Pleurisy: Infection in the Pleura – Causes and Treatment

The inflammation of the laminar layers covers the lungs (the pleura).

The most common symptom of pleurisy is acute pain in the chest when breathing deeply. Sometimes the pain is also felt in the shoulders.

The pain can be worse when coughing, sneezing, and moving, and it can be relieved by taking deep, gentle breaths. Other symptoms may include shortness of breath and a dry cough.

Visit your GP if you experience the above symptoms. Seek immediate medical help if your chest pain is severe, particularly if you have other symptoms, such as coughing up blood, nausea, or sweating.

When to see your GP

Usually, pleurisy can be diagnosed by studying its symptoms. Your GP can listen to your chest to check for the distinctive dry sound or a crunch that suggests that you may have pleurisy.

More tests may be needed to identify your pleurisy’s underlying cause and assess its severity. These may include:

  • Blood tests to determine if you have an infection or an autoimmune condition.
  • Chest radiographs.
  • An ultrasound.
  • A computed tomography (CT).
  • A biopsy – a small pleural or lung tissue sample is removed for further testing.

What causes pleurisy?

Most cases result from a viral infection (such as the flu) or a bacterial infection (such as pneumonia).


In rare cases, pleurisy may be caused by a blood clot that blocks blood flow to the lungs (pulmonary embolism) or lung cancer.

Pleurisy can affect people of all ages, but people 65 and older are at greater risk because they are more likely to develop a chest infection.


The treatment for pleurisy depends on the underlying cause.

For example, pleurisy caused by a viral infection often resolves without treatment.

However, pleurisy caused by a bacterial infection is usually treated with antibiotics, and people who are frail or already in poor health can be admitted to the hospital.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, often relieve chest pain associated with pleurisy.

If excess fluid accumulates between the pleural layers, it may be necessary to drain the fluid to avoid breathing difficulties.


Pleuritis is the inflammation of the pleura. It is usually caused by another condition, such as an infection, but sometimes no cause can be identified.

The pleura are two thin sheets of tissue that separate the lungs and the rib cage. One joins the rib cage, and the other enters the lungs.

Between the pleural laminae is a thin layer of fluid that lubricates the pleura, helping to reduce friction when inhaling and exhaling.

When there is inflammation, the surfaces of the two layers can become rough, and the liquid can become sticky. This can cause the layers to touch, resulting in pain and discomfort.


An infection is the most common cause of pleurisy. Any disease has the potential to spread to the pleura, but viral infections are generally responsible. Viruses are known to cause pleurisy, including:

  • The influenza virus (flu).
  • The Epstein-Barr virus – causes glandular fever.
  • Cytomegalovirus (CMV) – is a common virus found in most people, which usually does not cause noticeable symptoms.
  • Parainfluenza.

In some cases, pleurisy is caused by bacteria, such as:

Streptococcal bacteria – are often associated with pneumonia, throat infections, and some types of skin infections, such as impetigo and cellulitis.

Staphylococcal bacteria – are often associated with skin infections, food poisoning, and, more seriously, blood poisoning (sepsis).

Methicillin-resistant Staphylococcus aureus can cause pleurisy, especially in hospitalized patients. It is a type of bacteria resistant to a series of commonly used antibiotics.

Other causes

Other possible causes of pleurisy are:

  • Injury – if the ribs are bruised or fractured, the pleura may swell
  • Pulmonary embolism – a blood clot that develops inside the lungs.
  • Sickle cell anemia is a blood disorder that usually affects people of African or Caribbean descent.
  • Chemotherapy and radiotherapy.
  • VIH about SIDA.
  • Lung cancer.
  • Mesothelioma – is a type of cancer caused by the inhalation of asbestos.

Autoimmune diseases, such as rheumatoid arthritis and lupus, are other possible causes of pleurisy.

Under these conditions, something goes wrong with the immune system (the body’s natural defense against infection and disease), and it begins to attack healthy tissue.


The treatment of pleurisy usually involves relieving pain and treating the underlying cause of the disease.

If treated promptly, pleurisy often resolves without permanent damage to the lungs.

Pain treatment

Chest pain associated with pleurisy can be treated with an analgesic known as nonsteroidal anti-inflammatory drugs (NSAIDs). The most common is ibuprofen.

If NSAIDs are ineffective or inadequate, you may be prescribed another analgesic, such as paracetamol or codeine.

It may seem strange, but lying on the side of the chest that hurts can also help reduce the pain.

Treat the underlying cause.

It may also be necessary to treat the underlying cause of your pleurisy.

If you have pleurisy caused by a bacterial infection, you will need antibiotic treatment.

Depending on the severity of your symptoms, these may be tablets or injections. Sometimes combinations of different antibiotics are used.

However, if your pleurisy is caused by a viral infection, additional treatment may not be necessary since the condition usually resolves after a few days.

In cases where your symptoms are particularly severe, or you are already in poor health, you may need to be admitted to the hospital so they can stabilize your essential life functions.