Of the 39 consecutive patients with empyema thoracis managed by one of the five general surgical units at Lusaka, Zambia, 26 suffered from human immunodeficiency virus (HIV) infection and 19 were diagnosed as suffering from pulmonary tuberculosis within 3 years of developing empyema thoracis. Thirty patients were between 16 and 40 years of age; of these, 22 suffered from acquired immune deficiency syndrome (AIDS) and all 19 patients with pulmonary tuberculosis belonged to this age group. Of the four patients with empyema thoracis in the age group of 0-5 years, two were suffering from AIDS. The majority of cases of empyema thoracis associated with AIDS present insidiously and, because of late presentation, rib resection is necessary. After surgery these patients were managed at home with the help of a home care team, thus reducing the burden on hospital resources. The morbidity and mortality rates in these patients are higher than in those in whom empyema thoracis is not associated with AIDS.
PIP: Surgeons managed the care of 39 patients with empyema thoracis at the University Teaching Hospital in Lusaka, Zambia between April 1989-March 1990. 33 patients were males. 26 (23 males and 3 females) tested seropositive for HIV and had AIDS. 19 patients (17 male and 2 females) had tuberculosis (TB) of the lungs. Only 2 did not test positive for HIV. The leading complaints of the 39 patients were cough (30), chest pain (29), and generalized lymphadenopathy (28). HIV positive patients stayed in the hospital longer than HIV negative patients (60 days vs. 5 days). Most patients with empyema thoracis (30) were between 16-40 years old, as were AIDS patients (22) and TB patients (19). 2 of the 4 0-5 year old patients with empyema thoracis suffered from AIDS. The leading surgical procedure for the patients with empyema thoracis was intercostal drainage (12). All 12 patients who underwent rib resection were those who suffered from AIDS. Rib resection was required because these patients presented to the hospital late at which time the aspirate had already become thick. The surgeons were able to aspirate the accumulated pus quite easily in 8 of the 9 patients with AIDS who underwent only intercostal drainage. 8 AIDS patients experienced dried up sinuses at 8 weeks. A home care team managed the rib resection patients at home which resulted in a shorter mean duration at the hospital than for intercostal drainage (8 days vs. 0 days). None of the AIDS patients died from the procedure. Yet 3 AIDS patients died within 2 weeks of entry into the hospital. 5 other AIDS patients died within 6 months of their 1st admission. All HIV negative patients recovered satisfactorily. Home care minimized the burden on hospital resources.