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A case report of a patient with an abscess of the lung caused by a pancreaticobronchial fistula is presented. The patient was treated by pulmonary resection and distal pancreatectomy-splenectomy.
The stay in hospital was compared for patients with acute abscesses of the lungs treated according to the standard scheme and a new method of intrapulmonary antibiotic injections and endobronchial administration of actologous macrophages. The proposed treatment proved more efficient, as it resulted in a 12.1 +/- 0.3 day decrease in the duration of hospital stay versus control group on conventional regime.
A study of the immunological status in 52 patients with acute and 20 patients with chronic abscesses of the lungs, 86 patients with viral hepatitis revealed disorders of the immunological reactivity of a quantitative character with monotypic immune response. In autoimmune disorders it is necessary to carry out immunocorrection. In chronic forms immunocorrection should be considered the main treatment method.
The method of lymphosorption detoxication used in the complex treatment of abscesses of the lungs and their complications in 37 patients is described. The total amount of fractional lymphosorptions is 258. The application of the method is shown to be expedient and to give positive results.
A 26 year old female patient was admitted to our hospital because of septic temperatures and chills. In the patient's history renal insufficiency has been known for several years due to agenesia of the right and pyelonephritic renal congestion of the left kidney. Long lasting anorexia nervosa had been treated by psychotherapeutical interventions for years and when failing it necessitated repeated intravenous nutrition by central venous lines. The prominent symptom of the intravenously treated young woman was fever up to 39.7 degrees C and pneumonia, which was considered by the first treating clinic to be caused directly by diminished immunoreactivity in malnutrition and preuremia. The chest X-ray confirmed pneumonia and revealed multiple abscesses in both lungs (Figure 1). After being transferred to our intensive care unit the pathophysiological context became obvious. From inspection (positive jugular pulsation), from auscultation (holosystolic murmur at the left parasternal border) tricuspid incompetence due to infective endocarditis was suspected. This was confirmed immediately by TM and two-dimensional transthoracic echocardiography, which showed a large vegetation on the anterior tricuspid valve leaflet (Figures 2a and 2b). Tricuspid regurgitation was also ascertained by color flow echocardiography (Figure 2c). Several blood cultures were positive for staphylococcus aureus. Clinical and laboratory recovery was achieved by antibiotic therapy with vancomycin and cephtazidim for 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)
We report a case of lung abscess caused by Eikenella corrodens and reviewed the literature. A 51-year-old man was hospitalized because of an infiltrative shadow in the left upper lung on chest X-ray. The patient was intravenously given CEZ (2 g/day) followed by CEZ (4 g/day) and AMK (200 mg/day). We nevertheless deteriorated and was subsequently treated with CTM (4 g/day) and LCM (6 g/day), and the shadow improved but remained. Only Eikenella corrodens was isolated from aspiration materials obtained from the resected lung. We examined the susceptibility of 60 strains of Eikenella corrodens to various antimicrobial against. The organisms were very susceptible to PCG, ABPC, PIPC, CTM, CTX and LMOX, but were all resistant to LCM, CLDM, GM and AMK.
The clinical efficacy of clindamycin was compared with that of penicillin in a randomized study of the treatment of community-acquired putrid lung abscess. After starting therapy, patients treated with clindamycin had a shorter febrile period and fewer days of fetid sputum than patients treated with penicillin (mean 4.4 versus 7.6 days and 4.2 versus 8.0 days, respectively, p less than 0.05). Four of 20 patients treated with penicillin had clinically significant pulmonary or pleural extension of their infection within 10 days after starting therapy; this was not found in any of 19 patients treated with clindamycin (p less than 0.05). Penicillin treatment failed in two additional patients after 20 days of therapy. Within 1 month after treatment, 1 of 4 patients given penicillin for 3 weeks had relapse, but none of the 13 patients given clindamycin for 3 or 6 weeks, and none of the 5 patients given penicillin for 6 weeks had relapse. Overall, only 8 of 15 patients treated with penicillin who could be followed to the end of the study were cured, whereas all 13 patients treated with clindamycin who could be followed were cured (p less than 0.01). These results suggest that penicillin may not be optimal therapy for anaerobic lung abscess.
We describe a case of lung abscess caused by sporadic infection with Legionella micdadei in a patient with AIDS. L micdadei infection can be very difficult to diagnose because the organism stains only weakly Gram negative, requires special culture media, and is not detectable with some direct fluorescent antibody tests that are directed only at Legionella pneumophila. Since it can stain acid fast, it may be confused with mycobacteria. The abscess was successfully treated using antibiotics and percutaneous catheter drainage.
Mycobacterium fortuitum rarely causes lung disease despite its sporadic isolation as a saprophytic colonizer from sputum or saliva. If pulmonary disease occurs, it is usually indolent in nature. The case presented appears to be the first reported case of a M. fortuitum lung abscess that was successfully treated with a prolonged course of trimethoprim/sulfamethoxazole. The patient remains well without evidence of recurrence nearly 2 yr after the cessation of therapy.
An endobronchial lesion with lung abscess in a patient with AIDS was due to Rhodococcus equi. The patient responded to triple chemotherapy.
In a multicentre open prospective trial the effectiveness of AM-CA as first-line treatment of community-acquired lung abscess was evaluated in immunocompetent adult patients. AM-CA was administered intravenously in doses of 4 g/day for at least 7 days, then orally in doses of 2 g/day for at least 14 days. Radio-clinical and laboratory evaluations were made during treatment, and 30 and 60 days after it was discontinued. The results of this trial concerned 57 patients (48 men, 9 women; mean age 52 years). The facilitating factors were those usually found in lung abscess. Twenty-seven patients had previously received an antibiotic treatment which had failed. The clinical picture, built up gradually in 42/37 patients, consisted of infectious syndrome (52 cases), altered general condition (39 cases), purulent expectoration (47 cases), sometimes foetid (10 cases), and thoracic clinical abnormalities (57 cases. X-ray films of the chest showed round abscess images (44 cases) or looked like necrotizing pneumonia (13 cases) with pleural reaction (8 cases). Protecting bacteriological sampling by BFW brushing and transtracheal or transparietal sample collecting was performed in 41 of the 57 patients. The pathogens, isolated in 31 cases, were: S. pneumoniae 5; Streptococcus spp. 12; Staph. aureus 4; H. influenzae 7; Enterobacteriaceae 6; anaerobes 7. These organisms were associated in 8 cases. With the exception of Enterobacter cloacae, all were sensitive to AM-CA in-vitro. The outcome was satisfactory in 52 patients.
Clindamycin was used to successfully treat a lung abscess caused by Legionella pneumophila. The activity of clindamycin, erythromycin, and rifampin against cell-associated growth of L. pneumophila in human monocytes was determined by broth time-kill methodology. More killing of cell-associated growth of L. pneumophila was achieved with clindamycin than with erythromycin. Synergy with rifampin was demonstrated with both erythromycin and clindamycin.
The management of community-acquired lung abscess associated with aspiration is based on adequate antimicrobial treatment and effective drainage. Empiric antimicrobial treatment should cover basic microbial patterns and consist of aminopenicillin/beta-lactamase-inhibitor or clindamycin. Since the spectrum of clindamycin is restricted to Gram-positive microorganisms combination treatment of clindamycin with a second-generation cephalosporin may be warranted. It is crucial to continue antimicrobial treatment until complete resolution of the abscess cavity and the corresponding infiltrates. Drainage is frequently present spontaneously. Additional techniques to ensure effective drainage include bronchoscopic and percutaneous drainage. These techniques are only infrequently indicated in case of clinical failure and of delayed cavity closure. Indications for surgical emergency interventions are mainly limited to severe pulmonary hemorrhage. The clinical success rate of adequate antimicrobial treatment together with effective drainage reaches 75 - 90 %.
A double blind study was conducted to objectively evaluate the usefulness of Cefuzonam (CZON) in the treatment of bacterial pneumonia and lung abscess. Cefotiam (CTM) was used as a control drug. Each drug was administered by intravenous drip infusion at 1 g at a time, twice daily, for 14 days as a rule. The results are as follows: 1. Enrolled in this study were 145 cases in total, comprising 72 of CZON group and 73 of CTM group. Of the total cases, 109 (53 of CZON group and 56 CTM group) were evaluated for clinical efficacy by the evaluation committee. Exclusion rate and background of patients were not significantly different between the two groups. 2. Clinical effectiveness assessed by the committee showed the efficacy rates of 84.9% (45 cases out of 53) for the CZON group and 83.3% (47 cases out of 56) for the CTM group, with no significant difference between the two groups. 3. The bacteriological eradication rates were 89.5% (17 strains out of 19) for the CZON group and 78.3% (18 strains out of 23) for the CTM group, with no significant difference between the two groups. 4. The incidence of side effects was 5 cases (7.5%) for the CZON group and 3 cases (4.2%) for the CTM group. The incidence rate of laboratory test abnormality was 28.4% (19 cases out of 67) for the CZON group and 31.3% (12 cases out of 67) for the CTM group. There was no significant difference between the two groups. 5. Usefulness rates calculated by the committee were 79.2% (42 cases out of 53) for the CZON group and 76.8% (43 cases out of 56) for the CTM group. There was no significant difference between the two groups. These results show that CZON is a useful drug in the treatment of bacterial pneumonia and lung abscess.
We are reporting the case of an 18-month-old girl with a post-pneumonic lung abscess. The counterimmunoelectrophoresis (CIE) of the patient's urine during the bacteremic phase of the disease gave a precipitation line with pneumococcal antiserum. Later in the course of the disease, after the diagnosis of lung abscess had been established, the pus drained from the abscess gave positive reactions with pneumococcal omnivalent serum and type 3 pneumococcal antiserum. At this stage, the pus was sterile and blood cultures were negative. This case demonstrates that the CIE test is a simple procedure which gives a rapid and exact diagnosis up to the serotype level.
To determine the relative cultural accuracy of transtracheal aspiration (TTA), wire-brushing under direct vision through a flexible fiberoptic bronchoscope (WBB), and expectorated sputum (ES) in localized pulmonary infections, we compared each method with percutaneous needle lung aspiration (PLA) cultures in patients with peripheral lung abscesses. Of the 27 organisms that PLA cultures isolated from ten lung abscesses (eight aerobic, two anaerobic), TTA identified 81 percent plus an additional five, and WBB 68 percent plus 16. Of the 14 organisms that PLA cultures isolated from eight aerobic abscesses, TTA identified 93 percent plus an additional two, WBB 83 percent plus 12, and ES 71 percent plus 19. From a laboratory standpoint, we concluded the following: (1) when PLA cultures cannot be obtained, the most accurate method for determining the cause of a localized pulmonary infection is TTA generates false-negative and false-positive information, it may not be an appropriate standard to evaluate other methods, such as ES.
The authors report surgical treatment for thoracic empyema concurrent with rupture of lung abscesses and completely collapsed lung in a child. Right middle lobectomy for ruptured abscess, debridement and closure with interrupted sutures for another abscess in the lower lobe, and decortication were performed. Positive-pressure ventilation was needed to prevent reexpansion pulmonary edema because of long-term collapsed lobes. The patient is doing well with no recurrent empyema or thoracic deformity at 3 years postoperation.
Streptococcus agalactiae is a well-recognized cause of neonatal sepsis and meningitis. In adults, infections by S. agalactiae are rare. We report an adult case of lung abscess and pyogenic spondylitis caused by S. agalactiae. A 51-year-old male was admitted to our hospital because of an abnormal shadow in the chest and lumbago on May 25, 1995. He was diagnosed as lung abscess from the chest roentgenogram and CT scan and the subcutaneous pus was aspirated. The pus culture was only positive for S. agalactiae. He was treated with IPM/CS 1 g/day and CLDM 1.2 g/day and the abscess was drained. MRI showed his lumbago was caused by pyogenic spondylitis. The underlying disease of this case was diabetes mellitus. He recovered from the infections with in about 10 weeks of antibiotic treatment.