Adult thoracic empyema: A comparative analysis of tuberculous and nontuberculous etiology in 75 patients

Background: Thoracic empyema is a disease of significant morbidity and mortality in the developing world where tuberculosis is a common cause. Clinical outcomes in tuberculous empyema are complicated by fibrocavitary disease and bronchopleural fistulae. A prospective study to compare the clinical profiles and outcomes of patients with tuberculous and nontuberculous empyema was performed. Materials and methods: A prospective study of adult nonsurgical thoracic empyema cases admitted in a teaching hospital in India was performed over a period of 18 months. A comparative analysis of clinical characteristics, treatment modalities, and outcomes of patients with tuberculous and nontuberculous empyema was carried out. Results: 75 cases of empyema were seen during the study period, of which 46 (61.3%) were of nontuberculous etiology while tuberculosis constituted 29 (38.7%) cases. Among the nontuberculous empyema patients, Staphylococcus aureus (11, 23.93%) was the most frequent pathogen isolated. Tuberculous empyema was more frequent in younger population compared to nontuberculous empyema (mean age of 32.7 years vs. 46.5 years). Duration of illness and mean duration of chest tube drainage were longer (48.7 vs. 23.2 days) in patients with tuberculous empyema. Also the presence of parenchymal lesions and bronchopleural fistula often requiring surgical drainage procedures was more in tuberculous empyema patients. Conclusion: Tuberculous is a common cause of empyema thoracis in a developing country. Tuberculous empyema differs from nontuberculous empyema in the age profile, clinical presentation, management issues, and has a significantly poorer outcome.