This case will help you managing the Community Acquired Pneumonia complicated with empyema

10. Community Acquired Nosocomial
Pathogen
Bacterial 70-80% 90%
Streptococcus pneumoniae 60-75% 3-9%
Hemophilus influenza 4-5%
Legionella sp. 2-5% Up to 25%
Staphylococcus aureus 1-5% 10-20%
Gram-negative bacilli Rare 50%
Atypical 10-20% Rare
Mycoplasma pneumoniae 5-18% -
Chlamydia psittaci 2-3% -
Coxiella burnetii 1% -
Virus 10-20% Rare
Influenza - 8%
Hantavirus - Rare

25. Pleural Effusion Fluids
PH 6.5
Glucose 73
Protein 3.2
Albumin 1.2
LDH 1092
C+S No growth

28. TEST Result Normal
HIV Negative Negative
IgG 991 700 – 1600
IgG subtypes I – II – III Pending -
IgM 75 40 – 230
IgA 472 70 – 400
C3 122 90 – 207
C4 21 17.4 – 52.2

29. Pleural fluid sample
Color Cloudy - Orange
WBC 350
Neut 93%
Lymph 2%
Mono 5%
Glucose Not done
PH Not done
C+S No growth

32. Pleural Risk
Pleural fluid Pleural fluid
space Drainage
Category of
bacteriology chemistry
anatomy outcome
PH
•Minima
& Very
C+S
A0 & Bx Cx U/K 1 No
l FF
low
unknown
•<10mm
•Small –
moderate
& PH
Negative
A1 & B0 C0 2 Low No
FF
>7.2
C+S
•>10mm
•Large
Positive
FF B1 3 Mod Yes
C+S
•Thick
pleura
OR PH
A2 OR C1
•Hemi-
<7.2
thorax
B2 Pus 4 High Yes