-Etiology and Risk Factors:
Aspiration (1ry cause) | Post pneumonic (2ry) | Hematogenous (2ry) | Colonization (2ry to lung disease) | Immune deficiency (1ry/2ry) |
-Dental/ Periodontal sepsis (micro-aspiration) -Depressed conscious level (alcohol, sedation, epilepsy, head injury, diabetic coma, CV accident and others) -Disturbed swallowing (esophageal stricture, bulbar or pseudo-bulbar palsy, achalasia, pharyngeal pouch) | 1- UTI 2- Abd./ Pelvic sepsis. 3- IEC (rt.) 3- IV drug abuse. 3- Infected cannula. 3- Septic thrombophlebitis. | -Bronchiectasis -Cystic Fibrosis -Bronchial obstruction by F.B, tumor, congenital abnormality | -Local: .larynx:palsy, unconsc. .Cricophar. achalasia or Cancer .Inefficient expectoration (postoperative,posttraum.) .↓ciliary mov ( -General: defect in humeral or cellular mechanisms or functions | |
By: -Anaerobic 63% in community acq. (bacteroids, fusibacterium, peptostreptococci, micro-aerophilic streptococci) -Streptococci -Staph. A. -Spirochetes -Occasionally proteus, clostridia | By: -Staph A. -Klebsilella Pneumonie -Stept. Milleri .viridans gp. -Pseudomonas A. *(strept. Pn. isn't a cause of abscess) | By: 1-G –ve 2-Anaerobic 3-Septic emboli caused by Staph., Strept., Anaerobes. *rare bl born org.: plague, anthrax, salmonella , amoeba | By: G –ve organisms | By: -G –ve -Fungal .aspergillus .coccidiosis.histoplasm. .nocardia .actinomycosis -TB |
-Treatment:
a. Antibiotics: it's the mainstay for treatment à for 4-6 wks up to 6Ms according to clinical status and radiology.
§ Metronidazole (500mg/8hrs) à against anaerobes and G-ve
§ Penecillin-G (5-10 megaunits to 40) à against G+ve and anaerobes
§ Clindamycin (600mg/8hrs then 150-300mg qid)
§ Chloramphenicol à against all anaerobes
§ Other beta lactams such as ampicillin and sulbactam, ticarcillin or amoxicillin with clavulanate, piperacillin with tazobactam, imipenem, 3rd-4th generation cephalosporins à against anaerobes.
§ Presently, available quinolonesà have very poor activity against anaerobes and streptococci.
b. Postural drainage therapy:
§ Patient should have empty stomach and prepared with bronchodilator and humidification prior to postural drainage.
§ Consists of postural drainage, positioning, turning with percussion or vibration and cough or airway clearance techniques.
§ Designed to improve the mobilization of bronchial secretions and the matching of ventilation and perfusion and to normalize FRC based on the effects of gravity and external manipulation of the thorax.
§ Patient is kept in a position for 15 mins according to the site of abscess.
c. TTT of the cause: bronchoscopy for drainage (if failed control with the previous 2), F.B extraction or interventional ttt of a tumor (rigid bronchoscopy)
d. TTT of complications
e. Surgery: done if medical treatment failed or when suspecting malignancy or with life threatening hemoptysis or when chronic abscess (when there is sepsis and surrounded functionless lung) or for treating complication that can't be treated by the usual ways à resective surgery (lobectomy).
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