| ID | 93 |
|---|---|
| Name | SUPPURATIVE PNEUMONIA (Including Lung abscess) |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Essentials of diagnosis: 1. Predisposition to aspiration. 2. Poor oral hygiene. 3. Fever, weight loss, malaise. 4. Foul- smelling sputum (fewer than half of patients). 5. Infiltrate in dependent lung zone, with single or multiple areas of cavitation or pleural effusion. |
| Investigations | Radiological investigations: Homogenous lobar or segmental opacity consistent with consolidation or collapse. A large, dense opacity which may later cavitate and show a fluid level is the characteristic finding of a frank lung abscess. |
| Management | Management: A. Antibiotics- Antibiotic therapy should be given according to culture & sensitivity test if available- 1. Penicillins are the usual or standard treatment for anaerobic pleuro-pulmonary infections, such as- i. Amoxicillin 500mg orally 6-hourly or penicillin G 1-2 million units i.v may be effective in many patients. Or, Co-amoxiclav l-2gm orally 8-hourly may be given in case of aspiration pneumonia. Plus, ii. Metronidazole 400mg orally 8-hourly. 2. If patients do not respond to penicillins- Clindamycin 600mg i.v 8-hourly until improvement, then 300mg orally 6-hourly is an acceptable alternative to penicillin for treatment of anearobic pleuropulmonary infections. Cephalosporins or ciprofloxacin are also effective alternative. Antibiotic therapy should be continued until the chest radiograph improves, a process that may take a month or more. B. Adequate drainage is essential; postural drainage may be tried. But if it is ineffective tube thoracostomy is required for the treatment of empyema, but open pleural drainage is often necessary. C. Physiotherapy is of great value. Features associated with a high mortality in pneumonia: 1. Age- 60 years or more. 2. Respiratory rate > 30/min. 3. A diastolic BP < 60 mmHg. 4. Serum urea = 7 mmol/1. 5. The presence of confusion. 6. Leukopenia / leukocytosis 7. Involvement of more than one lobe. |
| Introduction | Suppurative pneumonia is characterised by destruction of the lung parenchyma by the inflammatory process and formation of microabscesses are the histologic features. But, the term ‘pulmonary abscess’ refers to lesion in which there is a fairly large localised collection of pus, or a cavity lined by chronic inflammatory tissue from which pus has escaped by rupture into the bronchus. Aspiration or inhalation of infected oropharyngeal contents or septic material during operations or feeding or sleeping or during unconsciousness or general anesthesia and the diseases which cause impaired deglutition lead to pneumonia in the dependent part of the lungs, such as the apical segment of the lower lobes. The onset of symptoms is usually insidious and gradually develop necrotizing suppurative pneumonia, lung abscess or empyema. About two-thirds of patients with suppurative pneumonia, lung abscess, and empyema are found to be infected with multiple species of anaerobic bacteria only. Most of the remainder are infected with both anaerobic and aerobic bacteria. |
| History | |
| Etiology | |
| Clinical Features | Clinical feature: Symptoms: Onset- acute or insidious Productive cough with large amount of sputum which is sometimes fetid and blood stained. Pleural pain common. Sudden expectoration of copious amount of sputum occurs if abscess ruptures into a bronchus Signs: 1. High remittent pyrexia. 2. Profound systemic upset. 3. Finger clubbing may develop quickly (10-14 4days). 4. Chest examination reveals signs of consolidation. 5. Pleural rub common. 6. Papid deterioration in general health. |
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