Lung abscess
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| Lung abscess Classification and external resources | |
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| Gross lung section showing apical abscess | |
| ICD-10 | J85. |
| ICD-9 | 513.0 |
| DiseasesDB | 7607 |
| eMedicine | med/1332 |
| MeSH | D008169 |
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WikiDoc Resources for Lung abscess | |
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Most recent articles on Lung abscess Most cited articles on Lung abscess | |
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Evidence Based Medicine | |
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Ongoing Trials on Lung abscess at Clinical Trials.gov Clinical Trials on Lung abscess at Google
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US National Guidelines Clearinghouse on Lung abscess
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Patient resources on Lung abscess Discussion groups on Lung abscess Patient Handouts on Lung abscess Directions to Hospitals Treating Lung abscess Risk calculators and risk factors for Lung abscess
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Causes & Risk Factors for Lung abscess | |
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Lung abscess is necrosis of the pulmonary tissue and formation of cavities (more than 2 cm)[1] containing necrotic debris or fluid caused by microbial infection.
This pus-filled cavity is often caused by aspiration, which may occur during altered consciousness. Alcoholism is the most common condition predisposing to lung abscesses.
Lung Abscess is considered primary(60%[1]) when it results from existing lung parenchymal process and is termed secondary when it complicates another process e.g. vascular emboli or follows rupture of extrapulmonary abscess into lung.
Causes
Conditions contributing to lung abscess
- Aspiration of oropharyngeal or gastric secretion
- Septic emboli
- Necrotizing pneumonia
- Vasculitis: Wegener's granulomatosis
- Necrotizing tumors: 8% to 18% are due to neoplasms across all age groups, higher in older people; primary squamous carcinoma of the lung is the commonest.
Organisms
In the post-antibiotic era pattern of frequency is changing. In older studies anerobes were found in upto 90% cases but they are much less frequent now[1].
- Anaerobic bacteria: Peptostreptococcus, Bacteroides, Fusobacterium species,
- Microaerophilic streptococcus : Streptococcus milleri
- Aerobic bacteria: Staphylococcus, Klebsiella, Haemophilus, Pseudomonas,Nocardia, Escheria coli, Streptococcus, Mycobacteria[1]
- Fungi: Candida, Aspergillus
- Parasites: Entamoeba histolytica,
Symptoms and signs
Onset of symptoms is often gradual, but in necrotizing staphylococcal or gram-negative bacillary pneumonias patients can be acutely ill. Cough, fever with shivering and night sweats are often present. Cough can be productive with foul smelling purulent sputum (≈70%) or less frequently with blood (i.e. hemoptysis in one third cases) [1]. Affected individuals may also complaint chest pain, shortness of breath, lethargy and other features of chronic illness.
Patients are generally cachectic at presentation. Finger clubbing is present in one third of patients[1]. Dental decay is common especially in alcoholics and children. On examination of chest there will be features of consolidation such as localised dullness on percussion, bronchial breath sound etc.
Diagnosis
- Chest Xray and other imaging studies
Abscess is often unilateral and single involving posterior segments of the upper lobes and the apical segments of the lower lobes as these areas are gravity dependent when lying down. Presence of air-fluid levels implies rupture into the bronchial tree or rarely growth of gas forming organism.
- Laboratory studies
Raised inflammatory markers ( high ESR, CRP) are usual but not specific. Examination of sputum is important in any pulmonary infections and here often reveals mixed flora. Transtracheal of Transbronchial (via bronchoscopy) aspirates can also be cultured. Fibre optic bronchoscopy is often performed to exclude obstructive lesion; it also helps in bronchial drainage of pus.
Management
Broadspectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection.
Complications
Rare now a days but include spread of infection to other lung segments, bronchiectasis, empyema, and bacteraemia with metastatic infection such as brain abscess[1].
Prognosis
Most cases respond to antibiotic and prognosis is usually excellent unless there is a debilitating underlying condition. Mortality from lung abscess alone is around 5% and is improving.
See also
- Other chronic lung infections
- Abscess
- Pleural effusion
External links
Reference
WikiDoc Research Resources for Lung abscess | |
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| Articles on Lung abscess | Most recent articles on Lung abscess • Most cited articles on Lung abscess • Review articles on Lung abscess • Articles on Lung abscess in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Lung abscess | Powerpoint slides on Lung abscess • Images of Lung abscess • Photos of Lung abscess • Podcasts & MP3s on Lung abscess • Videos on Lung abscess |
| Evidence Based Medicine Regarding Lung abscess | Cochrane Collaboration on Lung abscess • Bandolier on Lung abscess • TRIP on Lung abscess |
| Cost Effectiveness of Lung abscess | Cost Effectiveness of Lung abscess |
| Clinical Trials Involving Lung abscess | Ongoing Trials on Lung abscess at Clinical Trials.gov • Trial results on Lung abscess • Clinical Trials on Lung abscess at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Lung abscess | US National Guidelines Clearinghouse on Lung abscess • NICE Guidance on Lung abscess • NHS PRODIGY Guidance • FDA on Lung abscess • CDC on Lung abscess |
| Textbook Information on Lung abscess | Books and Textbook Information on Lung abscess |
| Pharmacology Resources on Lung abscess | Dosing of Lung abscess • Drug interactions with Lung abscess • Side effects of Lung abscess • Allergic reactions to Lung abscess • Overdose information on Lung abscess • Carcinogenicity information on Lung abscess • Lung abscess in pregnancy • Pharmacokinetics of Lung abscess • |
| Genetics, Pharmacogenomics, and Proteinomics of Lung abscess | Genetics of Lung abscess • Pharmacogenomics of Lung abscess • Proteomics of Lung abscess |
| Newstories on Lung abscess | Lung abscess in the news • Be alerted to news on Lung abscess • News trends on Lung abscess |
| Commentary on Lung abscess | Blogs on Lung abscess |
| Patient Resources on Lung abscess | Patient resources on Lung abscess • Discussion groups on Lung abscess • Patient Handouts on Lung abscess • Directions to Hospitals Treating Lung abscess • Risk calculators and risk factors for Lung abscess |
| Healthcare Provider Resources on Lung abscess | Symptoms of Lung abscess • Causes & Risk Factors for Lung abscess • Diagnostic studies for Lung abscess • Treatment of Lung abscess |
| Continuing Medical Education (CME) Programs on Lung abscess | CME Programs on Lung abscess |
| International Resources on Lung abscess | Lung abscess en Espanol • Lung abscess en Francais |
| Business Resources on Lung abscess | Lung abscess in the Marketplace • Patents on Lung abscess |
| Informatics Resources on Lung abscess | List of terms related to Lung abscess |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
