Empyema is a purulent accumulation of fluid in a natural cavity of the body. The lungs are particularly commonly affected. In most cases, empyema can be treated well; however, especially in the lungs, the condition may be life-threatening.
What is empyema?
The term empyema is used by physicians to describe a collection of purulent fluid in a body cavity. The name means “forming pus” in Greek. In most cases, empyema develops as a result of tissue inflammation, which subsequently leads to the typical formation of fluid. In many cases, the lungs are affected, more specifically the cavity located around the lung lobes. This condition is appropriately known as thoracic or pleural empyema, and is known in medical circles as empyema thoracis. In rarer cases, the gallbladder or pelvic cavity may also be affected by the accumulation of fluid. Empyema should always be treated medically as a matter of principle, as it can lead to the death of the patient without prompt and appropriate therapy.
Causes
A bacterial infection is responsible for empyema. In the lungs, these are particularly often the bacterial strains Haemophilus influenzae, which causes diseases such as bronchitis or pneumonia (lung inflammation), Streptococcus pneumoniae, which causes lung and meningitis, and Staphylococcus aureus, which causes pneumonia and sepsis, as well as boils. The latter is the culprit of fluid accumulation in nearly 90% of all cases involving babies and young children. If the empyema is located in the pelvis, the bacterium Pseudomonas aeruginosa is usually responsible. Particularly in older or chronically ill patients, it is also not uncommon to find the bacterium Klebsiella pneumoniae. The pathogens infect the tissue that covers the lungs, for example. As a protective reaction, the body rejects dead cells. At the same time, pus and fluids form, which, together with the dead cells, fill the body cavities and lead to empyema.
Symptoms, complaints, and signs
Empyema can manifest itself through a variety of symptoms. Sore throat, cough, and sputum are typical of the condition. The secretions are usually brownish-green and have an unpleasant odor. They occur mainly in the morning and cause the characteristic rattling or drilling breathing sounds. Usually shortness of breath and fatigue are also present. In the further course, the physical and mental performance decreases, the affected person is usually no longer able to cope with everyday tasks. Swallowing the secretions can lead to abdominal pain, nausea and vomiting. Diarrhea cannot be ruled out either. This is usually accompanied by bad breath. Many affected persons suffer from fever, which is manifested by circulatory problems, sweating and an increasing feeling of illness. If empyema is not treated, the infection can spread to other organs. If it spreads to the heart, this can lead to cardiovascular problems, heart failure and other serious symptoms and complications. If it affects the brain, it can lead to encephalitis or meningitis. Generally, spread of the infection is life-threatening and causes general symptoms such as high fever and coma. In extreme cases, death of the patient occurs.
Diagnosis and course
Pulmonary empyema can be detected by the treating physician by listening to the lungs and tapping the chest and back, among other methods. If a patient visits the physician with symptoms such as shortness of breath, cough, chest pain, fever, and fatigue, this also indicates fluid accumulation. Bad breath and brownish-green sputum may be other clues. An x-ray as well as an ultrasound examination will clearly reveal the empyema. The condition caused by an infection should always be treated medically as a matter of principle, otherwise the infection can spread to the heart or brain. In these cases, high fever, bloody sputum, and eventually coma and death of the patient occur.
When should you go to the doctor?
If there are problems with breathing, this is considered a cause for concern. A visit to the doctor is necessary if the symptoms persist for a long time or increase in intensity. If shortness of breath or intermittent breathing occurs, a doctor must be consulted.There is a continuous undersupply of the organism, which can end in a life-threatening condition. In case of sleep disturbances, problems with concentration or disturbances of attention, a doctor is needed. Heart palpitations, elevated blood pressure and problems with the heart rhythm must be examined and treated by a doctor. Without medical treatment, acute conditions can occur that can lead to lifelong impairments. If there is a fever or persistent fatigue despite adequate sleep, a doctor is needed. Pain in the chest or abdominal region must be clarified and treated. If the pain sensation increases, a visit to the doctor should be made as soon as possible. Before taking a painkilling medication, consultation with a medical professional is advisable to clarify possible side effects and risks. In case of a persistent cough, noticeable odors of the breath or repeated sputum, a doctor should be consulted. In case of disconcerting breathing sounds or inability to take a deep breath, a doctor should be consulted. If bloody sputum occurs during coughing, an emergency physician should be called because a critical health condition exists.
Treatment and therapy
If empyema has been clearly diagnosed, the attending physician must act promptly and initiate therapy. In most cases, this consists of a combination of medication and surgery. During surgery, the accumulated fluid can be removed, which significantly relieves the pressure and makes it easier to breathe in the case of pulmonary empyema. It also allows the organs to regain more space in the body. If the infection is still at an early stage, the fluid can be removed with the help of a procedure called thoracentesis. This is a hollow needle that is inserted into the chest cavity. If the empyema is more advanced, the chest must be opened by the surgeon and the fluid accumulation drained via a tube. If the tissue is already very badly affected, it must also be removed surgically. Afterwards, the lungs can develop better again and fill the chest cavity as usual. In addition to the surgical intervention, the bacterial infection must be treated. Antibiotics, especially penicillin, are given for this purpose. These should be given for at least two weeks to ensure that all bacteria have been killed. In most cases, the drugs are given intravenously, as this allows them to work more quickly and effectively. The earlier the empyema is detected, the more effective the drug treatment will be.
Outlook and prognosis
It is very difficult to give an exact outlook and prognosis, since medical treatment can positively influence the course of the disease. In most cases, such empyema develops in connection with bursitis. Normally, such an inflammation subsides within a few days. Pus production subsides, so that an uncomplicated healing process can be expected. The prospect of complete healing thus looks very good. However, if pus production does not recede but increases, then a more difficult course of the disease is to be expected. The prolonged production of pus can lead to the formation of bacteria, which can cause severe inflammation. If such a clinical picture remains without any treatment, then a significantly more difficult course of the disease is to be expected. Under certain circumstances, an abscess may form. If in such a case a visit to the doctor is waived, then in the worst case it can even come to blood poisoning.
Prevention
Since empyema is a bacterial infection, prevention in the true sense is not possible. A healthy lifestyle strengthens the immune system and can improve the general condition of the individual. However, this does not exclude the possibility that empyema may still occur. If the first symptoms appear, affected persons and family members should consult a doctor as soon as possible. If the accumulation of fluid is detected at an early stage, it may be possible to treat it purely with medication and prevent the condition from worsening. If symptoms such as shortness of breath, fever or a conspicuous sputum occur, it is advisable to go to the doctor in case of doubt and have the causes of the complaints clarified.
Aftercare
In the case of empyema, first and foremost, early treatment is very important to prevent further complications or, in the worst case, death of the affected person. The earlier the disease is detected in the process, the better the further course of the disease usually is. Therefore, the main focus is on early detection of empyema. As a rule, however, the measures or possibilities of aftercare are very limited or not really necessary. The treatment itself is carried out with the help of a surgical intervention. After this procedure, the affected person should in no case engage in physical exertion or activity. Stressful or athletic activities should be avoided in any case in order not to put unnecessary strain on the body. Furthermore, it is often advisable to take antibiotics after the operation to prevent infections. Antibiotics should not be taken together with alcohol, otherwise their effect is significantly reduced. In case of doubt or ambiguity, a doctor can also always be contacted. In most cases, empyema also does not reduce life expectancy if treatment is initiated early. The lungs should also not be subjected to unnecessary stress after the procedure, so smoking should also be refrained from.
What you can do yourself
Empyema is a serious disorder that should by no means be treated unassisted with home remedies or over-the-counter medications alone. The best form of self-help is to see a doctor promptly and strictly follow his or her orders. Failure to do so may result in serious complications such as blood poisoning. Pulmonary empyema can even be fatal. However, if empyema is detected early, it can usually be treated with antibiotics before complications develop. Antibiotics must be taken as prescribed by the doctor. Under no circumstances should antibiotic treatment be interrupted independently or terminated prematurely. This also applies if side effects appear. However, a patient may also treat these side effects with mild home remedies after consulting the doctor. Antibiotics kill not only pathogens, but also beneficial intestinal bacteria, which often leads to severe diarrhea. Probiotic foods, especially yogurt, can help the intestines recover. Women often suffer from vaginal infection with yeast during or shortly after treatment with antibiotics. This side effect can be prevented by using lactic acid suppositories, which are available over-the-counter at pharmacies. A healthy lifestyle supports the body’s defenses, which accelerates the healing of empyema.
