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Parapneumonic effusions: epidemiology and predictors of pleural infection

  • Pleural Diseases and Mesothelioma (G Lee, Section Editor)
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Abstract

The development of a pleural effusion represents a common complication of pneumonia. Clinically there is a recognised spectrum of effusions from simple parapneumonic, which typically resolve without requiring intervention other than antibiotic treatment, to complicated parapneumonic effusions associated with bacterial infection and inflammatory cell infiltration, through to empyema, with the presence of frank pus in the pleural space. It was previously believed that no clinical features could identify patients at risk of pleural infection, but recent research suggests this is not the case. Patients with pleural infection after pneumonia are younger, more frequently have a history of alcohol or substance abuse, and have evidence of marked systemic inflammation, with higher levels of C-reactive protein, leucocyte counts and platelet counts compared to patients with pneumonia who do not develop pleural complications. Intriguingly, patients with chronic obstructive pulmonary disease have a low risk of pleural infection, despite a high frequency of pneumonia, and it has been speculated that bacterial colonisation or inhaled corticosteroids may play a protective role in these patients.

This review summarises the data on the incidence and clinical predictors of pleural infection in patients with pneumonia, and considers the implications of these risk factors for management and what we know of the pathophysiology of parapneumonic effusions.

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Conflicts of Interest

James Chalmers has received honoraria/lecture fees from GlaxoSmithKline, Astrazeneca, and Chiesi. Simon Finch has declared no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Tayside Respiratory Research Group, University of Dundee, Dundee, DD1 9SY, Scotland

    Simon Finch & James D. Chalmers

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Finch, S., Chalmers, J.D. Parapneumonic effusions: epidemiology and predictors of pleural infection. Curr Respir Care Rep 3, 52–60 (2014). https://doi.org/10.1007/s13665-014-0074-4

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