Barrs Vanessa R, Allan Graeme S, Martin Patricia, Beatty Julia A, Malik Richard
Faculty of Veterinary Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
J Feline Med Surg. 2005 Aug;7(4):211-22. doi: 10.1016/j.jfms.2004.12.004. Epub 2005 Apr 20.
Pyothorax was diagnosed in 27 cats between 1983 and 2002. In 21 (78%) of the cases, pleural fluid culture and/or cytology was consistent with a mixed anaerobic bacterial infection of oropharyngeal origin. In six cases (22%), infection was caused by unusual pathogens or pathogens of non-oropharyngeal origin, including a Mycoplasma species, Cryptococcus gattii, Escherichia coli, Salmonella typhimurium and Staphylococcus aureus. The overall mortality rate was 22%. Treatment was successful in 18 of 19 cases (95%) where closed thoracostomy tubes were inserted. One case resolved only after thoracotomy. Actinomyces species were isolated in three cases and in contrast to dogs where thoracotomy is recommended, they were resolved with tube thoracostomy. Mechanical complications occurred in 58% of the cats with indwelling chest tubes. Probable mechanisms of pleural space infection were identified in 18 cats (67%) including haematogenous infection (n=1), direct inoculation of bacteria into the pleural space (n=1), intrathoracic oesophageal rupture (n=1) and parapneumonic extension of infection (n=15; 56%). Of the latter, perioperative aspiration was suspected in two cats, parasitic migration in two and antecedent upper respiratory tract infection was implicated in seven. Parapneumonic spread of infection after colonisation and invasion of lung tissue by oropharyngeal flora appears to be the most frequent cause of feline anaerobic polymicrobial pyothorax and contests the widespread belief that direct inoculation of pleural cavity by bite wounds is more common.
1983年至2002年间，27只猫被诊断出患有脓胸。其中21例（78%）的胸腔积液培养和/或细胞学检查结果与口咽源性混合厌氧菌感染相符。6例（22%）感染由不常见病原体或非口咽源性病原体引起，包括支原体、加氏隐球菌、大肠杆菌、鼠伤寒沙门氏菌和金黄色葡萄球菌。总体死亡率为22%。在19例插入闭式胸腔引流管的病例中，18例（95%）治疗成功。1例仅在开胸手术后病情缓解。3例分离出放线菌，与推荐开胸手术的犬类情况不同，这些猫通过胸腔闭式引流术治愈。留置胸管的猫中有58%出现机械性并发症。18只猫（67%）确定了胸膜腔感染的可能机制，包括血源性感染（n = 1）、细菌直接接种到胸膜腔（n = 1）、胸段食管破裂（n = 1）和肺炎旁感染蔓延（n = 15；56%）。在肺炎旁感染蔓延的病例中，2只猫怀疑有围手术期误吸情况，2只与寄生虫迁移有关，7只与先前的上呼吸道感染有关。口咽菌群定植并侵入肺组织后，感染的肺炎旁蔓延似乎是猫厌氧多微生物脓胸最常见的原因，这与普遍认为的咬伤直接接种胸膜腔更为常见的观点相悖。
