[Purulent pleurisy caused by anaerobic bacteria. A retrospective study of 19 cases].

A retrospective clinical, biological, radiological and evolutive study of 19 cases of pleural empyema caused by anaerobic organisms diagnosed between 1980 and 1986 was carried out. These 19 cases accounted for 30.6 p. 100 of all cases of pleural empyema diagnosed during the same period. A local or general contributory factor was found in all patients; false passage, gastrointestinal pathology and buccal or dental diseases were the most frequent aetiological circumstances. The clinical picture was rather torpid, with a body temperature below 38 degrees C in 42 p. 100 of the cases, which delayed the diagnosis: the mean time interval between onset and diagnosis was 20 days. In nearly one half of the cases, blood stained expectoration was present and air-fluid levels were visualized at standard radiography and computerized tomography, which is the best exploratory method to evaluate the size and appearance of the pleural lesion, to guide percutaneous drainage and later to assess possible sequelae. The predominant anaerobic flora consisted of Gram-positive cocci and Bacteroides spp; in 70 p. 100 of the cases the anaerobic organism(s) was (were) sensitive to penicillin G. The course of the disease was favourable in all patients. Surgery was performed in 3 of the 19 patients on account of chest wall gangrene due to Clostridium perfringens in 1 case and of the presence of multiple fluid pockets making drainage ineffective in 2 cases.