Lung Abscess
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Localised inflammation and necrosis (destruction) of lung tissue leading to pus formation. It is most commonly caused by aspiration of oral secretions by patients who have impaired consciousness.
Cause
- Infection of lungs with pus forming organisms: e.g. Klebsiella pneumoniae, Staphylococcus aureus
Clinical features
- Onset is acute or gradual
- Malaise, loss of appetite, sweating with chills and fever
- Cough with purulent sputum, foul-smelling breath (halitosis)
- Chest pain indicates pleurisy
- Finger clubbing
Complications
- Pus in the pleural cavity (empyema)
- Coughing out blood (haemoptysis)
- Septic emboli to various parts of the body, e.g. brain (causing brain abscess)
- Bronchiectasis (pus in the bronchi)
Differential diagnosis
- Bronchogenic carcinoma
- Bronchiectasis
- Primary empyema communicating with a bronchus
- TB of the lungs
- Liver abscess communicating into the lung
Investigations
- Chest X-ray
- Early stages: Signs of consolidation
- Later stages: A cavity with a fluid level
- Sputum: For microscopy and culture and sensitivity
ManagementTreatment
- Benzylpenicillin 1-2 MU IV or IM every 4-6 hours
- Child: 50,000-100,000 IU/kg per dose (max: 2 MU)
- Plus metronidazole 500 mg IV every 8-12 hours
- Child: 12.5 mg/kg per dose
Once improvement occurs, change to oral medication and continue for 4-8 weeks
- Metronidazole 400 mg every 12 hours
- Child: 10 mg/kg per dose
- Plus Amoxicillin 500 mg-1 g 8 hourly
- Child: 25-50 mg/kg per dose for for 4-6 weeks
- Postural drainage/physiotherapy
- Surgical drainage may be necessary
Prevention
- Early detection and treatment of pneumonia