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Communications to the Editor |

Thoracic Empyema in HIV-Infected Patients FREE TO VIEW

Marc Riquet, MD; Jean Pierre Hubsch, MD; Antoine Chehab, MD
Chest. 1999;115(4):1219-1220. doi:10.1378/chest.115.4.1219
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To the Editor:

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 microbiological findings.

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: marc.riquet@lnc.ap-hop-paris.fr

Table Graphic Jump Location
Table 1. Thoracic Empyema in HIV-Infected Patients: Comparison of Principal Data Between Valme and Laennec Hospitals
* 

Values are given as the mean (range) of the No. of years that HIV infection has been known.

 

Values given as mean (range).

Hernández Borge, J, Alfageme Michavila, I, Munoz Méndez, J, et al (1998) Thoracic empyema in HIV-infected patients: microbiology, management and outcome.Chest113,732-738. [PubMed] [CrossRef]
 
Debesse, B, Bellamy, J, Dumouchel, A, et al Drainage pleural et eradication du foyer pulmonaire: traitement standard des pleurésies purulentes aigues à germes banals (113 cas).Rev Fr Mal Respir1983;11,245-246
 
Mouroux, J, Riquet, M, Padovani, B, et al Surgical management of thoracic manifestations in human immunodeficiency virus-positive patients: indications and results.Br J Surg1995;82,39-43. [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1. Thoracic Empyema in HIV-Infected Patients: Comparison of Principal Data Between Valme and Laennec Hospitals
* 

Values are given as the mean (range) of the No. of years that HIV infection has been known.

 

Values given as mean (range).

References

Hernández Borge, J, Alfageme Michavila, I, Munoz Méndez, J, et al (1998) Thoracic empyema in HIV-infected patients: microbiology, management and outcome.Chest113,732-738. [PubMed] [CrossRef]
 
Debesse, B, Bellamy, J, Dumouchel, A, et al Drainage pleural et eradication du foyer pulmonaire: traitement standard des pleurésies purulentes aigues à germes banals (113 cas).Rev Fr Mal Respir1983;11,245-246
 
Mouroux, J, Riquet, M, Padovani, B, et al Surgical management of thoracic manifestations in human immunodeficiency virus-positive patients: indications and results.Br J Surg1995;82,39-43. [PubMed]
 
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