presentation of lung abscess

1. LUNG ABSCESS
Presented by: Shivangi Sharma

2. Introduction
 In the 1920s, approximately one third of
patients with lung abscess died. Dr David
Smith postulated that aspiration of oral
bacteria was the mechanism of infection. He
observed that the bacteria found in the walls of
the lung abscesses at autopsy resembled the
bacteria noted in the gingival crevice.

4. Definition
 A lung abscess is a localized area of
destruction of lung parenchyma (usually >2 cm
in diameter) in which infection by pyogenic
organisms results in tissue necrosis and
suppuration manifested radiologically as a
cavity with air fluid level.

6. Necrotizing Pneumonia:
 Necrosis with multiple micro abscesses
actually form a larger cavitary lesion; actually
represents a continuum of the same
process(less than 2cm in diam)

7. Necrotizing pneumonia

8. Epidemiology
Frequency
 The frequency of lung abscesses in the
general population is not known.
Sex
 A male predominance for lung abscess
Age
 Lung abscesses likely occur more commonly
in elderly patients

9. Prognosis
 Lung abscess was a devastating disease in
the preantibiotic era, when 1/3 of the patients
died, another 1/3 recovered, & the remainder
developed debilitating illnesses[ i.e. recurrent
abscesses, chronic empyema, bronchiectasis]

10. Classification

12. Aspiration of Oropharyngeal
flora
 Dental / Periodontal sepsis
 Paranasal sinus infection
 Depressed conscious level
 Impaired laryngeal closure (cuffed
endotracheal tube, tracheostomy tube)
 Disturbances of swallowing
 Delayed gastric emptying. / gerd / vomiting

13. Necrotizing pneumonia
 Staph aureus
 Strep milleri / intermedius
 Klebsiella pneumonia
 Pseudomonas aeruginosa

14. Hematogenous spread from a
distal site
 UTI
 Abdominal sepsis
 Pelvic sepsis
 Infective endocarditis
 IV drug abuse
 Infected IV cannulae
 Septic thrombophlebitis

15. Pre existing lung disease
 Bronchiectasis
 Cystic fibrosis
 Bronchial obstruction : tumor, foreign body,
 Infected pulmonary infarct
 Trauma
 Immunodeficiency

16. Organisms commonly
isolated
 Anaerobes- Anaerobic bacterial commonly
cause necrotizing pneumonia.
 Gram-negative bacilli: Bacteroides fragilis.
Prevotella and Porphyromonas.
 Gram-positive cocci: Peptostreptococcus and
anaerobic or microaerophilic streptococci.
 Long thin Gram-negative rods: Fusobacterium
species, particularly F. nucleatum and F.
necrophorum.

17. Cont..
 Aerobic: Aerobic organisms tend to cause
lung abscesses as part of a necrotizing
pneumonia.
 Gram-positive aerobes: Staph. aureus , Strep.
pyogenes, Strep. pneumoniae , Strep.
intermedius, Strep. constellatus and Strep.
Anginosus.
 Gram-negative aerobes: Klebsiella
pneumoniae, Pseudomonas aeruginosa ,
Haemophilus influenzae, Escherichia coli,
Proteus species

18. Pathophysiology
aspiration pneumonia
Causative organism and factor invade the
pulmonary tissues
Alveolar macrophages initiates the
inflammatory response to bolster lower
respiratory tract defense

19. Cont..
Release of inflammatory mediators, such
as interleukin(IL-1) and TNF(Tumor necrosis
factor)
(fever)
These mediators start to necrotize the tissue
increase purulent secretion and form lesions
Impaired gas exchange and appearance of
clinical features

21. Cont..
Due to bronchus/carina anatomy, occur most
frequently in posterior segment of RUL then
posterior segment of LUL and then the
superior segments of RUL/LL

22. Cont..
 studies of patients with known time of
aspiration suggest that tissue necrosis with
lung abscess formation takes at least 1 week
and up to 2 weeks to develop.

23. Cont..
 Amebic lung abscess typically occurs in RLL
due to direct extension of liver abscess
through the diaphragm

24. Clinical features
Signs
 Digital clubbing
 Dullness to
percussion
 Diminished breath
sounds
 Amphoric /
cavernous breath
sounds
Symptoms
 Symptoms progress
over weeks to
months
 Fever, cough, and
sputum production
 Night sweats, weight
loss & anemia
 Hemoptysis,
pleurisy

25. Diagnostic evaluation
 Gram stain:both +ve &-ve,mixed.
 AFB & Anaerobic culture
 CT CHEST

26. X-ray

27. CT-Scan

28. Transtracheal aspirates
 transtracheal
aspiration, transtracheal wash. a technique
for collecting a sample of bronchial exudate for
histological and microbiological examination. A
needle is inserted through the skin overlying
the trachea and through the cricothyroid
ligament.

30. Transthoracic needle aspirates

31. Management
Medical management
Surgical management
Nursing management

32. Medical management
 Clindamycin is the treatment of choice.
 Penicillin + Flagyl
 Metronidazole 400mg PO X TDS if there is foul
smell of the sputum
 Oral administration of antibiotic therapy is
continued for an additional 4 to 8 weeks.

33. Surgical management
 percutaneous catheter drainage or surgical
resection is usually considered.
 lobectomy or pneumonectomy

34. Nursing management
 Assessment
-history collection
-physical examination
 Nursing diagnosis
 Goal
 Planning
 Implementation
 Evaluation