What is lung abscess
Necrosis of the pulmonary parenchyma caused by microbial infection or localized collection of pus in a large cavity lined by chronic inflammatory tissue
What is the most common group of bacteria that causes lung abscess
Anaerobes 90%
What are the most common anaerobes involved in lung abscess
- Pepto Streptococcus
- Provotella
- fusobacterium
What are the frequently involved aerobic bacteria that cause lung abscess
- S aureus
- E. coli
- klebsiella
- pseudomonas
85 to 95% of cases of lung abscess have a clear association with what
- Periodontal disease
- predisposition to aspiration
What are the aetiological causes of lung abscess
- Aspiration pneumonia
- supportive pneumonia
- poor dental hygiene and periodontal disease
- spread from amoebic liver abscess
- swallowing defect, paralysis
- pre-existing cavities
- infective endocarditis
- inhalation of oral pharyngeal Content GERD
- Brachial obstruction
What are the signs and symptoms of lung abscess
- Fever, weight loss, copious sputum
- Purulent cough
- High fever with rigor and sweating
- large amounts of sputum which has an odor/foul smell or bloodstained
- plural chest
- pain clubbing within 10 to 14 days
- signs of consolidation
- pleural rub
- Poor dental hygiene
- Increased heart rate
What is the common type of organism present in patients who are diabetic or alcoholics
Klebsiella
 How can we tell that klebsiella is the causing organism of lung abscess by looking at the sputum
Thick mucoid sputum thick cell wall of klebsiella
What are the investigations for lung abscess
- Chest x-ray
- ultrasound chest
- sputum D/R
- Blood CBC
What are the clinical findings of chest x-ray for a patient who has lung abscess
Single thick walled cavity with air fluid level surrounded by chronic inflammatory tissue and consolidation
In which long does abscess usually develop and why
Develops in the right lung because the right bronchus is larger
What are the D/DS Of lung abscess
- TB
- Bronchogenic carcinoma
- fungal infection
- pulmonary infarction
- Wagners granulomatosis
- infected bullae and cyst 
What will ultrasound chest reveal In lung abscess
Reveal pleural loculation‘s
What will blood CBC show for lung abscess
neutrophil leukocytosis
What are the complications of lung abscess
- Bronchiectasis
- residual fibrosis
- empyema
- internal haemorrhage
- brain abscess
- pneumothorax
What type of management is best for lung abscess and why
Medical management instead of surgical management because antibiotics treat the problem
What is the common side of aspiration in the upright position for lung abscess
Lower lobes
What is the most common site for aspiration in supine position for lung abscess
Posterior segment of right upper lobe
What is the empirical treatment for lung abscess
Clindamycin or penicillin
What is The specific antibiotic therapy for lung abscess
- Clindamycin 600 mg IV eight hourly. After improvement clindamycin 300 mg oral six hourly or Augmentin 625 mg 8- hourly
OR
- Injection Augmentin 1.2 g eight hourly plus metronidazole injection 500 mg 8- hourly
How long should antibiotics be taken for a lung abscess
Continue until chest x-ray shows improvement
 what is the management of lung abscess
- Antibiotic therapy
- chest tube drainage required of the patient develops empyema
- postural drainage to expel secretions from the cavity
