pulmonary abscess
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Etiology
- most frequently following aspiration of oropharyngeal contents containing large numbers of anaerobes
- gingival & dental disease predispose to lung abscess formation
- pathogens
- anaerobic bacteria (30-50%)
- aerobic gram-positive bacteria (25%)
- aerobic gram-negative bacilli ( 5-12%)
- opportunistic infections:
- newborns with congenital cardiopulmonary disorders
- elderly patients with blood dyscrasias
- cancer of the lung or oropharynx
- nosocomial/iatrogenic
- steroid therapy
- post-operative
- hematogenous lung abscess
Clinical manifestations
Laboratory
- leukocytosis
- sputum culture for:
- skin testing
- bronchoscopy
- if obstruction suspected from tumor or foreign body
- cultures
- drainage
Complications
- rupture into the pleural space causing empyema
Differential diagnosis
- tuberculosis
- fungal disease
- acute necrotizing pneumonia
- carcinoma
- vasculitis
- septic embolism
- pulmonary embolism with infarction
Management
- drainage of involved segment
- postural with physiotherapy
- bronchoscopy may be necessary for abscess drainage
- antibiotics
- penicillin G 1.5-2.0 million units IV every 4 hours; switch to Penicillin VK 500 mg PO every 6 hours once definite clinical response;
- continue until cavity closes
- ampicillin sulbactam
- clindamycin
- duration of therapy: at least 4-6 weeks
- penicillin G 1.5-2.0 million units IV every 4 hours; switch to Penicillin VK 500 mg PO every 6 hours once definite clinical response;
- healing may take 6-12 months
- surgical resection or percutaneous drainage rarely required
- persistent fevers & leukocytosis despite therapy
- bronchopulmonary fistula
- empyema
- hemoptysis (persistent)
- enlarging abscess cavity
- mechanical ventilation dependence