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PubMedDate not supplied

Clindamycin in the treatment of anaerobic lung abscess.

A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral penicillin and oral metronidazole is described. Anaerobic pathogens resistant to one or the other of the above drugs were isolated. The patient had a striking clinical response to subsequent therapy with oral clindamycin. Failure of therapy should alert physicians to the possibility of infection with resistant anaerobic pathogens and in such situations, clindamycin is considered as an effective alternative.

Adult↗
PubMed1977

Transtracheal drainage of lung abscesses in children.

Experience with three patients with primary lung abscesses indicates that transtracheal catheter drainage of lung abscesses is a safe and beneficial procedure in childhood. The ability to drain abscesses not easily reached percutaneously will promote emptying and collapse of the abscess and provide bacteriological information which will enable the physician to select the correct antibiotics.

Adolescent↗
PubMed2006

Asymptomatic Mycobacterium xenopi lung abscess in an immunocompetent male without pre-existing lung pathology.

Like other non-tuberculous mycobacteria, Mycobacterium xenopi infects more commonly patients with altered immune defenses. In immunocompetent individuals, infection with M. xenopi has been described in the setting of underlying lung disease. We here report the first case of M. xenopi lung abscess in a previously healthy patient with no known predisposing factors who was successfully treated with rifampin, isoniazid and ethambutol.

Adult↗
PubMed1996

Percutaneous catheter drainage of tension pneumatocele, secondarily infected pneumatocele, and lung abscess in children.

OBJECTIVE: To describe the use of percutaneous catheter drainage of tension pneumatocele, secondarily infected pneumatocele, and lung abscess in children. DESIGN: Retrospective case series. SETTING: A 24-bed pediatric intensive care unit. PATIENTS: Patients with tension pneumatocele, secondarily infected pneumatocele, or lung abscess. Tension pneumatocele was defined as an expanding intraparenchymal cyst compressing adjacent areas of the lung. Infected pneumatocele and lung abscess were defined, respectively, as intraparenchymal thin-walled cyst or thick-walled cavity containing an air-fluid level and purulent fluid. INTERVENTIONS: Seven pneumatoceles/lung abscesses were percutaneously drained in five patients. After computed tomography of the chest was obtained to localize the optimum site for drainage, a modified Seldinger technique was used to insert an 8.5-Fr soft catheter percutaneously into the cyst/cavity. The catheter was left in place until drainage (fluid and air) stopped. MEASUREMENTS AND MAIN RESULTS: All patients had clinical and radiologic improvement and were afebrile within 24 hrs after drainage. Bacterial culture grew aerobic bacteria from three cysts/cavities, anaerobic bacteria from one, and mixed bacteria from three. One patient had three secondarily infected pneumatoceles. Four of five secondarily infected pneumatoceles were under tension in two patients receiving mechanical ventilation. In both patients, the trachea was extubated within 24 hrs of drainage after prolonged mechanical ventilation. The number of days the catheter was in place ranged from 1 to 20 days. CONCLUSIONS: Percutaneous catheter drainage of tension pneumatocele, secondarily infected pneumatocele, and lung abscess can be performed safely and effectively in children. Early drainage is helpful, both as a diagnostic and therapeutic procedure. Drainage of tension pneumatocele may assist in weaning from mechanical ventilation. Computed tomography of the chest is helpful in determining the optimum site for percutaneous drainage.

Adolescent↗
PubMed1985

Percutaneous tube drainage: the treatment of choice for refractory lung abscess.

During the years 1978 to 1982, 48 patients with primary lung abscess were seen in the Sheba Medical Center in Israel. Seven of them (14%) did not respond to conservative treatment and were candidates for operation. All were successfully treated by percutaneous tube drainage initiated under local anesthesia, and all recovered completely. There were no relapses after a follow-up period of 2 to 5 years. During this period, we did not perform pulmonary resection for primary lung abscess. Three patients with malignant abscesses were also treated initially by transthoracic drainage but eventually required surgical intervention. We conclude that percutaneous transthoracic drainage is an efficient and safe mode of treatment, and we recommend transthoracic drainage as the treatment of choice for long-standing, refractory primary lung abscesses.

Adult↗
PubMed1985

Fiberoptic bronchoscopy in the evaluation of lung abscesses.

To define the results of flexible fiberoptic bronchoscopy (FFB) in patients with lung abscess and to characterize those patients most likely to have an underlying carcinoma, we retrospectively studied the records of 52 consecutive patients undergoing FFB at our institution between 1975 and 1982. Nineteen patients (36.5 percent) had an associated bronchogenic carcinoma (group 1); 33 (63.5 percent) had no malignancy (group 2). The FFB aided in diagnosing 73.7 percent of group 1 patients, but added no information in group 2 patients. Group 1 and 2 patients differed significantly with respect to prevalence of systemic symptoms (15.8 percent vs 51.5 percent, p less than 0.01); predisposition to aspiration pneumonia (26.3 percent vs 60.6 percent, p less than 0.01); mean presenting white blood cell count (10.9 vs 14.2, p less than 0.05); mean oral temperature at presentation (37.5 vs 38.3 degrees C, p less than 0.05); and the prevalence of extensive infiltrates on the initial chest roentgenogram (17.0 percent vs 83.6 percent, p less than 0.05). Based on these data, we believe that by carefully considering the available clinical information, it is possible to identify those patients whose lung abscesses are likely to be related to bronchogenic carcinoma. Such individuals should be promptly evaluated. It is not necessary, however, to routinely order bronchoscopy for all patients with lung abscess.

Adult↗
PubMed1995

The etiology and antimicrobial susceptibility patterns of microorganisms in acute community-acquired lung abscess.

OBJECTIVE: To determine the spectrum and antibiotic susceptibility patterns of microorganisms causing acute community-acquired lung abscess. DESIGN: A prospective survey. SETTING: Medical emergency department and wards of a tertiary teaching hospital. PATIENTS: Thirty-four adult patients with both clinical and radiologic features compatible with a diagnosis of acute community-acquired lung abscess who had received less than 48 h of antibiotic therapy. INTERVENTIONS: Microbiologic specimens obtained by percutaneous lung aspiration and with a protected specimen brush via fiberoptic bronchoscopy were submitted for aerobic and anaerobic culture. MAIN OUTCOME MEASURES: Identification of all microorganisms, including anaerobes, and determination of antibiotic susceptibility. RESULTS: A mean of 2.3 bacterial species per patient was isolated, anaerobes alone being isolated in 44% of cases, aerobes alone in 19%, and mixed aerobic and anaerobic isolates in 22%. Aerobic Gram-negative pathogens were uncommon. In seven patients, Mycobacterium tuberculosis was identified; in two it was associated with other bacteria. In four patients, no organisms were isolated. All the nonmycobacterial isolates were susceptible to amoxicillin-clavulanate and in addition the anaerobes were all susceptible to chloramphenicol and almost all to a combination of penicillin and metronidazole. Among the anaerobes, the level of resistance to penicillin, metronidazole, and clindamycin individually was 21%, 12%, and 5%, respectively. CONCLUSIONS: Community-acquired acute lung abscess is usually caused by multiple anaerobic and less frequently aerobic Gram-positive microorganisms, which should respond to empirical therapy with amoxicillin-clavulanate, chloramphenicol, or a combination of penicillin and metronidazole. Tuberculosis, which may be indistinguishable from an acute lung abscess, occurred in 21% of patients in our study. Most bacterial pathogens are sensitive to conventional antimicrobial therapy and further investigation with percutaneous lung aspiration or bronchoscopy is indicated only when there is lack of early response to therapy or there is the presence of atypical clinical features.

Acute Disease↗
PubMedDate not supplied

[Lung abscess in infancy--a rare disease. Clinical cases].

Lung abscess is a rare entity in childhood, but leads to high morbidity and long length of hospitalisation. It appears commonly in children with risk factors or other disease, have a good response to antibiotic therapy and it is rarely necessary the use of invasive techniques. Authors present two cases of lung abscess in children, one of them with risk factors to aspiration, that improved with antibiotic therapy and make a revision about this entity in infancy.

Child↗
PubMed1976

[Pneumomediastinum and mediastinitis, rare complications of a lung abscess. 1 case].

A case is reported with pneumomediastinum and mediastinitis complicating lung abscess in the lingula of a 77-year-old man. Causative factors were the association of virulent organisms having necrotizing properties in a host with diminished resistance and location of the cavity adjacent to the mediastinal pleura. A review of 1119 documented patients with lung abscess revealed that this complication has been reported only twice previously. Early surgical drainage combined with systemic administration of antimicrobial agents are the most effective therapeutic measures for mediastinal infection. Therefore, close observation is required of patients with lung abscess adjacent to mediastinal structures.

Aged↗
PubMed2000

Swyer-James syndrome complicated by lung abscess.

Swyer-James syndrome, a rare disease with unilateral hyperlucent lung due to bronchiolitis obliterans and pulmonary artery hypoplasia, generally develops after lower respiratory tract infection during early childhood. Invasive procedures, including bronchoscopy and angiography, are often necessary for a definitive diagnosis. We report a 17-year-old man admitted because of cystic bronchiectasis complicated by lung abscess. Chest roentgenography showed the typical findings of Swyer-James syndrome. Noninvasive magnetic resonance angiography was used to confirm hypoplasia of the right pulmonary artery. The patient received antibiotic therapy, underwent a right lower lobectomy for the lung abscess, and recovered.

Adolescent↗
PubMed2004

Pediatric lung abscess: a retrospective review of 23 cases.

Pulmonary abscess is a rare but critical problem in childhood. We did a retrospective review of 23 children with documented lung abscess who had been admitted and treated at the Taipei Veterans General Hospital over a 20-year period from April 1982 to April 2002. Among the 23 children, 11 cases were primary lung abscess, and 12 were secondary lung abscess. The pathogens were isolated in 16 patients (69.6%), and blood cultures yielded in only 3 patients (13.0%). The most common microorganism isolated in this series was Streptococcus pneumoniae. The 2 patients (8.7%) that died in our series had secondary lung abscess. We herein report the presenting symptoms, bacteriology, clinical management, and outcome of these 23 cases.

Adolescent↗
PubMedDate not supplied

Bilateral lung abscesses due to pseudomonas aeruginosa infection after open heart surgery in an infant: report of one case.

Lung abscess is an infrequent but serious problem in children. Bilateral lung abscesses occur even less commonly. We experienced a case of bilateral Pseudomonas aeruginosa lung abscesses in a 2-month-old infant after open heart surgery for interrupted aortic arch. The clinical and radiographic manifestations, together with treatment responses, are described in the following case report.

Anti-Bacterial Agents↗
PubMed1995

Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis.

There are multiple etiologies reported as causes of lung abscess; however, this differential rarely includes intra-abdominal abnormalities other than extension of a hepatic process. We describe a patient who was found to have a lung abscess and empyema resulting from the development of a nephrobronchial fistula secondary to nephrolithiasis and pyelonephritis. The patient had no urinary symptoms or known abdominopelvic infection and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.

Bronchial Fistula↗
PubMed1978

Percutaneous drainage of lung abscess.

The availability of effective antimicrobial agents has greatly decreased the need for surgical intervention in patients who have a pyogenic lung abscess. We describe 3 patients with lung abscesses caused by gram-negative bacteria who failed to respond to medical treatment and who were believed to be unable to withstand lobectomy. Percutaneous insertion of a drainage tube directly into the abscess brought about a dramatic clinical response, with prompt closure of the cavity. This procedure provides an alternative to thoracotomy and lobectomy in treating lung abscesses that fail to respond to medical therapy.

Drainage↗
PubMed2006

Clinical presentation and management of empyema, lung abscess and pleural effusion.

PURPOSE OF REVIEW: Pleural effusions, lung abscess and empyema remain a commonly encountered clinical problem and a significant source of morbidity. The aim of this review is to summarize recent developments with emphasis on controlled trials. RECENT FINDINGS: There is wide variation in the management of infectious pleural effusions, partly because of the relative lack of randomized controlled trials. The recent MRC/BTS UK controlled trial of interapleural streptokinase for pleural infection assessed the efficacy of intrapleural streptokinase compared with placebo in complicated parapneumonic effusions. The study showed no difference in the primary end point, mortality, or in the need for surgery or length of the hospital stay among patients with pleural infection. The first large report published for over a decade has suggested that the bacteriological characteristics of lung abscess have changed. SUMMARY: The major recent development in the management of pleural infections is the finding that we should dampen the ardor for the routine use of fibrinolytic agents in all patients with pleural infections. We strongly recommend the necessity for additional, well-designed trials to help determine optimal care for these seriously ill patients.

Anti-Infective Agents↗
PubMed1995

Serratia marcescens lung abscess in a child with autoimmune neutropenia.

Though Serratia marcescens is widely known to be the cause of serious infections in immunocompromised hosts, a lung abscess caused by S. marcescens is very rare. A 5 year old boy who had previously been diagnosed with autoimmune neutropenia was admitted because of fever and cough. In spite of treatment with some antibiotics, he developed a lung abscess. Aspiration of the pleural fluid revealed that S. marcescens was the pathogen of the disease. In the present case, there were feasible risk factors for the development of Serratia lung abscess namely neutropenia, chronic gingivitis at the time, and treatment with cyclosporin A. There are no reported cases of autoimmune neutropenia which developed into S. marcescens lung abscess in the literature as far as we can determine.

Autoimmune Diseases↗
PubMed1979

Asymptomatic esophageal carcinoma with esophagopulmonary fistula masquerading as a primary lung abscess.

A 58-year-old man presented with the clinical signs and symptoms of a large right upper lobe lung abscess. His course was complicated by diffuse bilateral necrotizing pneumonitis, and death occurred as a result of massive aspiration of lung abscess contents into uninvolved lung. At postmortem examination, an esophageal carcinoma with a direct fistulous communication with the abscess cavity was present. Although rare, asymptomatic malignant esophageal disease should be considered in the differential diagnosis of a lung abscess which does not follow a typical course.

Diagnosis, Differential↗