isolated. Twelve pts (80%) had ≥1 immunodeficiency disease: surgery in the 4 weeks before (n=6), cancer (n=4), alcoholism (n=2) and hepatic transplant (n=1). CT placement and antifungal therapy were used in 10 pts (66%), the most being azole derivatives. Seven pts (46%) underwent VATS with wash. The mean overall survival was 375 days. Pts submitted to CT placement had a longer survival (mean 520 days, p=0.04), but no significant differences were found in those treated with antifungals (p=0.08) or VATS (p=0.06). In this series of cases, CT placement was the isolate...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Respiratory infections Source Type: research