HEMOLYTIC STREPTOCOCCAL PNEUMONIA AND EMPYEMA; A STUDY OF 55 CASES WITH SPECIAL REFERENCE TO TREATMENT

Abstract

Fifty-five cases of hemolytic streptococcal pneumonia and empyema have been studied and analyzed with respect to outcome and treatment, and illustrative cases are presented. There were 39 cases of pneumonia alone and 16 cases of empyema. 14 of 16 cases of empyema followed an infection of the lung. The cases of pneumonia were divided into 3 groups: those which were primary; those which followed a respiratory infection; and those which were superimposed on a preexisting chronic pulmonary infection. The fatality rate in the 39 cases with pneumonia was 17%. Unfavorable factors in influencing the outcome were age (i.e., over 50 yrs.), bacteremia and debilitating disease. The fatality rate in patients with empyema was 18%, but it was striking that there was only one death from empyema between the ages of 10 and 40 yrs. Bacteremia was present in 12% of cases. It was more common in the patients over 50 yrs. of age, and the fatality rate in bacteremic cases was 57%, whereas in the non-bacteremic cases it was only 7%. The use of sulfanilamide or sulfa-pyridine did not reduce the incidence of empyema, and it was not possible to show that it shortened the course of the disease. There was suggestive evidence that the fatality rate in the cases of both pneumonia and empyema was reduced by using these drugs. There were 4 cases of empyema which recovered following multiple aspirations of the chest and chemotherapy. The best results were obtained with a combination of chemotherapy and thoracotomy.