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First, let’s quickly review some anatomy and physiology. Remember that the pleura is a serous membrane that consists of two layers: the visceral pleura, which sticks to the surface of the lungs; and the parietal pleura, which lines the inside of the chest wall. Between these two layers is the pleural space, which contains 20 to 25 milliliters of pleural fluid. This lubricating fluid reduces friction between the two pleural layers, which allows them to slide over each other during respiration, as the lungs expand with inhalation and then relax with exhalation. Finally, it’s worth mentioning that the parietal pleura also has pain receptors, called nociceptors, with innervation coming from the intercostal nerves and fibers from the phrenic nerve that also innervates the diaphragm.
Now, the most common cause of pleurisy is a viral infection caused by the influenza virus, which causes the flu. Less frequently, pleurisy can be caused by a parainfluenza virus, adenovirus, coxsackieviruses, cytomegalovirus, Epstein-Barr virus, or respiratory syncytial virus. Pleurisy can also be caused by bacterial infections, such as pneumonia from Streptococcus pneumoniae, or tuberculosis; as well as fungal infections such as coccidioidomycosis or histoplasmosis.
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