Lung

A lung abscess is a necrotizing pulmonary infection which is characterized by a pus-filled cavitary lesion. Most of all he caused in patients with impaired consciousness due to aspiration of oral secretions. The symptoms consists of persistent cough, fever, sweats and weight loss. The diagnosis is based primarily on the chest x-ray. The treatment is usually carried out with clindamycin or a combination of ?-lactam antibiotics / ?-lactamase inhibitors.

A lung abscess is a necrotizing pulmonary infection which is characterized by a pus-filled cavitary lesion. Most of all he caused in patients with impaired consciousness due to aspiration of oral secretions. The symptoms consists of persistent cough, fever, sweats and weight loss. The diagnosis is based primarily on the chest x-ray. The treatment is usually carried out with clindamycin or a combination of ?-lactam antibiotics / ?-lactamase inhibitors. Etiology aspiration of oral secretions (most) Endobronchial obstruction Haematogenous colonization of the lung (rare) Most lung abscesses develop after aspiration of oral secretions of patients with gingivitis or poor oral hygiene. Typically, patients have an altered consciousness as a result of alcohol poisoning, illegal drugs, anesthetics, sedatives or opioids. Also at risk are the elderly and those who – often due to neurological disorders – are able to swallow properly oral secretions not. can be secondary to lung abscesses develop endobronchial disability (z. B. due to lung cancer) or immunosuppression (eg. as a result of HIV / AIDS or after transplantation and the use of immunosuppressive drugs) as well. A less common cause of a lung abscess is necrotizing pneumonia, which can be caused by hematogenous spread of the lungs due to purulent thromboembolism (z. B. septic embolism due to i.v. drug use), or right-sided endocarditis. In contrast to the aspiration and obstruction these diseases typically cause multiple and no solitary lung abscesses. Pathogens Anaerobic bacteria are the most common pathogen in lung abscesses due to aspiration, at about half of all cases, however, both anaerobic and aerobic (s. Infectious causes of cavernous lung lesions) involved. The most common pathogens are anaerobic Peptostreptococcus, Fusobacterium, Prevotella, and bacteroids. The most common aerobic pathogens are streptococcus and staphylococcus – sometimes methicillin-resistant Staphylococcus aureus (MRSA). Occasionally arise cases due to gram-negative bacteria, particularly Klebsiella. Immunocompromised patients with lung abscess are infected most with Pseudomonas aeruginosa and other gram-negative bacteria can also infections with Nocardia, Mycobacteria sp. have or fungi. It has been reported rare cases of pulmonary gangrene or fulminant pneumonia with sepsis, with pathogens such as MRSA, pneumococcus, undKlebsiella. In some patients, particularly in developing countries, there is a risk of abscesses caused by Mycobacterium tuberculosis. Rarely there are cases pseudomallei due to amoebic infection (z. B. with Entamoeba histolytica), Paragonimiasis or infection with Burkholderia. The entry of these pathogens in the lungs initially causes an inflammatory reaction that eventually leads over a week or two to tissue necrosis and abscess formation. Most commonly, these abscesses drained into a bronchus, the content is expectorated and there remains a column filled with air and liquid cavern. In about one third of the cases, the direct or indirect expansion (through a bronchopleural fistula) into the pleural space to a empyema. Infectious causes of cavernous lung lesions causes examples (disorder) Aerobic organisms Burkholderia pseudomallei * Klebsiella pneumoniae * Nocardia sp. † Pseudomonas aeruginosa * Staphylococcus aureus ‡ Streptococcus milleri ‡ streptococci different kind ‡ Anaerobic organisms Actinomyces sp. † Bacteroides sp. * Clostridium sp. † Fusobacterium sp. * * fungi Aspergillus sp Peptostreptococcus sp. ‡ Prevotella sp.. (Aspergillosis) Blastomyces dermatitidis (blastomycosis) Coccidioides immitis (Coccidioidomycosis) Cryptococcus neoformans (cryptococcosis) Histoplasma capsulatum (histoplasmosis) Pneumocystis jirovecii Rhizomucor (mucormycosis) Rhizopus sp. (Mucormycosis) Sporothrix schenckii (sporotrichosis) mycobacteria Mycobacterium avium-cellulare Mycobacterium kansasii Mycobacterium tuberculosis parasite Entamoeba histolytica (amoebiasis), Echinococcus granulosus (echinococcosis) Echinococcus multilocularis (echinococcosis) Paragonimus westermani (Paragonimiasis) * Gram-negative rods † Gram positive rods ‡ Gram Positive Kokk s symptoms and complaints The symptoms of abscesses by anaerobic or aerobic-anaerobic bacterial infections are usually mixed chronic (eg. B. occurrence for weeks or months) and includes productive cough, fever, night sweats and weight loss. Patients may also have hemoptysis and pleuritic chest pain. The sputum may be purulent or bloody tinged and smells and tastes typically putrid. The symptoms of abscesses by aerobic pathogens acute develops and similar to that of bacterial pneumonia. Abscesses by non anaerobic organisms (eg. As Mycobacteria, Nocardia) are not accompanied by purulent respiratory secretions and can more likely occur in independent parts of the lung. The clinical findings of lung abscesses are, if any, non-specific and are similar to those of pneumonia: attenuated breath sounds as signs of consolidation or effusion, temperature ? 38 ° C, rales over the affected areas, Ägophonie and percussion sound attenuation at effusion. Patients typically have signs of periodontal disease and a predisposing cause of aspiration, such as dysphagia or leading to impaired consciousness disorder in prehistory. Diagnostic chest X-ray Occasionally CT sputum cultures (except when an anaerobic infection is very likely), also for fungi and mycobacteria bronchoscopy as necessary to rule out cancer and determine unusual pathogens such as fungi or mycobacteria and in immunosuppressed patients culture of any pleural fluid is suspected, a lung abscess, if it is determined based on the history that the patient because of altered consciousness or dysphagia has an increased risk of aspiration. Confirmation will be received by a chest x-ray, which shows cavitation. Cavernous lung lesions are not always caused by an infection. The non-infectious causes of kavitären pulmonary lesions include the following: empyema or air blow-liquid level Cystic (sac-like) bronchiectasis lung pulmonary infarction silicosis nodules with central necrosis pulmonary embolism Lung sarcoidosis granulomatosis with polyangiitis (Wegener’s granulomatosis) In a Anaerobierinfektion by aspiration of the chest X-ray shows typically includes a consolidation with solitary cavity including an air-fluid level in the dependent lying lung areas (z. B. posterior upper lobe segment or upper or lower lobe laterobasales segment). Through this distribution pattern abscesses can be distinguished by anaerobes of lung caverns of other origin because diffuse or embolic pulmonary disease can often cause multiple caverns and tuberculosis usually the lungs tips with attacks. CT is not routinely required (eg. As when cavitation in a patient, the risk factors for lung abscess, has on chest x-ray is unique). However, a CT may be useful when cavitation is suspected, but is not clearly visible on the Röntgenthoraxb, if it is suspected that an underlying pulmonary mass impedes the drainage of a lung segment, or if an abscess by a empyema or bullae with air-liquid levels must be distinguished. A lung cancer may lead to disability that causes pneumonia and the formation of abscesses. A lung cancer for patients who do not respond to antimicrobial treatment or atypical findings, as have a cavitary lesion and are free of fever. A bronchoscopy is sometimes performed in order to exclude or cancer or the presence of a foreign body to unusual pathogens such. To recognize as fungi or mycobacteria. A bronchoscopy is performed when the patients are immunocompromised. Lung With permission of the publisher. From Leaf H. In Atlas of Infectious Diseases: pleuropulmonary and bronchial Infections. Edited by G. L. Mandell (series editors), and M.S. Simberkoff. Philadelphia, Current Medicine, 1996. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/lung_abcess_b_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/ – / media / manual / professional / images / lung_abcess_b_high_de.jpg lang = en & thn = 0 ‘, title:’? Lung ‘, description:’ u003Ca id = “v37893190 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eGroßer abscess in the right lower lobe

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