Frequency and Types of Parapneumonic Effusion in Pleural Fluid Specimen

Abstract

Background: Parapneumonic effusion (PPE) is exudative pleural effusion resulting from community acquired pneumonia or lung
abscess. In USA about one million people develop PPE annually. The better outcome of PPE depends on early diagnosis and
timely management.
Objective: The aim of this study was to see the frequency and types of parapneumonic effusion in pleural fluid specimen using
different laboratory parameters in pneumonia patients.
Material and Methods: This study was conducted in Shah Noor Medical laboratory in Bannu KPK. Pakistan. Pleural fluid
specimen were collected from both public and private sectors hospitals of the territory. A total of 422 pleural effusions were
collected. These fluid were analysed for transudate, exudate with possible causes. The PPE were subtyped into simple,
complicated and empyema on the basis of color, PH value, ratio of blood and fluid glucose level, total protein level, total and
differential leukocyte count of fluid, Gram's stain and culture for presence or absence of bacteria. The pleural fluid color was
examined for subjective grades of turbidity i.e. mild, moderate and marked for simple, complicated and empyema respectively. PH
cut off value was 7.2 for simple and complicated PPE, glucose cut off value of 52mg/dl for simple and complicated PPE. Gram's
stain and culture was performed by using conventional Gram's stain and different culture media for differention of simple from
complicated PPE and emyema. Inclusion criteria was all pleural effusions either exudative or transudative. Exclusion criteria was
insufficient pleural fluid. The data was collected and analysed for frequencies with percentages and mean with standard deviation
using SPSS version 20.
Results: In this study a total of 422 pleural fluid out of which 77(18.24%) PPE cases were analysed. The age range was from
11-80 years with mean age of 54.34±9.22 years. Amongst these PPE 41 were from males patients and 36 from female
patients. Simple PPE were 21(27.30%), complicated PPE 37(48.05%) and empyema were 29(37.7%).
Conclusion: The laboratory parameters for differentiation of different types of parapneumonic effusion have significant role in
differentiation and management of different types of PPE and must be analysed in laboratory to separate the subtypes and guide
the physician about using non invasive and invasive management modalities.