Dr. Hernández Borge and colleagues1 have
provided us with an interesting article in the March issue of
CHEST. In this paper, they stressed the scarcity of thoracic
empyema (TE) in HIV-infected patients and a good outcome after prompt
drainage and appropriate antibiotic treatment precluding more
aggressive surgical management. The authors also stressed that TE was
often the primary cause leading to hospital admission and subsequent
HIV diagnosis and that IV drug abuse was the predominant factor for HIV
infection and was also related to clinical presentation and
Having observed a small series (n=9) with such an association, we
compared their results and ours (Table 1).
We fully agree about the rarity, but the epidemiologic findings were
quite different. Only one patient was an IV drug user—five were
homosexual and three were heterosexual—and in only two instances, TE
led to the discovery of the seropositivity (heterosexuals in both
cases). All of our patients recovered after prompt drainage with chest
tube and administration of fibrinolytics, although all of them were
referred to our thoracic surgery department in view of decortication.
We think that empyema is neither directly related to nor
facilitated by their HIV status as suggested by Hernández Borge
and colleagues. In 1983, we reported2having routinely
cured loculated parapneumonic empyemas using a similar approach in 113
patients with only one failure, and since that time, we never needed
another surgical approach to treat TE. Two hundred three complicated
TEs were successfully cured without surgery between 1983 and 1997. The
study of Mouroux and colleagues3 reporting decortication
in such cases was the cumulative experience of two centers, one of them
using decortication on a routine basis in managing empyema. We think
our data provide further information worth being added to the excellent
and valuable work of Hernández Borge and colleagues.
Correspondence to: Marc Riquet, MD, Service de Chirurgie
Thoracique, Hôpital Laennec, 42 rue de Sèvres, 75007 Paris,
France; e-mail: firstname.lastname@example.org
Values are given as the mean (range) of the No. of
years that HIV infection has been known.
Values given as mean (range).
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