Scientific Letter
Fungal Empyema: An Uncommon Entity With High Mortality
Empiema fúngico: una entidad infrecuente con elevada mortalidad
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Even so, fungal empyemas are still rare entities, with a mortality rate of over 70%. The most common ways for fungi to reach the pleural cavity are via lung infections, complications of pre-existing chronic empyemas, esophageal-bronchial fistulas, or repeated thoracentesis,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> so in patients with risk factors, the possibility of a fungal etiology must be taken into account.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report a retrospective analysis of exclusively fungal pleural effusions diagnosed in our hospital between 2005 and 2016. Aseptic sampling of pleural fluids was performed by thoracentesis or endothoracic drainage; the samples underwent microbiological processing including culture, identification using biochemical galleries and mass spectrometry, direct observation by electron microscopy in the case of filamentous fungi, followed by antifungal sensitivity testing using commercial Sensititre<span class="elsevierStyleSup">®</span> Yeast One panels (Thermo Fisher Scientific, UK).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Fungal isolates were obtained from 9 patients (8 males with a median age of 65<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 years) characterized by nonspecific symptoms (respiratory failure and dyspnea), a 5-week mortality rate of 50%, and long hospital stays (47<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>24 days). Seven yeasts (2 non-<span class="elsevierStyleItalic">Candida albicans</span> species) and 3 <span class="elsevierStyleItalic">Aspergillus fumigatus</span> (<span class="elsevierStyleItalic">A. fumigatus</span>) were isolated, and no resistance was documented. The total rate of antifungal therapy was 55%, the most common being azole derivatives, and the least common, caspofungin or inhaled liposomal amphotericin B. None of the patients had received antifungal prophylaxis prior to the study episode. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the risk factors for fungal infection identified in each patient and the species isolated in each case.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">As in other series with larger numbers of cases,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> the causative agents associated with fungal empyema that presented a slightly lower mortality rate in our series were <span class="elsevierStyleItalic">Candida</span> spp. followed by <span class="elsevierStyleItalic">A. fumigatus</span>. All patients except one had 1 or more previous immunodeficiency diseases according to the accepted classifications<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>: cancer, diabetes mellitus, long-term steroid treatment, hepatic cirrhosis, solid organ transplant, alcoholism, human immunodeficiency virus infection, or surgery in the 4 weeks prior to isolation of the fungus.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical suspicion, chest drainage, early introduction of antifungal agents, and long-term treatment are associated with a reduced mortality rate.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However, the treatment of fungal empyema is not protocolized, and combinations that include several drugs can be used (amphotericin B and voriconazole, echinocandins) due the variable penetration of systemically administered antifungals into the pleural cavity.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> The percentage of patients treated with broad-spectrum antibiotic therapy was higher than that of patients treated with antifungal drugs, despite determination of the etiology, and no subsequent antibiotic de-escalation was performed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The lack of specific antifungal treatment may be due to clinicians’ failure to consider fungi as true pathogens. Each case must be studied on an individual basis and the role of each causative agent must be evaluated in order to optimize treatment. This includes the need for pharmacological prophylaxis in patients at high risk of developing fungal empyema (hemodialysis, post-surgical re-exploration, environmental colonization by <span class="elsevierStyleItalic">Aspergillus</span>, or documented cytomegalovirus infection).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The seriousness of this entity and its devastating consequences in patients should not be underestimated.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Vega Sánchez B, López Ramos I, Ortiz de Lejarazu R, Disdier Vicente C. Empiema fúngico: una entidad infrecuente con elevada mortalidad. Arch Bronconeumol. 2017;53:641–642.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient number \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Identified risk factors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Isolated species \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alcoholism<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>cirrhosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Candida krusei</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Solid tumor (pleural mesothelioma)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>chemotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Candida parapsilosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No documented risk factors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Candida albicans</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Previous surgery (esophagectomy)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>alcoholism<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>solid tumor (esophageal epidermoid carcinoma) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Candida albicans</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Previous surgery (total gastrectomy)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>solid tumor (gastric) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Candida albicans</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Previous surgery (bariatric) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Candida albicans</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Heart transplant<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>diabetes mellitus 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Aspergillus fumigatus</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hematological cancer (myelodysplastic syndrome)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>diabetes mellitus 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Aspergillus fumigatus</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Previous surgery (lateral thoracotomy)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>alcoholism<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>chronic obstructive pulmonary disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Aspergillus fumigatus</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1592629.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Risk factors in patients with fungal pleural effusion and species isolated.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fungal empyema thoracis: an emerging clinical entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.C. Ko" 1 => "K.Y. Chen" 2 => "P.R. Hsueh" 3 => "K.T. Luh" 4 => "P.C. Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2000" "volumen" => "117" "paginaInicial" => "1672" "paginaFinal" => "1678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10858401" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Report of a 63-case series of Candida empyema thoracis: 9-year experience of two medical centers in central Taiwan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.H. Lin" 1 => "Y.M. Liu" 2 => "P.C. Lin" 3 => "C.M. Ho" 4 => "C.H. Chou" 5 => "J.H. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jmii.2012.08.010" "Revista" => array:7 [ "tituloSerie" => "J Microbiol Immunol Infect" "fecha" => "2014" "volumen" => "47" "paginaInicial" => "36" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23102708" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1058274615000737" "estado" => "S300" "issn" => "10582746" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of Aspergillus empyema successfully treated with combination therapy of voriconazole and micafungin: excellent penetration of voriconazole and micafungin into pleural fluid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Matsuda" 1 => "Y. Koreeda" 2 => "H. Mataki" 3 => "T. Taira" 4 => "S. Noma" 5 => "I. Higashimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Inter Med" "fecha" => "2010" "volumen" => "49" "paginaInicial" => "1163" "paginaFinal" => "1169" "itemHostRev" => array:3 [ "pii" => "S0749806315007069" "estado" => "S300" "issn" => "07498063" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.J. Walsh" 1 => "E.J. Anaissie" 2 => "D.W. Denning" 3 => "R. Herbrecht" 4 => "D.P. Kontoyannis" 5 => "K.A. Marr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/525258" "Revista" => array:7 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "327" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18177225" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0749806314009852" "estado" => "S300" "issn" => "07498063" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EPICO 3.0. Antifungal prophylaxis in solid organ transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Zaragoza" 1 => "J.M. Aguado" 2 => "R. Ferrer" 3 => "A.H. Rodríguez" 4 => "E. Maseda" 5 => "P. Llinares" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.riam.2016.02.001" "Revista" => array:6 [ "tituloSerie" => "Rev Iberoam Micol" "fecha" => "2016" "volumen" => "33" "paginaInicial" => "187" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27067875" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000011/v2_201711201359/S157921291730294X/v2_201711201359/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000011/v2_201711201359/S157921291730294X/v2_201711201359/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291730294X?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 136 | 28 | 164 |
| 2024 September | 126 | 24 | 150 |
| 2024 August | 164 | 40 | 204 |
| 2024 July | 121 | 39 | 160 |
| 2024 June | 127 | 37 | 164 |
| 2024 May | 136 | 31 | 167 |
| 2024 April | 81 | 35 | 116 |
| 2024 March | 103 | 31 | 134 |
| 2024 February | 102 | 25 | 127 |
| 2023 March | 35 | 7 | 42 |
| 2023 February | 162 | 30 | 192 |
| 2023 January | 110 | 37 | 147 |
| 2022 December | 110 | 37 | 147 |
| 2022 November | 146 | 36 | 182 |
| 2022 October | 150 | 44 | 194 |
| 2022 September | 148 | 38 | 186 |
| 2022 August | 110 | 48 | 158 |
| 2022 July | 107 | 42 | 149 |
| 2022 June | 128 | 45 | 173 |
| 2022 May | 123 | 49 | 172 |
| 2022 April | 188 | 51 | 239 |
| 2022 March | 176 | 61 | 237 |
| 2022 February | 173 | 45 | 218 |
| 2022 January | 146 | 50 | 196 |
| 2021 December | 143 | 59 | 202 |
| 2021 November | 119 | 64 | 183 |
| 2021 October | 117 | 64 | 181 |
| 2021 September | 107 | 59 | 166 |
| 2021 August | 121 | 51 | 172 |
| 2021 July | 173 | 40 | 213 |
| 2021 June | 106 | 54 | 160 |
| 2021 May | 127 | 45 | 172 |
| 2021 April | 292 | 120 | 412 |
| 2021 March | 189 | 45 | 234 |
| 2021 February | 124 | 44 | 168 |
| 2021 January | 109 | 18 | 127 |
| 2020 December | 116 | 22 | 138 |
| 2020 November | 103 | 35 | 138 |
| 2020 October | 110 | 35 | 145 |
| 2020 September | 159 | 21 | 180 |
| 2020 August | 155 | 25 | 180 |
| 2020 July | 147 | 28 | 175 |
| 2020 June | 153 | 21 | 174 |
| 2020 May | 151 | 51 | 202 |
| 2020 April | 141 | 38 | 179 |
| 2020 March | 269 | 28 | 297 |
| 2020 February | 132 | 28 | 160 |
| 2020 January | 321 | 28 | 349 |
| 2019 December | 108 | 37 | 145 |
| 2019 November | 156 | 26 | 182 |
| 2019 October | 131 | 31 | 162 |
| 2019 September | 133 | 31 | 164 |
| 2019 August | 73 | 29 | 102 |
| 2019 July | 76 | 25 | 101 |
| 2019 June | 107 | 15 | 122 |
| 2019 May | 137 | 27 | 164 |
| 2019 April | 137 | 43 | 180 |
| 2019 March | 91 | 37 | 128 |
| 2019 February | 68 | 15 | 83 |
| 2019 January | 88 | 37 | 125 |
| 2018 December | 105 | 23 | 128 |
| 2018 November | 136 | 27 | 163 |
| 2018 October | 121 | 20 | 141 |
| 2018 September | 69 | 12 | 81 |
| 2018 August | 1 | 0 | 1 |
| 2018 July | 2 | 0 | 2 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 17 | 1 | 18 |
| 2018 April | 49 | 12 | 61 |
| 2018 March | 19 | 7 | 26 |
| 2018 February | 20 | 7 | 27 |
| 2018 January | 6 | 0 | 6 |
| 2017 November | 1 | 0 | 1 |
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