Lung abscess
Iskandar
Madya Respirology Pediatric Resident
Lung abscess
DEFINITION:
Lung abscess (Latin: abscessus) is a collection
of pus that has built up within the lung tissue.
This is usually caused by a bacterial infection.
Definition
• A localized area of destruction of lung parenchyma in
which infection by pyogenic organisms results in tissue
necrosis & suppuration.
• It manifests radiographically as a cavity with an air –
fluid levels.
Alsubie H and Fitzgerald DA. Lung abscess in children. Journal of Pediatric Infectious Disease. 2009; 4: 27-35.
Epidemiology
■ It is a rare problem in childhood period.
■ It has a prevalence of 7/100.000 and it is often
identified among men.
■ It may emerge at any age, however, most of the
cases are below the age of 10.
Bekdas M, Goksugur BS, Dermicioglu F, Ozturk H. Lung abscess in a child: a case report. Global Journal of Medicine and Public
Health. 2013; 2 (5): 1-4
Lung abscess
ETIOLOGY:
Aerobic bacteria infection (streptococcus
pneumoniae, streptococcus pyogenes, staphylococus aereus,
klebsiella pneumonie, pseodomonas aeruginosa, proteus The most
vulgaris, escherichia coli, neisseria meningitidis, haemophillus common
influenzae)
Anaerobic bacteria infection
(clostridium hystoliticum, bacteroides fragilis).
Mixed bacterial flora (common)
Fungal infections
Classification: Lung abscess
PRIMARY ABSCESS:
In healthy lung parenchyma
(anaerobic aspiration,
specific pneumonia)
SECONDARY ABSCESS:
In lung tissue affected by: existing lung disease, metastatic
tumors, lung carcinoma, foreign body, infarction, emphysema,
cystic fibrosis, bronchiectasis, immune deficiency or
neurological disease.
Lung absces: predisposing factors:
Alsubie H and Fitzgerald DA. Lung abscess in children. Journal of Pediatric Infectious Disease. 2009; 4: 27-35.
Pathophysiology
Pathophysiology
Clinical Manifestations :
fever
chills,
cough,
expectoration,
chest pain,
weight loss,
dyspnoea
hemoptysis
Clinical Manifestations
Alsubie H and Fitzgerald DA. Lung abscess in children. Journal of Pediatric Infectious Disease. 2009; 4: 27-35.
Lung absces (diagnosis) ?
Lung absces
Diagnosis:
Clinical signs,
Chest X-ray
CT scan
bronchoscopy
sputum analysis
CRP, OB, WBC elevation
Lung abscess (chest X-ray)
Staphylococcus pneumonia
Lung abscess treatment
Conservative treatment with antibiotics
Antibiotics based on drug sensitivity-
6-8 weeks or longer
Lung abscess
THERAPY:
It is thought that lung abscess in its early stage can regress
spontaneously in approximately 20-30% of cases.
If conservative treatment is ineffective or complications are
observed adequate invasive or surgical treatment should be
initiated.
It is estimated that invasive treatment by intercostal tube drainage
or surgery is indispensable in 11-12% of patients in whom
antibiotic therapy was ineffective.
Estrera AS, Platt MR, Mills LJ, et al. Primary lung abscess. J Thorac Cardiovasc Surg
1980; 79:275-282
Antibiotic therapy for lung abscess
■ The choice of antibiotics varies
somewhat between institutions.
■ First choice is third-generation
cephalosporin and flucloxacillin (or
clindamicin) until the aspirated
lung abscess fluid culture results
are available to rationalize therapy.
■ For patients at risk of secondary
lung abscess through aspiration, it
is important to cover anaerobes
normally found in the upper airway,
with clindamicin providing coverage
against these organisms as well as
S. aureus.
■ Alternatives could include
benzylpenicillin and metronidazole.
Alsubie H and Fitzgerald DA. Lung abscess in children. Journal of Pediatric Infectious Disease. 2009; 4: 27-35.
Antibiotic therapy for lung abscess
(duration)
■ There is no generally agreed-on duration for the treatment of lung
abscess.
■ Patients often are treated for 6 to 8 weeks or longer.
■ One study using clindamycin to treat anaerobic abscess showed
excellent efficacy, with no advantage of 6 weeks over 3 weeks of
therapy,
■ Many authorities recommend weekly or biweekly chest radiographs in
patients showing clinical improvement, with discontinuation of
therapy when chest radiograph is clear or there is a small stable
residual lesion
Mustafa M, Iftikhar HM, Muniandy RK, Hamid SA, Sien MM, Ootha N.. Lung abscess: diagnosis, treatment, and mortality.
International Journal of Pharmaceutical Science Invention. 2015; 4 (2): 37-41
Lung abscess
Surgicasl treatment - INDICATIONS:
Massive hemoptysis,
Pleural empyema,
Bronchopleural fistula,
Conservative treatment failure,
Foreign body,
Big abscess (big cavity, >6cm after 8 weeks of treatment),
Cancer suspicion.
Lung abscess drainage
Lung abscess
Bad prognostic factors:
Big abscess,
Right lower lobe,
Bad general condition (anemia, hipoproteinemia,
alcohol abuse, narcotics abuse, neurogical
abnormaity)
Pathogenic bacteria:
- Pseudomonas aeruginosa – mortality rate: app. 83%,
- Staphylococus aureus – mortality rate: app. 50%.
- Klebsiella pneumoniae -44%).
Lung abscess
General complicatons:
bacterial endocarditis,
multifocal liver abscess,
multifocal brain abscess,
nephritis, amyloidosis,
sepsis,
multi-organ failure
Mortality rate: 15%-20%
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