Lung abscess
Severe, localize suppurative (dead tissue, discharge pus) infection in lung.
Necrotic cavity formation
Surrounded by fibrous reaction, forming abscess wall.
Necrotizing Pneumonia
Types of lung abscess
1. Primary abscess
Caused by aspiration (anaerobic organism), or pneumonia.
2. Secondary abscess
Pre existing condition; lung Abnormality
Etiology
1. Bacterial colonization in lung
2. Inhalation of foreign body
3. Extension of hepatic abscess
4. Bronchial carcinoma
5. Pneumonia
6. Diabetes mellitus
7. Chronic lung disease; cystic fibrosis
8. Bacteraemia due to anaerobic bacteria.
9. Penetrating pulmonary trauma
10. Tricuspid endocarditis; septic pulmonary embolism
11. Severe or completely treated pneumonia
12. Severe periodontal disease
Common anaerobes causing lung abscess
1. Microaerophilic streptococci
2. Bacteroides
3. Fusobacterium
Common aerobes
Staphylococcus aureus
streptococcus pyogenes
Haemophilus influenza
Klebsiella pneumoniae
Streptococcus pneumoniae
Others
1. Mycobacterium tuberculosis
2. Fungi;
Aspergillus
Cryptococcus
Histoplasma
Blastomyces
Coccidioides species
Parasite; Entamoeba histolytica
Clinical manifestation
1. Spiking Temperature with rigors and night sweats
2. Cough and phlegm production; blood stained
3. Pleuritic chest pain
4. Breathlessness
Sign of lung abscess
1. Tachypnea
2. Tachycardia
3. Localize dullness on percussion
4. Consolidation present
5. Infective endocarditis
6. Severe periodontal disease
Diagnostic Evaluation
1. Blood and sputum culture, acid fast bacilli (AFB) test
2. ESR and c- reactive protein elevated
3. Chest X ray; presence of empyema (pocket of pus) or effusion.
4. Study of pleural fluid
5. CT scan of thorax; multiple small abscess
6. Fibre optic bronchoscopy
Sample for culture
7. Trans-thoracic biopsy/ aspiration or trans-tracheal biopsy
Management
1. Intravenous antibiotics
First line therapy;
Beta-lactamase Inhibitors
Cephalosporin
Clindamycin
2. Supportive
1. Analgesics
2. Oxygen Administration
3. Postural drainage
4. Chest physiotherapy
Sugial management
1. Lobectomy
Removal of one lobe.
2. Pneumonectomy
Removal of lung.
Complication
1. Emphysema
2. Brain abscess
3. Pneumatocele; air filled cyst within lung parenchyma.
4. Bronchoplueural fistula; abnormal passage between bronchial tree and pleural space.
5. Bronchiectasis
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