Pleural empyema laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Diagnosis is confirmed by thoracentesis. Aspiration of the purulent fluid is necessary especially when condition is not resolving on antibiotics. The pleural fluid typically has a low pH (<7.20), low glucose (<60 mg/dL), and contains infectious organisms. Although the presence of pus or organisms on gram stain is extremely helpful in making a diagnosis of empyema, a positive bacteria culture from pleural fluid is not needed before diagnosis of empyema is comfirmed.[1][2]
Laboratory Findings
Diagnosis is confirmed by thoracentesis. Aspiration of the purulent fluid is necessary especially when condition is not resolving on antibiotics. The pleural fluid typically has the following features:
- Low pH (<7.20)
- Low glucose (<60 mg/dL) and
- Contains infectious organisms.
Although the presence of pus or organisms on gram stain is extremely helpful in making a diagnosis of empyema, a positive bacteria culture from pleural fluid is not needed before diagnosis of empyema is comfirmed.[1][2]
The COMPLES score has been developed to differentiate between tuberculous effusions with low pleural pH or glucose and complicated parapneumonic effusions.
The components are:
- pleural fluid adenosine deaminase (ADA) (<46 IU/L [0 points]
- The percentage of mononuclear cells (MNC %), ≥100 IU/L [6 points]), 46-100 IU/L [4 points], MNC % (<10 % [0 points], 10-50 [3 points], >50 [8 points])
- PH, pH (<7.07 [0 points], 7.07-7.20 [3 points], >7.20 [5 points]),
- Age.age (≥30 [0 points], <30 years [3 points])
A score of 12 or more points is highly sensitivity and specificity for complicated tuberculous pleural effusion.[3]
References
- ↑ 1.0 1.1 Mavroudis C, Ganzel BL, Cox SK, Polk HC (1987). "Experimental aerobic-anaerobic thoracic empyema in the guinea pig". Ann Thorac Surg. 43 (3): 298–302. PMID 3548615.
- ↑ 2.0 2.1 Perez VP, Caierão J, Fischer GB, Dias CA, d'Azevedo PA (2016). "Pleural effusion with negative culture: a challenge for pneumococcal diagnosis in children". Diagn Microbiol Infect Dis. 86 (2): 200–4. doi:10.1016/j.diagmicrobio.2016.07.022. PMID 27527890.
- ↑ Corral-Gudino L, García-Zamalloa A, Prada-González C, Bielsa S, Alexis D, Taboada-Gómez J; et al. (2016). "Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions". Lung. 194 (5): 847–54. doi:10.1007/s00408-016-9923-y. PMID 27401009.