SUPPURATIVE AND ASPIRATION PNEUMONIA &PULMONARY ABSCESS Dr.kassim.m.sultan F.R.C.P

Objectives: Upon completion of this lecture the students will be able to : Define suppurative and aspiration pneumonia &pulmonary abscess and bronchiectasis To know their etiological causes Describe their clinical features Illustrate ways of diagnosis Management of suppurative and aspiration pneumonia &pulmonary abscess and bronchiectasis

Definition suppurative pneumonia:destruction of the lung parenchyma by inflammatory process&micro abscesses formation lung abscess is localized large collection of pus or cavity usually morethan 2cm lined by chronic inflammatory tissue from which pus has escaped by rupture into a bronchus. inhalation of septic material,tend to localize in dependent areas of lung in 50%(apical segment of lower lobe&posterior segment of upper lobe).

aetiology 1-aspiration: A-reduced level of consciousness due to CVA,alcoholism,drug abuse,general anesthesia. B-dysphagia,achalasia,foreign body,nasogastric tube,endotracheal tube. 2-gingivitis,sinusitis,bronchiectasis may result in lung abscess 3-infection in lung infarction. 4-infection with virulent microorganism like klebsiella&staph.aureus

CLINICAL FEATURES symptoms Acute:fever,cough,malaise,pleurisy Chronic:Cough productive of large amounts of sputum which is sometimes fetid and blood-stained,low grade fever,malaise,anemia,weight loss, Sudden expectoration of copious amounts of foul sputum occurs if abscess ruptures into a bronchus . signs High remittent pyrexia Profound systemic upset Digital clubbing may develop quickly (10-14 days) Chest examination usually reveals signs of consolidation; signs of cavitation are rarely found Pleural rub is common

Diagnosis Clinical features sputum& blood for culture&sensitivity. Sputum for AFB. CXR: A large, dense opacity, which may later cavitate and show a fluid level, is the characteristic finding when a frank lung abscess is present. CT scan also show acavity&fluid level Bronchoscopy to exclude obstruction by foreign body,tumor or lymph node.

recently MRSA are isolated which produce the toxin panton-valentine lukocidin,which cause rapidly progressive severe necrotizing pneumonia.

anaerobic pneumonia with abscess formation in a 48-year-old alcoholic man. the abscesses are located in the posterior segment of right upper lobe,pa view

the same patient,lat.view

treatment 1-antibiotics:according to culture & sensitivity co-amoxiclav 1.2g 8hrly i.v. If an anaerobic bacterial infection is suspected (e.g. from fetor of the sputum),metronidazole 400 mg 8-hourly i.v should be added. MRSA is treated by clindamycin 600mg 6hrly i.v prolonged Rx for 4-6 wk(2 weeks via i.v route,then continue on oral route) is required for lung abscess or even longer. 2- physio Rx especially in large abscesses&abscesses of upper lobes.

Treatment/continue 3-surgery should be considered in treatment failure or complication like bronchiectasis. 4-bronchoscopic removal of materials obstructing bronchi.

prognosis Mortality rate is 5-10% Poor prognostic criteria: 1-larg abscess more than 6cm. 2-underlying obstructive tumor. 3-immunocomporomised patients.

complications Empyema&pyopneumothorax. Amyloidosis. Brain&systemic abscesses.

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