30YM diagnosed to have Viral fever - Dengue NS1 reactive who was admitted in hopsital on Rx c/o pleuritic chest pain, o/e crepts+, USG showed pleural collection. Aspirate was purulent and hemorrhagic. Analysis report enclosed. Can anyone interpret the data below and how to manage this further??

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Mild to moderate pleural effusion and ascites are common findings in Acute Dengue Syndrome. There was no need to perform pleurocentesis on this patient. Patient will have thrombocytopenia and will be higher risk of bleeding for any Invasive procedure, and therefore the results show hemorrhagic fluid. And there is no benefit from getting a pleural tap on this patient. Please avoid unnecessary test and procedures which can jeopardize patients safety.

patient came with dengue.. his platelet counts n total counts improved now they are normal. Still patient was running on fever with chest pain.. Purulent pleural effusion is an uncommon thing in dengue pt.. he had an abscess on hand also.. CRP was around 200. Its a secondary infection and need to be controlled.. After starting antibiotics now patient is improving.. Empyema if not drained it may lead to unnecessary complications.
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In many patients with pneumonia, a sterile simple parapneumonic effusion develops in the pleural space. If this pleural effusion becomes infected, it is labeled a complicated parapneumonic effusion, whereas the presence of frank pus in the pleural space defines an empyema. The development stages of an effusion can be divided into 3 phases: exudative, fibropurulent, and organizational. The initial effusion develops from increased pulmonary interstitial fluid along with progressive capillary vascular permeability. A simple effusion is frequently sterile and resolves with antibiotic treatment of the underlying pulmonary infection. http://emedicine.medscape.com/article/807499-overview#a4

This reference also says "frank pus in pleural space defines empyema"
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Most probably synpneumonic effusion due to pneumococcal pneumonia. ..ns1ag positive may b on incidental finding. .sputum afb..gram stain .c/s..ct chest. .and antibiotics

pleural effusion in dengue can occur because of serositis.. but presence of rbcs could be because of thrombocytopenia... but neutrophils predominantly indicates secondary bacterial infection.. it should be treated with broad spectrum antibiotics..once platelet count improves,treat as empyema...

Treat the patient as empyema. Pleural fluid protein, sugar, ldh along with serum protein, sugar, ldh are important for diagnosis and drainage of empyema. follow cultures. if required, correct coagulation and decide for drainage. Correct fluid/electrolyte as required for dengue treatment, follow hematocrit.

Pleural effusion, unless Significant or causing respiratory embarrassment/Desaturation/mediastinal shift does not indicate any intervention. Mild pleural effusion is common in Dengue due to serositis,and needs least specific intervention. Moderate effusion may accompany with complicated dengue infection,sepsis& multiorgan dysfunction. Biochemistry of fluid and patients platelet count and LFTs /Coagulation INR not mentioned. -Hemorrhagic pattern may be because of associated thrombocytopenia. -Empyematous collection needs higher spectrum Antibiotic cover. Rx- Continue Hydration/Supportive management /Antibiotic for secondary infection cover according to level of sepsis and multiorgan involement/Platelet transfusion if platelet count are low and bleeding manifestation. FFP if coagulopathy/Deranged LFTs/INR.

Its just a Dengue hemorrhagic fever so such findings.no tapping needed in such patients. just treat the patient not Reports. Iv fluid with monitoring of fly8d overload is the ideal treatment.n when necessary then platelets or PCVs. Nothing else.

Viral with pleural effusion, cytology is eosinophilia, rule out allergic reason & deworming also rule out malignancy.

To call it empyema is wrong until the culture is positive in pleural fluid, or atleat presence of organism on Gram Stain.

Wow, we now have a new new terminology.... culture negative empyema, based on visual acuity.

Refer to Light's classification of parapneumonic effusions (4th,5th,6th edition, its not new). Culture positivity is considered bad prgnostic marker.
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