Empyema causes

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Empyema Microchapters

Patient Information



Subdural empyema
Pleural empyema

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Prince Tano Djan, BSc, MBChB [3]


Streptococcus pneumoniae was the most common bacteria found in empyemas before the development of antibiotics. More recently, however, anaerobes have become the predominant organism in culture positive empyemas (and therefore careful anaerobic cultures should always be sent when working up parapneumonic effusions). Mixed aerobic and anaerobic infections are also common. In general any bacteria can cause an empyema, however different bacteria are associated with different rates of empyema formation.[1] Some of the common bacteria causes include; bacteroides, fusobacterium, haemophilus influenzae, pneumococcal infections, staphylococcus aureus, streptococcus, and TB.


Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of empyema, however complications resulting from untreated empyema is common.

Common Causes

The following are common causes of empyema:[1]

Less common causes

Less common causes of empyema include:

Causes by Organ System

Cardiovascular Purulent pericarditis
Chemical/Poisoning Chemical pleurodesis, talc pleurodesis
Dental No underlying causes
Dermatologic Ulcer
Drug Side Effect No underlying causes
Ear Nose Throat Acute mastoiditis, sinusitis
Endocrine Diabetes
Environmental No underlying causes
Gastroenterologic Cholecystitis, esophageal rupture, gallbladder empyema, liver abscess
Genetic Chronic granulomatous disease
Hematologic No underlying causes
Iatrogenic Lung transplantation, pneumonectomy
Infectious Disease Actinomyces, acute mastoiditis, anaerobic infection, bacterial meningitis, bacteroides, brain abscess, bronchiectasis, candida, capnocytophaga, community-acquired pneumonia, echinococcus, entamoeba histolytica, fusobacterium, haemophilus influenzae, HIV, infection, klebsiella pneumoniae, Lemierre's syndrome, liver abscess, lung abscess, mycobacterium tuberculosis, mycoplasma hominis, mycoplasma, nocardia, nocardiosis, odontogenic infection, orbital cellulitis, pasteurella multocida, pneumonia, purulent pericarditis, rhodococcus equi, sinusitis, staphylococcus aureus, streptococcus anginosus, streptococcus pneumoniae infection, streptococcus pyogenes, streptococcus, subdural empyema, tularemia, typhoid fever, yersinia
Musculoskeletal/Orthopedic Ulcer
Neurologic Bacterial meningitis, brain abscess
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Bronchogenic carcinoma, tumor
Ophthalmologic Orbital cellulitis
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Bronchiectasis, bronchogenic carcinoma, chemical pleurodesis, community-acquired pneumonia, lung abscess, lung transplantation, mycobacterium tuberculosis, pleural effusion, pneumonectomy, pneumonia, talc pleurodesis
Renal/Electrolyte Nephrotic syndrome
Rheumatology/Immunology/Allergy Chronic granulomatous disease, immunocompromised
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Fistula, foreign body, ulcer

Causes in Alphabetical Order


  1. 1.0 1.1 Brims FJ, Lansley SM, Waterer GW, Lee YC (2010). "Empyema thoracis: new insights into an old disease". Eur Respir Rev. 19 (117): 220–8. doi:10.1183/09059180.00005610. PMID 20956197.
  2. Gomes MM, Alves M, Correia JB, Santos L (2013). "Empyema necessitans: very late complication of pulmonary tuberculosis". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-202072. PMC 3863066. PMID 24326441.
  3. Atay S, Banki F, Floyd C (2016). "Empyema necessitans caused by actinomycosis: A case report". Int J Surg Case Rep. 23: 182–5. doi:10.1016/j.ijscr.2016.04.005. PMC 5022073. PMID 27180228.
  4. Yauba MS, Ahmed H, Imoudu IA, Yusuf MO, Makarfi HU (2015). "Empyema necessitans complicating pleural effusion associated with proteus species infection: a diagnostic dilemma". Case Rep Pediatr. 2015: 108174. doi:10.1155/2015/108174. PMC 4393920. PMID 25893125.