Lung abscess II

Lung abscess II

LABORATORY:

• Leukocytosis
• Anemia
• Hypoalbuminemia
• Sputum smear - mixed bacteria and neutrophils
• Sputum culture - mixed flora, anaerobes
• Gram-negative rods and cocci
• Pleural fluid - neutrophilia
• Bacteriology:
• Generally anaerobes
• Staphylococcus
• Klebsiella spp.
• Pseudomonas aeruginosa
• Other (uncommon)

Drugs that may alter lab results: Prior antibiotics
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS:

• Gross - solitary abscess
• Multiple abscesses
• Micro - suppuration
• Cavitation

SPECIAL TESTS:

N/A

IMAGING:

• Chest x-ray: consolidation with radiolucency
• Air-fluid level
• Pleural effusion
• CT: define location and extent

DIAGNOSTIC PROCEDURES:

• Bronchoscopy if obstruction suspected
• Bronchoscopic protected brushing
• Bronchoalveolar lavage
• Transthoracic needle aspiration

TREATMENT

APPROPRIATE HEALTH CARE:

• Inpatient if ill, otherwise outpatient
• Inpatient surgery

GENERAL MEASURES:

• Postural drainage
• Pulmonary physiotherapy
• Treat underlying etiology (e.g., with antibiotics)
• Bronchoscopy with selective therapeutic lavage - rarely

SURGICAL MEASURES:

Rarely, surgery for complications (pulmonary resection)

ACTIVITY:

Reduced activity until x-ray evidence of clearing

DIET:

No restrictions

PATIENT EDUCATION:

Pulmonary physiotherapy techniques

MEDICATIONS

DRUG(S) OF CHOICE:

Antibiotics according to culture and sensitivity results. For presumed anaerobes, data from two prospective randomized trials have shown clindamycin 600 mg every 6-8 hours IV, followed by 300 mg every 6 hours orally for 4 weeks to result in fewer treatment failures than penicillin.

Contraindications: Refer to manufacturer's literature.
Precautions: Refer to manufacturer's literature
Significant possible interactions: Refer to manufacturer's literature

ALTERNATIVE DRUGS:

• Anaerobes: standard therapy has been
penicillin G 1-2 million units IV every 4 hours until improved, followed by 1.2 million units (750 mg) orally every 6 hours for 3-4 weeks.
Metronidazole has not proven as effective as clindamycin.
• Bacteroides: cefoxitin, cefotetan, ticarcillin-clavulanate, chloramphenicol, imipenem
• Fusobacterium: first generation cephalosporin

FOLLOW UP

PATIENT MONITORING:

Continue treatment until cavity has resolved on serial x-rays (may take several months)

PREVENTION/AVOIDANCE:

Treat predisposing diseases

POSSIBLE COMPLICATIONS:

• Extension
• Empyema
• Massive hemoptysis
• Pneumothorax
• Brain abscess

EXPECTED COURSE AND PROGNOSIS:

Without underlying disease, guardedly favorable. Increased sequelae and mortality with concomitant disease (up to 75% mortality).

MISCELLANEOUS

ASSOCIATED CONDITIONS:

• Pneumonia
• Alcoholism
• Epilepsy
• Empyema
• Periodontal disease
• Unconsciousness
• Neoplasia
• Bronchogenic carcinoma
• Tuberculosis
• Fungal diseases

AGE-RELATED FACTORS:

Pediatric: Occurs in children, Staphylococcus most common organism
Geriatric: Mortality higher in this age group
Others: N/A

PREGNANCY:

N/A

SYNONYMS:

Pulmonary abscess

ICD-9-CM:

513.0 abscess of lung

(see images)

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Medical Diagnosis » L » Lung abscess II