3. 3
Lung abscesses can be classified based on the
duration & the likely etiology.
1. Acute abscesses are less than 4-6 wks.
2. Chronic abscesses are of longer duration.
1. Primary abscess is infectious in origin, caused
by aspiration or pneumonia in the healthy host.
4. 4
2. Secondary Abscess is caused by:
- Pre-existing condition.
- Spread from an extra-pulmonary site.
- Bronchiectasis.
- An immuno-compromised state.
Lung abscesses can be further characterized by the
responsible pathogen, such as Staphylococcus
lung abscess & anaerobic or Aspergillus lung
abscess.
5. Microbiology
Anaerobes are recovered in up to 89% of the
patients, 46% of patients with lung abscess had
only a mixture of anaerobes isolated from
sputum cultures while 43% of patients had a
mixture of anaerobes & aerobes.
6. Other organisms that may infrequently
cause lung abscess include:
Staphylococcus aureus.
Klebsiella pneumoniae.
Hemophilus influenza.
Actinomyces species.
7. 7
Non-bacterial pathogens may also cause lung
abscesses .
Theses micro-organisms include:
1) Parasites [Paragonimus , Entamoeba].
2) Fungi [Aspergillus , Cryptococcus ,
Histoplasma, Coccidioides].
3) Mycobacterium.
8. 8
Causes
The bacterial infection may reach the
lungs in several ways .that most common
is aspiration of oro-pharyngeal contents.
9. 9
Factors contributing to lung abscess
1. Oral cavity disease
2. Gingivitis
3. Altered consciousness[ inability to protect
their airways coz of an absent gag reflex]
4. Alcoholism
5. Drug abuse
6. Anesthesia
7. Seizures
15. 15
History
The usual symptoms are fever , cough with
sputum production , night sweats , anorexia
& weight loss.
The expectorated sputum characteristically
is foul smelling & bad tasting.
Patients may develop hemoptysis or pleurisy.
16. 16
Physical examination
low-grade fever in anaerobic infections &
temperature > 38.5 C in other infections.
Evidence of gingival disease may be present.
Decreased breath sounds, Dullness to
percussion, bronchial breath sounds, course
inspiratory crackles.
Digital clubbing may develop rapidly.
17. 17
Lab Studies
- CBC.
- ESR & CRP
- Sputum for gram stain, culture & sensitivity.
- If T.B. is suspected, acid fast bacilli stain &
mycobacterial culture is requested.
- Blood culture may be helpful.
24. 24
Medical treatment
Antibiotic therapy:
Anaerobic lung infection = Clindamycin [shown to
be superior over parenteral penicillin coz several
anaerobes may produce B-lactamase & therefore
develop penicillin resistance].
Although metronidazole is an effective drug
against anaerobic bacteria, a failure rate of 50%
has been reported.
25. 25
In hospitalized patients who have aspirated and
developed a lung abscess, antibiotic therapy
should include coverage against S aureus and
Enterobacter and Pseudomonas species.
26. 26
Duration of therapy:
Most clinicians prescribe antibiotic therapy
generally for 4-6 weeks.
Current recommendations are that antibiotic
treatment should be continued until the chest
radiograph has shown either the resolution of
lung abscess or the presence of a small stable
lesion.
27. 27
Response to therapy:
Patients show clinical improvement, with
improvement of fever, within 3-5 days after
initiating the antibiotic therapy.
Patients with poor response to antibiotic therapy
include:
1. Bronchial obstruction with a foreign body or
neoplasm.
2. Infection with a resistant bacteria.
3. Mycobacteria, or fungi.
28. 28
Surgical treatment
The usual indications for surgery are:
1. Failure to respond to medical
management.
2. Suspected neoplasm, or congenital lung
malformation.
29. 29
Prognosis
The prognosis for lung abscess following
antibiotic treatment is generally favorable.
Over 90% of lung abscesses are cured with
medical management alone, unless caused
by bronchial obstruction secondary to
carcinoma.
31. DEFINITION
Abnormal permanent dilation and
destruction of bronchial walls. Is focal or
diffuse.
The induction of bronchiectasis requires two
factors:
(1) an infectious insult
(2) impairment of drainage, airway obstruction.
32. ETIOLOGY
AIRWAY OBSTRUCTION DUE TO FOREIGN
BODY ASPIRATION.
Hypogammaglobulinemia (IgG,IgG2)
CYSTIC FIBROSIS
YOUNG SYNDROME: sinusitis, bronchiectasis,
obstructive azospermia
DYSKINETIC CILIA (kartagener syndrome):
sinusitis, bronchiectasis & infertility.
Recurrent pulmonary infections.
33. CLINICAL FINDING
Symptoms include:
1. Cough productive of mucopurulent phlegm.
2. Intermittent hemoptysis.
3. Pleurisy.
4. Shortness of breath.
Physical findings include:
1. Crackles.
2. Rhonchi.
3. Digital clubbing is rare.
40. SURGERY
Removal of destroyed lung partially
obstructed by a tumor or the residue of a
foreign body.
Elimination of bronchiectatic airways
causing poorly controlled hemorrhage.
or removal of an area suspected of harboring
resistant organisms.
43. TREATMENT
Antimicrobial therapy and drainage
are the keystones of treatment.
Periods of 1 to 3 months or more may
be required
PCN+METRONIDAZOLE
CLINDAMYCIN
