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Aspiration pneumonia, anaerobic infections, and lung abscess.

Anaerobic pleuropulmonary infections are common in the setting of aspiration. Treatment is with penicillin or in mixed infections, penicillin and other appropriate antimicrobial agents. Four syndromes are commonly recognized. Simple pneumonitis resolves promptly with antibiotic therapy. If treatment is delayed, simple pneumonitis may evolve into a more fulminant process of necrotizing pneumonia with a significant mortality despite antibiotic therapy. Lung abscess, typically a subacute or chronic infection, responds well to antibiotic therapy so long as the cavity is drained via the communicating bronchus. Empyema requires surgical drainage by either closed or open thoracostomy if resolution is to be achieved.

Anti-Bacterial Agents↗

Interventional radiology of the chest: image-guided percutaneous drainage of pleural effusions, lung abscess, and pneumothorax.

Percutaneous catheter drainage of intrathoracic collections has developed as a natural extension of similar interventional radiologic procedures in the abdomen. The advent of CT and sonography, which allow detection and characterization of pleural and parenchymal collections, combined with advances in drainage catheter design and interventional techniques, have made imaging-guided management of intrathoracic collections a safe and effective alternative to traditional surgical therapy. This article begins with a review of the etiology, pathophysiology, diagnosis, and treatment of parapneumonic pleural effusion, which remains the most common indication for image-guided percutaneous drainage. Subsequent sections consider issues related to percutaneous drainage of malignant pleural effusion, lung abscess, and pneumothorax.

Drainage↗

Salmonella lung abscess and bacteraemia in an AIDS patient.

This report describes a 28-year-old, HIV-infected man presenting with subacute onset of pyrexia, cough, dyspnoea and pleuritic pain. Chest radiograph showed bilateral multiple cavitary lesions. The diagnosis of salmonellosis was secured by isolation of salmonella typhimurium in blood, as well as in sputum. Therapy with sequential ceftriaxone/ciprofloxacin led to satisfactory improvement symptomatically and radiologically. The present report serves to heighten the awareness of AIDS-associated salmonella bacteremia and lung abscesses.

AIDS-Related Opportunistic Infections↗

Nocardia asteroides lung abscess in acute ulcerative colitis treated with cyclosporine.

Cyclosporine is a potent suppresser of cell-mediated immunity that is mainly used in organ transplantation to prevent rejection. It is also being used increasingly outside of transplantation and probably is the only new treatment to have made an impact in acute ulcerative colitis (UC) resistant to steroid therapy. We describe a case of Nocardia asteroides lung abscess in a patient treated with cyclosporine for acute steroid resistant UC that was successfully managed with antibiotics and by discontinuing cyclosporine. With increasing use of cyclosporine for acute UC it is to be anticipated that opportunistic infections such as Nocardia will be more frequently encountered in the future.

Acute Disease↗

Local administration of interleukin-1beta for the treatment of lung abscesses induces neutrophil activation and changes in proinflammation cytokine production.

Interleukin-1 (IL-1) is a potent immunostimulatory molecule with broad range biological activity that limits its systemic application in humans. Alternatively, IL-1 can be applied locally, directly to the inflammatory site for stimulation of local defense mechanisms, without activating an acute phase response. IL-1beta preparations have been successfully used for local therapy of patients with purulent bacterial lung abscesses who were resistant to usual antibiotic treatment. IL-1beta was applied directly to the abscess cavity at a concentration of 10 ng/ml, once a day for 7 days. Before IL-1beta administration, local leukocyte functional activity was significantly reduced compared to the same activity in neutrophils isolated from the peripheral blood of the same patient. Local application of IL-1beta led to increases in adhesion, chemotaxis, oxygen radical production and phagocytosis of abscess fluid neutrophils. After local IL-1beta treatment, the concentration of IL-8 and TNF-alpha in the abscess fluids increased, while in nearly all patients levels of endogenous IL-1beta decreased. Immunocytochemical analysis showed that IL-1beta increased the numbers of cytokine-producing cells and induced proinflammatory cytokine production by neutrophilic granulocytes. According to the results obtained, the mechanism of the local immunostimulatory activity by IL-1beta is associated with the significant activation of neutrophilic granulocyte functions and changes in cytokine production at the inflammatory site. IL-1beta can be used as a highly effective immunotherapeutic drug when applied locally at adequate immunostimulatory dose levels.

Adult↗

Pneumonia, lung abscesses and pleuritis in adult horses: a review of 51 cases.

Case records are reviewed of 51 adult horses in which a diagnosis of pneumonia, pulmonary abscess or pleuritis had been made. Forty-five horses were afflicted with pneumonia and/or pulmonary abscesses; in 11 of these the infection was primary, whereas in 34 it was secondary to another disease process (inhalation of food or saliva, thoracic trauma, generalised infection, airway disease, neoplasia or thromboembolism). Of the 11 horses with primary pulmonary infections, 10 appeared to be associated with a previous episode of stress; this took the form of long distance travel in eight cases. There was a statistically significant association between primary pneumonia and/or lung abscesses and the use of the horses, with the highest incidence in showjumpers. Eighteen horses had pleuritis, of which 12 were secondary to pneumonia or pulmonary abscesses, two to thoracic trauma and one to generalised avian tuberculosis. Three cases of primary pleuritis were identified.

Animals↗

[Lung abscess due to Mycoplasma pneumoniae in an adolescent].

UNLABELLED: Pulmonary abscess is an uncommon complication of pneumonia in children. Pyogenes, in particular Staphylococcus aureus or Streptococcus pneumoniae are the principal responsible bacteria. Mycoplasma pneumoniae is rarely the cause. CASE REPORT: A 14-year-old child was hospitalized with right thoracic pain. The patient was non-febrile and had a recent history of moderate infection. He was receiving antibiotic (macrolide) and non-steroidal anti-inflammatory therapy. CT scan confirmed a mid-lobe abscess in the right lung. Interruption of therapy resulted in fever and increase in C-reactive level with hyperleucocytosis, suggesting that the abscess was caused by a bacterial infection. The child's general condition and the radiographic picture improved with combined antibiotic therapy with amoxycillin and clavulanic acid, aminoglycosides and macrolides. The suspected diagnostic of M. pneumoniae was confirmed by increased IgM antibodies for M. pneumoniae. Recovery was complete two months later without sequelae. COMMENT: Pulmonary abscess is a rare complication of M. pneumoniae infection in children. This complication should be considered when the general condition does not improve despite appropriate early treatment of a pneumonia, as in the case of our patient.

Adolescent↗

Zygomycotic lung abscess: a case report.

Zygomycosis is an uncommon, but frequently fatal, fungal infection caused by members of the class Zygomycetes. The risk factors include diabetes mellitus, uremia, leukemia and use of deferoxamine as an iron-chelating agent; healthy persons also are occasionally infected. Those fungi, spread by their ubiquitous spores, most frequently involve the respiratory system. Rhinocerebral zygomycosis occurs predominantly in patients with uncontrolled diabetic ketoacidosis. Pulmonary zygomycosis most frequently is observed in granulocytopenic and corticosteroid-treated patients. Other clinical manifestations are gastrointestinal, cutaneous, disseminated and miscellaneous. This report concerns a previously robust farmer who suffered from left upper lung abscess caused by Rhizopus spp.-one member of the order Mucorales. Initially, it was intended to administer amphotericin B to a total dose of 2,000 mg; however, the patient could not tolerate such side effects as nausea, vomiting and refused further management when the cumulative dose was 948 mg. However, he did recover without further fever and cough. Chest X-ray, followed every three months, disclosed satisfactory improvement.

Amphotericin B↗

Atrial septal defect presenting as recurrent primary amoebic lung abscess.

A middle-aged female with an atrial septal defect (secundum type) presented with a primary pulmonary amoebic abscess. She was successfully treated with antiamoebic therapy. One year later she presented with a similar lung abscess which again responded to antiamboebic treatment. Attention is drawn to the fact that a patient with a left to right shunt can present with a recurrent rare primary parasitic infection of the lung.

Amebicides↗