130225 fok lung abscess kalabay

8/11/2019 130225 Fok Lung Abscess Kalabay

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LUNG ABSCESS



Definition

• Lung parenchyma in an area of infection

undergoes necrosis communication

with bronchi cavitation with formation of

air-fluid level. Chronic process.



Lung abscess with bronchopleural

fistula



Causative agents of lung abscess

• Most commonly: combination of anaerobeand microaerophilic bacteria(Fusobacterium nucleatum) , often in

association with aerobes• Common in staphylococcal, Klebsiella,

Pseudomonas, pneumococci,Haemophilus influenzae and otherpneumonias, except for those caused byMycoplasma pneumoniae



↓ Destructive pneumococcal pneumonia

Right lower lobe abscess in an alcoholic ↓



Pulmonary tuberculosis presenting

as a lung abscess



Lung abscess caused by Entamoeba histolytica



Aspiration as a cause of lung abscess

• Aspiration of the contents of the mouth material plugs off a bronchus or bronchiole anaerobic environment the anaerobicbacteria that are always present grow.

Aspiration occurs:

• During an episode of unconsciousness(alcohol, drug overdose, head trauma,anesthesia, seizure, coma from any cause)

• Neuromuscular disease of oropharynx or

esophagus• Following operative procedure in the mouth.

• Poor oral hygiene.

• Gag reflex may be absent.



Other pathogenesis of lung abscess

• Obstructive disease of the bronchus: tumor(Lung abscess in edentulous patient withnormal oral hygiene - tumor suggested).Bronchiectasis: predisposing factor.

• Subdiaphragmatic process: e.g., amebic

abscess of the liver right lower lobeinfection

• Metastasis from suppurative pelvic or jugularthrombophlebitis (usually caused byanaerobes)

• Metastasis from right-sided endocarditis(Staphylococcus - IV drug abusers)

• Metastasis from bacteremia from other sites.



Clinical findings of lung abscess

A. Symptoms:

• Fever, cough productive of purulent sputum withor without blood, pleuritic chest pain (ifempyema developed).

• Lung abscess: History of fever, anorexia, weightloss, malaise, cough for days or weeks or evenmonths, with or without an initial acute onset.

B. Physical examination:

• Chest: dullness, amphoric breathing, rales (butoften negative). Clubbing of the finger mayoccur.



Clubbing of the fingers in lung disease

• Chronic: Bronchiectasis, lung abscess, emphysema, chronic bronchitis

• Acute: lung cancer



Laboratory findings of lung abscess

• Microscopic examination of the sputum: manyPMN leukocytes, a mixed flora of gram positivecocci in chain, gram negative bacilli, gramnegative cocci, and/or gram positive bacilli.

• Culture of the sputum: "normal flora" (no value!).Most commonly isolated: Fusobacterium,Peptostreptococcus, Peptococcus organisms,microphilic streptococci, Bacteroidesmelaninogenicus, Streptococcus pneumoniae.

• Blood culture.



Chest X-ray in lung abscess

• Infiltrate ofpneumonia, often with

multiple cavities.

Well-defined cavities,

a rim of infiltrate.

• Air-fluid level -

patients lying on their

back.• Pleural effusion

empyema



LUNG ABSCESS

• Development of pulmonarysymptoms about 1-2 weeksafter possible aspiration,bronchial obstruction, orprevious pneumonia

• Septic fever and sweats• Periodic sudden expectoration

of large amount of purulentsputum (sometimeshemoptysis)

• X-ray density with centralradiolucency and fluid level



Radiography in lung abscess

• Chest X-ray and CT: lung abscess, necrotizing

pneumonia, empyema



Differential diagnosis of lung

abscess

• Cavitating carcinoma

• Tuberculosis

• Fungal infection• Wegener granulomatosis



Treatment of lung abscess• Antibiotics:

– Penicillin G: 1 -2 million units IV every 4 hours.

– Penicillin V: 0.5 - 1 g p.o. every 6 hours (afterimprovement with IV penicillin G).

– Clindamycin: 600 mg IV every 8 hours untilimprovement, then 300 mg p.o. every 6 hours.

– Other antibiotics: ampicillin, cephalotin, cefazolin,cephalexin, ampicillin-sulbactam, cefoxitin, penicillinG + metronidazole or ticarcillin-clavulinic acid.

– Antibiotics should be continued until the chest x-raystabilizes - a month or more.

• Postural drainage• Bronchoscopy: free airways

• Empyema should be drained!

• Septic phlebitis: heparin therapy, vein ligation

• Surgical treatment: lobectomy



Prognosis of lung abscess

• Depends on the underlying disease

• Overall mortality: 15%.

130225 fok lung abscess kalabay

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