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Revue Des Maladies Respiratoires Jun 2019Lung abscesses are necrotic cavitary lesions of the lung parenchyma. They are usually caused by anaerobic bacteria or mixed flora and typically occur after aspiration.... (Review)
Review
Lung abscesses are necrotic cavitary lesions of the lung parenchyma. They are usually caused by anaerobic bacteria or mixed flora and typically occur after aspiration. Primary lung abscesses occur in previously healthy patients with no underlying medical disorders and are usually solitary. Secondary lung abscesses occur in patients with underlying or predisposing conditions and may be multiple. The initial diagnosis is usually made by chest radiography showing a lung cavity with an air-fluid level. Typically, the cavity wall is thick and irregular, and a surrounding pulmonary infiltrate is often present. The differential diagnosis of pulmonary cavitation is wide, including different types of possible infections, neoplasia and malformations of the bronchial tree. Management is usually based on prolonged antibiotic treatment. Failure of conservative management, manifested by the persistence of sepsis and/or other abscess complications, may necessitate drainage with invasive techniques (percutaneous, endoscopic or surgical) or open surgical removal of the lung lesion in patients with good performance status and sufficient respiratory reserve.
Topics: Diagnosis, Differential; Humans; Lung Abscess
PubMed: 31202603
DOI: 10.1016/j.rmr.2018.07.010 -
Zentralblatt Fur Chirurgie Dec 2020Lung abscess is a localized infectious pus-filled cavity of the lung tissue by viral, bacterial, mycotic or parasitic pathogens. Currently, there are different...
Lung abscess is a localized infectious pus-filled cavity of the lung tissue by viral, bacterial, mycotic or parasitic pathogens. Currently, there are different classifications, which are based primarily on the genesis and duration of symptoms. Important steps for diagnosis are in addition to clinical examination, laboratory and chest X-ray especially bronchoscopy with microbiological examinations and computed tomography. Treatment of lung abscesses continues to be a domain of conservative antibiotic therapy. The vast majority of cases can be cured with this. Interventional procedures such as transthoracic or endobronchial abscess drainage with subsequent irrigation can effectively support the healing process. Thoracic surgery is particularly important in cases of failure of conservative and interventional therapy as well as secondary abscesses on the basis of a lung carcinoma. Mostly anatomical resections are required. Alternatively, VAC therapy (vacuum-assisted closure therapy) may be considered in seriously ill, old, immunosuppressed, and multimorbid patients with complicated abscesses (e.g. perforation in the pleural cavity and sero-pneumothorax).
Topics: Bronchoscopy; Drainage; Humans; Lung Abscess; Negative-Pressure Wound Therapy; Pneumothorax
PubMed: 33260228
DOI: 10.1055/a-0949-7414 -
Seminars in Thoracic and Cardiovascular... Apr 1995The problems of lung abscess and empyema were recognized by physicians in ancient times, and continue to pose a challenge for contemporary practitioners. Until the... (Review)
Review
The problems of lung abscess and empyema were recognized by physicians in ancient times, and continue to pose a challenge for contemporary practitioners. Until the current century, anaerobic bacterial infections were undoubtedly the most common cause of lung abscess and empyema. However, other infectious causes are becoming increasingly common as more patients present with complex comorbidities and/or severe immunosuppression. Most lung abscesses respond to appropriate antimicrobial therapy; only about 10% of patients require external drainage or surgical therapy. Noninfected parapneumonic effusions usually respond to systemic antibiotic therapy alone. However, complete drainage of the pleural space is indicated if an effusion is infected or has the characteristics of frank pus. Some parapneumonic effusions that are not grossly turbid and that have negative cultures are nevertheless "complicated"; that is, these effusions have a high risk for causing pleural loculations unless drained early in their course. Over the past 20 years, it has been demonstrated that chemical analysis of parapneumonic effusions (eg, pH, glucose, LDH) is helpful in identifying apparently noninfected, but nevertheless "complicated," parapneumonic effusions. Optimum diagnosis and management of lung abscess and empyema require the coordinated efforts of thoracic surgeons and medical specialists.
Topics: Diagnosis, Differential; Empyema; Humans; Lung Abscess
PubMed: 7612756
DOI: No ID Found -
Current Opinion in Pulmonary Medicine May 2024Lung abscess is a severe and complex respiratory infection. The purpose of this review is to discuss recent publications on lung abscess, covering topics such as... (Review)
Review
PURPOSE OF REVIEW
Lung abscess is a severe and complex respiratory infection. The purpose of this review is to discuss recent publications on lung abscess, covering topics such as epidemiology, clinical presentation, diagnosis, and treatment and prevention.
RECENT FINDINGS
Risk factors associated with lung abscess include structural lung disease, poor dental hygiene, and ventilator-associated pneumonia, while concerns are now raised regarding the potential of electronic cigarettes use as a risk factor. The complexity of lung abscess is reflected by the relative high number of case reports describing rare and complex cases. Early transthoracic drainage could improve in-hospital outcomes, while next-generation sequencing could become an important tool in diagnostics and future clinical studies.
SUMMARY
High-quality evidence and guidelines to support treatment of lung abscess are lacking. Despite advancements, we call for prospective studies to evaluate the use of invasive procedures and antibiotic treatment regimens.
Topics: Humans; Anti-Bacterial Agents; Electronic Nicotine Delivery Systems; Lung Abscess; Risk Factors
PubMed: 38411181
DOI: 10.1097/MCP.0000000000001058 -
ANZ Journal of Surgery Jul 2022Lung abscess is a rare condition in paediatrics with a paucity of literature. Intravenous antibiotics is the main therapy; however interventional radiological approaches...
BACKGROUND
Lung abscess is a rare condition in paediatrics with a paucity of literature. Intravenous antibiotics is the main therapy; however interventional radiological approaches have led to the use of percutaneous drainage. Surgery is reserved for the management of complications. The aim of this study was to describe lung abscess in a cohort of paediatric patients' and determine associations between factors at presentation and outcomes.
METHODS
A 14-year retrospective cohort study was conducted including all children who presented to a tertiary paediatric hospital in Western Australia with lung abscess. Clinical characteristics, laboratory and radiologic findings, management options and clinical outcomes were examined.
RESULTS
Sixty-eight patients (median age 3.6 (0.08-17.6) years; 44.1% female) were identified to have a lung abscess, with 81% being primary lung abscess. Staphylococcus aureus (including MRSA) and Streptococcus pneumoniae were the most common organisms identified, with S. aureus being most common in Aboriginal patients (80%). A total of 25 antibiotics were prescribed on initiation of treatment in over 20 combinations. 44.9% of patients had complications and hospitalization was prolonged. Patients with S. aureus had longer hospitalization (20.5 days (3-67) than those without (median 13 days (3-52), p = 0.04). There were no associations between factors at presentation and subsequent outcomes. Factors at presentation were not associated with outcomes.
CONCLUSION
There is unwarranted variation in management of paediatric lung abscess and high complication rates. There is a need for collaboration and clinical practice guidelines to standardize care for lung abscess in children.
Topics: Anti-Bacterial Agents; Child; Child, Preschool; Drainage; Female; Hospitals, Pediatric; Humans; Lung Abscess; Male; Retrospective Studies; Staphylococcus aureus
PubMed: 35678219
DOI: 10.1111/ans.17844 -
Surgical Infections Jun 2013
Topics: Aged; Cardiac Surgical Procedures; Humans; Lung Abscess; Male; Postoperative Complications; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 23662943
DOI: 10.1089/sur.2012.060 -
The American Journal of Medicine Jul 2022
Topics: Adult; Foreign Bodies; Humans; Lung Abscess
PubMed: 35314133
DOI: 10.1016/j.amjmed.2022.02.034 -
Paediatric Respiratory Reviews Mar 2007Lung abscess is an uncommon paediatric problem, with a paucity of quality data on the subject in the medical literature. Although the condition has for many years been... (Review)
Review
Lung abscess is an uncommon paediatric problem, with a paucity of quality data on the subject in the medical literature. Although the condition has for many years been managed successfully with prolonged courses of intravenous antibiotics, the evolution of interventional radiology has seen the use of percutaneously placed 'pigtail catheters' inserted under ultrasound and computed tomography guidance become the mainstay of therapy where such resources are available. This has been suggested to result in a more rapid defervescence of fever and symptoms, shorter periods of intravenous antibiotics and a decreased length of inpatient care. More invasive procedures, aspiration and drainage, together with improved microbiological diagnostic techniques, including polymerase chain reaction testing, has increased the yield of pathogens identified from abscess fluid samples. Culture results will guide treatment, especially for immunocompromised subjects who may develop a lung abscess as a complication of their underlying condition. The predominant pathogens isolated from primary lung abscesses in children include streptococcal species, Staphylococcus aureus and Klebsiella pneumoniae. Children with a lung abscess, both primary and secondary, have a significantly better prognosis than adults with the same condition.
Topics: Child; Female; Humans; Lung Abscess
PubMed: 17419981
DOI: 10.1016/j.prrv.2006.10.002 -
Zentralblatt Fur Chirurgie Oct 2015A lung abscess is an infectious pulmonary disease characterised by the presence of a pus-filled cavity within the lung parenchyma. The content of an abscess often drains... (Review)
Review
A lung abscess is an infectious pulmonary disease characterised by the presence of a pus-filled cavity within the lung parenchyma. The content of an abscess often drains into the airways spontaneously, leading to an air-fluid level visible on chest X-rays and CT scans. Primary lung abscesses occur in patients who are prone to aspiration or in otherwise healthy individuals; secondary lung abscesses typically develop in association with a stenosing lung neoplasm or a systemic disease that compromises immune defences, such as AIDS, or after organ transplantation. The organisms found in abscesses caused by aspiration pneumonia reflect the resident flora of the oropharynx. The most commonly isolated organisms are anaerobic bacteria (Prevotella, Bacteroides, Fusobacterium, Peptostreptococcus) or streptococci; in alcoholics with poor oral hygiene, the spectrum of pathogens includes Staphylococcus aureus, Streptococcus pyogenes and Actinomyces. Chest radiography and computed tomography (CT) are mandatory procedures in the diagnostic algorithm. Standard treatment for a lung abscess consists of systemic antibiotic therapy, which is based on the anticipated or proven bacterial spectrum of the abscess. In most cases, primary abscesses are successfully treated by calculated empiric antibiotic therapy, with an estimated lethality rate of less than 10 %. Secondary abscesses, despite targeted antimicrobial therapy, are associated with a poor prognosis, which depends on the patient's general condition and underlying disease; lethality is as high as 75 %. Negative prognostic factors are old age, severe comorbidities, immunosuppression, bronchial obstruction, and neoplasms. Surgical intervention due to failure of conservative treatment is required in only 10 % of patients, with a success rate of up to 90 % and postoperative mortality rates ranging between 0 and 33 %. Treatment success after endoscopic or percutaneous drainage is achieved in 73 to 100 % of cases, with an acceptable mortality rate (0-9 %).
Topics: Anti-Bacterial Agents; Bronchoscopy; Combined Modality Therapy; Diagnosis, Differential; Disease Progression; Humans; Lung Abscess; Microbial Sensitivity Tests; Pneumonectomy; Tomography, X-Ray Computed
PubMed: 26351764
DOI: 10.1055/s-0035-1557883 -
Internal Medicine (Tokyo, Japan) Dec 2023
Topics: Humans; Fusobacterium nucleatum; Lung Abscess; Fusobacterium Infections
PubMed: 37081680
DOI: 10.2169/internalmedicine.1751-23