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. 2021 Apr 17;8(4):ofaa656. doi: 10.1093/ofid/ofaa656

Table 1.

Classification of Sources of Candida Empyema

Classification Description and Pathophysiology
Spontaneous esophageal rupture Direct inoculation of Candida into the pleural space after spontaneous esophageal rupture without any antecedent cardiothoracic surgery or invasive procedure
Intrathoracic source Candida inoculation into the pleural space via any of the following routes: (1) inoculation during intrathoracic (esophagus, lung, heart) surgery or invasive procedure; (2) inoculation via complications of these surgeries (eg, anastomotic leaks or perforation at the surgical site); (3) inoculation via trauma to the chest; (4) inoculation from oropharyngeal, retropharyngeal, or paraspinal infection to the pleural space; (4) esophageal cancer eroding into the lung with subsequent bronchopleural fistula formation; (5) bronchopleural fistula of unclear etiology
Diaphragmatic translocation from GI source Candida inoculation from an intra-abdominal source, across the diaphragm. The infection can originate from the following: (1) rupture of an intestinal viscous; (2) primary or secondary Candida peritonitis; (3) intra-abdominal surgery, hepatobiliary surgery, or complications from these surgeries; (4) subdiaphragmatic liver abscess; (5) pancreatitis and/or pancreatic-pleural fistula
Recent pleural manipulation Candida inoculation of the pleural space via repeated pleural effusion sampling or drainage, or indwelling chest tubes
Pneumonia Candida empyema originating from an infection of the lung, as in cases of aspiration pneumonia
Unknown source Most often involve chronic pleural effusion, for which the source of Candida is not apparent

Abbreviations: GI, gastrointestinal.