EMPYEMA AND ITS HOMEOPATHIC MANAGEMENT

                                                                    EMPYEMA

DEFINITION:-

  Collection of purulent fluid or frank pus inside the pleural cavity is known as empyema. Such a fluid may fill up the whole or only a part of the pleural cavity or remain localized inside a pocket (localized or encysted empyema).

AETIOLOGY OR CAUSES:-

-          Most cases occur due to spread of infection from the adjoining lungs. Two such common conditions are pulmonary tuberculosis and pneumonia.

-          It may also occur due to a penetrating wound in the chest or due to rupture of a subpleural septic focus or lung abscess.

-          Common causative organisms are pneumococcus, streptococcus, staphylococcus, tubercular bacillus, e.coli and h. influenza in children, staphylococcus is the commonest pathogen.

PATHOLOGY:-

  The purulent fluid collected inside the pleural cavity is thick and light yellow in colour. The protein content of the fluid is high, the principal content being fibrin. The fluid is golden yellow in colour and full of pus cells and microorganisms when the causative organisms are pneumococcus, where if the organism is p.pyocyaneus, it is greenish yellow in colour and foul smelling. In streptococcal empyema, the fluid is thin and light yellow in colour. Since the fluid contains lot of fibrin, it is likely to get organized soon and cause fibrosis. Accordingly, pleurogenous fibrosis, adhesions and contraction of affected part of the chest wall are possible sequelae. The fluid may get loculated in a pocket.

SYMPTOMS:-

-          Swelling and tenderness present in the inter costal spaces. There may be a sinus or a bronchopleural fistula present over the chest wall. This may discharge pus while coughing.

-          The patient is wasted and looks ill.

-          Intermittent fever with rigors.

-          Sharp, stitching or scratching pain present disappears and is replaced by a dull, dragging discomfort or a feeling of heaviness on affected side.

INVESTIGATIONS:-

-          X- ray chest.

-          Routine blood count wbc count.

TREATMENT:-

-          Aspiration of the requisite amount of fluid.

-          Use of appropriate antibiotics.

HOMEOPATHIC TREATMENT:-

1.       ARSENIC ALBUM:-

Unable to lie down; fears suffocation. Air-passages constricted. Burning in chest. Cough worse after midnight; worse lying on back. Expectoration scanty, frothy. Darting pain through upper third of right lung.Haemoptysis with pain between shoulders; burning heat all over. Cough dry, as from sulphur fumes; after drinking.

2.       CALCAREA SULPH:-

Suppurative processes come within the range of this remedy, after pus has found a vent. Mucus discharges are yellow, thick and lumpy. Cough, with purulent and sanious sputa and hectic fever.Empyema, pus forming in the lungs or pleural cavities. Catarrh, with thick, lumpy, white-yellow or pus-like secretion. Purulent, sanious expectoration.

3.       KALI SULPH:-

Yellow, mucus and serous discharges, profuse and intermittent. Rattling of mucus in chest. [Tart. em.]. Post-grippal cough, especially in children. Bronchial asthma, with yellow expectoration. Cough; worse in evening and in hot atmosphere. Croupy hoarseness. [Hep.; Spong.]. Pain in nape, back and limbs, worse in warm room.

4.       MERC SOL:-

Spasmodic cough (whooping cough); two paroxysms follow one another rapidly, from tickling in larynx and upper part of chest, at night, without cough during day, with expectoration of acrid yellowish mucus, which is sometimes mixed with coagulated blood, tasting putrid or salty. Dyspnoea (sensation of spasmodic contraction when coughing or sneezing). Pains in head and chest when coughing, as if these parts were about to burst; or shootings in occiput; or pain as from excoriation in chest, and pain in loins. Cough with expectoration of pure blood.

5.       SILICEA:-

Colds fail to yield; sputum persistently mucopurulent and profuse.Slow recovery after pneumonia.Cough and sore throat, with expectoration of little granules like shot, which, when broken, smell very offensive. Cough with expectoration in day, bloody or purulent. Stitches in chest through to back. Violent cough when lying down, with thick, yellow lumpy expectoration; suppurative stage of expectoration. [Bals. Peru.]

6.       SULPHUR:-

Oppression and burning sensation in chest. Difficult respiration; wants windows open. Loose cough; worse talking, morning, greenish, purulent, sweetish expectoration.Chest feels heavy; stitches, with heart feeling too large and palpitating.

Some of other drugs for empyema are arsenic iod, calcarea carb, carbo veg, china, hepar sulph, kali carb, lachesis, natrum ars, nitric acid, phos and sepia.