Empyema is a condition where you have pus between your lung and the membrane surrounding it. It’s caused by an infection and can cause symptoms such as pain and shortness of breath.
You’re more likely to develop empyema if you have conditions like chest trauma or pneumonia. Read on to learn more about empyema, what it is, what causes it, and how it can be treated.
What Is Empyema?
Empyema occurs when pus starts building up in the cavity that’s between your lung and the pleural space, which is the membrane surrounding your lung.
This condition is the result of an infection that spreads to the lung. As the pus builds up in the pleural space, you will experience a lot of pressure on your lungs, causing pain and shortness of breath.
You’re more likely to have empyema if you have or recently had conditions such as:
- Lung abscess
- Chest injury or trauma
- Thoracic surgery, which is performed on chest organs such as your lungs, heart, and esophagus
Other risk factors include:
- Intravenous drug abuse
- Gastric acid reflex
- Alcohol abuse
- Diabetes mellitus
- Immunosuppression, which is when your immune system isn’t working the way it should. This can be caused by diseases as well as medications.
Generally, empyema won’t result in permanent damage to your lungs. But it can be fatal if not treated, particularly if you develop empyema through a fungal infection.
In general, 20% to 30% of patients with empyema will require surgery or will pass away in the first year after getting empyema.
Symptoms
If you have empyema, you may experience the following symptoms:
- Feeling unwell in general
- Feeling uneasy
- Weight loss
- Chest pain that gets worse if you inhale deeply
- Chills and fever
- Dry cough
The symptoms of empyema are similar to those of pneumonia, but those with empyema may have these symptoms for a longer time.
Diagnosis
Your doctor will use the following methods to see if you have empyema:
- CT scans
- X-rays
- Thoracentesis, which is when your doctor removes air or fluid around the lungs using a needle to look at the pus in your pleural space
- Pleural fluid Gram stain and culture, which will help your doctor to figure out what kind of fungal or bacterial infections are causing your empyema
Doctors may also use the RAPID system to determine how to treat your empyema. The RAPID system looks at the following:
- Renal or kidney function (0-2 points. The worse the kidney function, the higher the number)
- Pus, specifically how much of it there is and how white it is (or albescence) (1 point if not white)
- Infection, whether you got it at the hospital or outside of it (1 point if you got the infection in the hospital where there are typically more dangerous bacteria and fungus)
- Diet, which specifically looks at your albumin levels. Albumin is a protein your liver creates. Higher levels of albumin indicate that your body is fighting against more inflammation (1 point if albumin is low)
- Age (0-2 points) the older you are the higher the number)
Low-risk patients have zero to two points, while medium-risk patients have three to four points. Finally, high-risk patients have five to seven points. The higher your score, the longer your hospital stay may be.
Causes
You can get empyema through bacterial or fungal infections.
Bacterial infections. You can get empyema by being exposed to various types of bacteria, such as Streptococcus aureus and Pseudomonas, which are particularly common if you got an infection at the hospital. Getting empyema through Streptococcus aureus is particularly common if you’ve had surgery or trauma.
The bacteria cause inflammation, which causes more fluid to be produced in the pleural cavity. As time goes on, bacteria and other microorganisms create an empyema by taking over the fluid. The fluid is made of the following:
- Dead cells
- Proteins
- Neutrophils, which are a type of immune cell that’s sent to infection sites throughout the body to destroy microorganisms causing the infection
After the infection goes away, your lung tissue may stiffen and become hard in a process known as fibrosis. This will make it more difficult for your lungs to work properly. That's why empyema needs to be diagnosed and treated as soon as possible.
Fungal infections. Fungal empyema is rare and associated with higher mortality. The most common type of fungus associated with this kind of infection is the Candida species.
Like bacteria, fungal infections cause fluid to be produced in the pleural cavity.
Treatment
The goal of treating empyema is to remove the pus from the lung and cure the infection.
Your doctor will prescribe antibiotics to get rid of the infection and use a chest tube to drain the pus.
If you got your bacterial infection outside the hospital, you may be prescribed cephalosporin combined with metronidazole or ampicillin with a beta-lactamase inhibitor. The beta-lactamase inhibitor boosts the effectiveness of the antibiotics by interrupting bacterial cell wall formation. This makes it easier for the antibiotics to wipe out the bacteria.
If needed, a surgeon will perform decortication, or removal of the lung lining, if your lung isn’t expanding properly.
In any case, make sure to talk to your doctor about your medical history and current health to determine the best way to treat your empyema. Your doctor will determine what might work best for you given your circumstances.
