Lung abscess: Difference between revisions
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*Tooth extraction |
*Tooth extraction |
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== Clinical Presentation == |
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* Cough, fever, night sweats |
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* Anaerobes more likely to be involved when symptoms are subacute or indolent (lasting longer than 2 weeks) |
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==Differential Diagnosis== |
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== Investigations == |
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* Routine investigations: CT chest, sputum for Gram stain (though may not grow anaerobes), blood cultures |
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* If easy to obstain, can consider transtracheal aspirates, transthoracic needle aspirates, and pleural fluid culture |
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* If diagnosis is uncertain, bronchoscopy |
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== Diagnosis == |
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* Usually made based on CT chest plus compatible symptoms |
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==Management== |
==Management== |
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*Unless clearly monomicrobial, should treat broadly and include good anaerobic coverage |
*Unless clearly monomicrobial, should treat broadly and include good anaerobic coverage |
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**Either a β-lactam plus [[metronidazole]], or [[clindamycin]] |
**Either a β-lactam plus [[metronidazole]], or [[clindamycin]] |
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**Possibly [[amoxicillin-clavulanic acid]] or [[moxifloxacin]], though anaerobic coverage may not be adequate |
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*Duration depends on clinical and radiographic response |
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**Indicated in failure of medical management, suspected neoplasm, or hemorrhage |
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**May also be indicated if slow response with obstructed bronchus, large abscess (>6 cm diameter), or resistant organisms (such as [[Pseudomonas aeruginosa]]) |
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**If poor surgical candidate, can consider endoscopic or percutaneous drainage |
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[[Category:Respiratory infections]] |
[[Category:Respiratory infections]] |
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Revision as of 20:05, 3 January 2021
Background
Microbiology
- Usually polymicrobial, including oral anaerobes
- Can also be monomicrobial, caused by Klebsiella, Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia pseudomallei (melioidosis), Pasteurella multocida, Streptococcus pyogenes, Haemophilus influenzae types b and c, Legionella species, Rhodococcus equi, Actinomyces species, and Nocardia species
Pathophysiology
- Mostly from chronic aspiration
Risk Factors
- Chronic aspiration from any etiology
- Alcohol use disorder
- Seizure disorder, stroke, drug overdose, general anesthesia
- Dysphagia or respiratory dysfunction from ALS, Parkinson disease, or stroke
- Tooth extraction
Clinical Presentation
- Cough, fever, night sweats
- Anaerobes more likely to be involved when symptoms are subacute or indolent (lasting longer than 2 weeks)
Differential Diagnosis
Investigations
- Routine investigations: CT chest, sputum for Gram stain (though may not grow anaerobes), blood cultures
- If easy to obstain, can consider transtracheal aspirates, transthoracic needle aspirates, and pleural fluid culture
- If diagnosis is uncertain, bronchoscopy
Diagnosis
- Usually made based on CT chest plus compatible symptoms
Management
- Unless clearly monomicrobial, should treat broadly and include good anaerobic coverage
- Either a β-lactam plus metronidazole, or clindamycin
- Possibly amoxicillin-clavulanic acid or moxifloxacin, though anaerobic coverage may not be adequate
- Duration depends on clinical and radiographic response
- As short as 3 weeks, but usually up to 6 to 8 weeks
- Can follow progress radiographically
- Rarely requires surgical intervention for lobectomy or pneumonectomy
- Indicated in failure of medical management, suspected neoplasm, or hemorrhage
- May also be indicated if slow response with obstructed bronchus, large abscess (>6 cm diameter), or resistant organisms (such as Pseudomonas aeruginosa)
- If poor surgical candidate, can consider endoscopic or percutaneous drainage
