Purulent pleuritis in Africa: clinical patterns, aetiologies, and treatment outcomes

Abstract

<bold>Background:</bold> Purulent pleuritis is a severe infection with pus accumulation in the pleural cavity, requiring urgent intervention to prevent complications. <bold>Aim:</bold> This study aims to evaluate the clinical, radiological, microbiological characteristics, and management outcomes of purulent pleuritis. <bold>Methods:</bold> We conducted a retrospective descriptive study in the pulmonology department of the Internal Security Forces Hospital in Tunisia, including nine patients diagnosed with purulent pleuritis. <bold>Results:</bold> The mean age was 52.1 years [20–73 years], with a male-to-female ratio of 3.5. Smoking was prevalent in 67% of cases. The most common comorbidities were diabetes (44%), COPD (33%), and hypertension (22%). Two patients had a history of pulmonary malignancy. The most prevalent symptoms were chest pain, fever, and dyspnea (78% each), followed by productive cough (56%). Left-sided pleuritis was observed in 67% of cases, with loculated pleuritis detected on chest CT in 33% of cases. Parapneumonic purulent pleuritis accounted for 7 cases (78%), while 2 cases (22%) were iatrogenic. Cultures were negative in 6 of 7 parapneumonic cases, with Klebsiella pneumoniae isolated in one. Pseudomonas cepacia and Klebsiella pneumoniae were identified in iatrogenic cases. Thoracic drainage, followed by surgical intervention, was required in 89% of cases. The mean hospital stay was 24 days [9-40 days], and antibiotic therapy lasted an average of 32 days [21-45 days]. Favorable outcomes were achieved in 89% of cases, except one death due to septic shock. <bold>Conclusion:</bold> Early diagnosis, targeted antibiotic therapy, and timely drainage or surgery are essential for optimal purulent pleuritis management.