Fungal Empyema Thoracis

Recruiting now · Not applicable

Conditions studied: Pyothorax, Fungal Infection Lungs, Pleural Empyema

In brief

Background: Fungal empyema thoracis is a rare but life-threatening pleural infection caused by fungal organisms such as Aspergillus and Candida species. It typically occurs in immunocompromised or debilitated patients and carries a high mortality rate. Conventional management involves systemic antifungal therapy and surgical decortication; however, many patients are unfit for surgery due to poor clinical status or multiple comorbidities. The use of local intrapleural antifungal therapy remains poorly studied. Objective: This study aims to evaluate the efficacy and safety of pleural lavage with voriconazole in patients with fungal empyema thoracis, both as a pre-surgical adjunct and as a palliative measure for patients who cannot undergo surgery. Methods: A prospective cohort study will be conducted at the Department of Thoracic Surgery, Services Hospital, Lahore. Patients diagnosed with fungal empyema confirmed by pleural fluid culture or cytology will be included. Through an indwelling chest tube, voriconazole (200 mg in 100 mL normal saline) will be instilled into the pleural cavity once daily for three consecutive days. Patients will be assessed for improvement in clinical symptoms, radiological clearance, reduction in fungal load, and the need for surgical intervention. Data will be statistically analyzed to determine treatment response and safety outcomes. Conclusion: Pleural lavage with voriconazole offers a promising, minimally invasive approach for managing fungal empyema thoracis. If proven effective, this method could serve as a valuable addition to current antifungal strategies, improving outcomes for critically ill patients who are not candidates for surgery.

Key facts

Study ID

NCT07337993

Run by

University of Health Sciences Lahore

People needed

50

Starts

2025-07-01

Expected to finish

2027-03-31

Last updated by the study team

2026-01-13

Who can join

Age: any. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• All age patients with confirmed fungal empyema thoracis.
• Patients with adequate pleural drainage through an intercostal chest tube.
• Patients receiving systemic antifungal therapy.
• Patients either:
• scheduled for surgical decortication but undergoing lavage as a preoperative adjunct, or
• considered unfit for surgery and managed conservatively.

You may not qualify if…

• Bacterial empyema without fungal growth.
• Known hypersensitivity to anti-fungals.
• Severe hepatic impairment (Child-Pugh class C) contraindicating voriconazole.
• Pregnancy or lactation.
• Refusal to participate.

Where it is running

• Services Hospital Lahore — Lahore, Punjab Province, Pakistan (enrolling)

Full record on ClinicalTrials.gov

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