Chest
Volume 74, Issue 2, August 1978, Pages 170-173
Journal home page for Chest

Clinical Investigations
The Incidence and Clinical Correlates of Parapneumonic Effusions in Pneumococcal Pneumonia

https://doi.org/10.1378/chest.74.2.170Get rights and content

Pneumococcal parapneumonic effusions are thought to be uncommon. Considering the frequency off pleuritic pain and the proposed pathogenesis off pneumococcal pneumonia, a higher incidence was suspected. Thirty-five consecutive patients with pneumonia due to Streptococcus pneumoniae were studied prospectively utilizing frequent chest x-ray films, including lateral decubitus views. Twenty (57 percent) of the 35 patients had parapneumonic effusions. The presence of parapneumonic effusions correlated significantly with the duration of symptoms before admission, bacteremia, and prolonged fever after therapy (P < 0.05). Three of the effusions were empyemas, and the remainder were uncomplicated parapneumonic effusions showing the characteristics of a sterile inflammatory exudate. AD empyemas were present on admission, and none developed after institution of therapy with antibiotics. Since pneumococcal parapneumonic effusions were associated with prolonged fever, cautious observation may be warranted, in lieu of immediate diagnostic and therapeutic maneuvers. The incidence of pneumococcal parapneumonic effusions is greater than generally appreciated, and the clinical factors with which the effusions are associated suggest that patients who develop effusions have had their pneumonia for longer periods without therapy.

Section snippets

MATERIALS AND METHODS

All admissions to the medical service of a Veterans Administration Hospital for three months and a city-county hospital for the following three months were reviewed by one of us. The group under study was comprised of all patients with an acute clinical event, a new radiographic alveolar infiltrate, a sputum stain showing gram-positive diplococci, a culture of blood or sputum (or both) positive for Streptococcus pneumoniae, the absence of other pathogens in cultures of sputum, and an

RESULTS

Thirty-five patients comprised the group under study. There were 27 men and eight women, reflecting the population of the Veterans Administration Hospital. The mean age was 57 ± 3 years (± SE) (range, 22 to 89 years). Of the 35 patients, 20 (57 percent) had parapneumonic effusions. Nine of the 20 effusions were present on admission, and the remaining 11 developed variably between the second day and the sixth day of hospitalization. Sixteen of the 20 effusions were suspected on the

DISCUSSION

The incidence of parapneumonic effusions in parapneumococcal pneumonia was 57 percent (20/35). These effusions were associated with prolonged symptoms prior to admission, bacteremia, and persistent fever after therapy.

Although pleurisy is common,10 pleural effusions are claimed to be rare11, 12, 13 and are considered a complication of pneumococcal pneumonia.2 The increased incidence found in this series is not surprising, considering the pathogenesis of pneumococcal pneumonia, but may partially

REFERENCES (18)

There are more references available in the full text version of this article.

Cited by (0)

Presented in part at the scientific session of the American Thoracic Society, San Francisco, May 17, 1977.

From the Division of Pulmonary Sciences, Department of Medicine, University of Colorado Medical Center, Denver.

Manuscript received November 11; revision accepted January 23.

View full text