Lung abscess

A lung abscess is usually caused by bacteria that normally live in the mouth or throat and that are inhaled (aspirated) into the lungs, resulting in an infection. Often, Periodontitis Periodontitis is a severe form of gingivitis, in which the inflammation of the gums extends to the supporting structures of the tooth. Plaque and tartar build up between the teeth and gums and... read more (periodontal disease) is the source of the bacteria that cause a lung abscess. The body has many defenses (such as a cough) to help prevent bacteria from getting into the lungs. Infection occurs primarily when a person is unconscious or very drowsy because of alcohol or recreational drug use, medication use, sedation, anesthesia, or a disease of the nervous system and is thus less able to cough to clear the aspirated bacteria. In people whose immune system functions poorly, a lung abscess may be caused by organisms that are not typically found in the mouth or throat, such as fungi or Mycobacterium tuberculosis (the organism that causes Tuberculosis (TB) Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs, but almost any organ can be involved. Tuberculosis... read more ). Other bacteria that can cause lung abscesses are streptococci and staphylococci, including methicillin-resistant Staphylococcus aureus ( Methicillin-resistant Staphylococcus aureus (MRSA) Staphylococcus aureus is the most dangerous of all of...

Empyema is defined as pus in the pleural space. It typically is a complication of pneumonia. However, it can also arise from penetrating chest trauma, esophageal rupture, complication from lung surgery, or inoculation of the pleural cavity after thoracentesis or chest tube placement. An empyema can also occur from extension of a subdiaphragmatic or paravertebral abscess. For patient education resources, see the The development stages of an effusion can be divided into three phases: exudative, fibropurulent, and organizational. The initial effusion develops from increased pulmonary interstitial fluid along with progressive capillary vascular permeability. A simple effusion is frequently sterile and resolves with antibiotic treatment of the underlying pulmonary infection. This more complicated parapneumonic effusion requires both antibiotics and some form of surgical drainage or alternative treatment modality to remove the purulent effusion. In these more complicated effusions, decreased fibrinolysis and activation of the coagulation cascade leads to the production of fibrin with subsequent adhesions and loculated fluid collections. This process ultimately can cause pleural fibrosis and impairment of lung expansion. Polymicrobial bacteria can be found in over 90% cases of lung abscess. [ Bacteroides, Fusobacterium, and Peptostreptococcus species. Other organisms include Pseudomonas species, Klebsiella species, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus mi...

Jia-Hao Zhang 1, Shun-Mao Yang 2,3, Cheng-Hung How 3,4, Yun-Fang Ciou 5 1 Division of Pulmonary Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2 Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan; 3 Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; 4 Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 5 Department of Fine Arts, National Taiwan Normal University, Taipei, Taiwan Contributions: (I) Conception and design: SM Yang, CH How; (II) Administrative support: YF Ciou; (III) Provision of study materials or patients: JH Zhang, CH How; (IV) Collection and assembly of data: JH Zhang, SM Yang; (V) Data analysis and interpretation: CH How; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Cheng-Hung How, MD. Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; 7, Chung-Shan South Road, Taipei 10002, Taiwan. Email: [email protected]. Abstract: Lung abscess is a type of infectious pulmonary disease, which occurs because of infection and destruction of the pulmonary parenchyma with central necrosis, eventually leading to cavity formation. The characteristic finding of chest roentgenog...

• Key Factors • positive past medical history • fever • productive cough • cardiac murmur • cavernous (amphoric) breath sounds • Other Factors • pleuritic chest pain • constitutional symptoms • cachexia • pallor • gingival disease • halitosis • absence of gag reflex • dyspnea • hemoptysis • rigors • weakness • arthralgia • hemorrhagic lesions • inspiratory crackles • bronchial breathing • decreased breath sounds • unilateral fixed rhonchus • • 1st Tests to Order • CBC • chest x-ray • sputum Gram stain • sputum culture • blood culture • empyema fluid culture • Other Tests to consider • CT chest • bronchoscopy • quantitative cultures of protected specimen brushings • quantitative cultures of protected bronchoalveolar lavage samples • percutaneous needle aspiration and culture • sputum cytology • lung ultrasound • echocardiogram • rapid enzyme-linked immunosorbent assay (ELISA) for D-dimer • multidetector CT thorax • ventilation-perfusion scan • A 64-year-old man presents with fever, cough productive of copious sputum with a putrid odor, and malaise. He is unable to assign the exact onset of his symptoms but claims they have developed over at least 1 month. He lives alone and is a long-time smoker with a history of chronic alcohol abuse. He also reports the occasional use of illicit drugs. Over the past year he has been admitted twice to the local emergency room after being found unconscious due to alcohol intoxication. On physical exam he looks profoundly malnourished and hi...

The treatment of lung abscess is guided by the available microbiology with consideration of the underlying or associated conditions. No treatment recommendation has been issued by major societies specifically for lung abscess. Some clinical trials referred to below have included patients with aspiration pneumonia with or without lung abscess. For the following reasons, inpatient care is advisable in patients with lung abscess: • Standard treatment of an anaerobic lung infection is clindamycin (600 mg IV q8h followed by 150-300 mg PO qid). This regimen has been shown to be superior over parenteral penicillin in published trials. Several anaerobes may produce beta-lactamase (eg, various species of Bacteroides and Fusobacterium) and develop resistance to penicillin; therefore, treatment with a beta-lactamase inhibitor in conjunction with a beta-lactam or carbapenems should be considered. [ In hospitalized patients who have aspirated and developed a lung abscess, antibiotic therapy should include coverage against S aureus and Enterobacter and Pseudomonas species. When methicillin-resistant S aureus (MRSA) is the source of lung abscesses, vancomycin and linezolid should be considered. Vancomycin 15 mg/kg IV every 12 hours, with a goal trough of 15-20 mcg/mL, is adjusted renally. Linezolid therapy should be started at a dose of 600 mg IV every 12 hours. Once the patient has defervesced once, consider switching to an equivalent oral regimen. Linezolid has been shown to have impro...

Pneumonia and your lungs Most pneumonia occurs when a breakdown in your body's natural defenses allows germs to invade and multiply within your lungs. To destroy the attacking organisms, white blood cells rapidly accumulate. Along with bacteria and fungi, they fill the air sacs within your lungs (alveoli). Breathing may be labored. A classic sign of bacterial pneumonia is a cough that produces thick, blood-tinged or yellowish-greenish sputum with pus. Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. Symptoms The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the infection, and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last longer. Signs and symptoms of pneumonia may include: • Chest pain when you breathe or cough • Confusion or changes in mental awareness (in adults age 65 and older) • Cough, which may produce phlegm • Fatigue • Fever, sweating and shaking chills • Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) • Nausea, vomiting or diarrhea • Shortness of breath Newborns and infants may not show any sign of the infection. Or they may vomit, have a fe...

Lung abscess is defined as necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection. The formation of multiple small (< 2 cm) abscesses is occasionally referred to as necrotizing pneumonia or lung gangrene. Both lung abscess and necrotizing pneumonia are manifestations of a similar pathologic process. Failure to recognize and treat lung abscess is associated with poor clinical outcome. 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. A typical lung abscess could be reproduced in animal models via an intratracheal inoculum containing, not 1, but 4 microbes, thought to be Fusobacterium nucleatum, Peptostreptococcus species, a fastidious gram-negative anaerobe, and, possibly, Prevotella melaninogenicus. Lung abscess was a devastating disease in the preantibiotic era, when one third of the patients died, another one third recovered, and the remainder developed debilitating illnesses such as recurrent abscesses, chronic empyema, bronchiectasis, or other consequences of chronic pyogenic infections. In the early postantibiotic period, sulfonamides did not improve the outcome of patients with lung abscess. After penicillins and tetracyclines became available, outcome...