Lung Abscess Sign, Symptoms And Treatment

Describe Clinical Features, Investigations, And Management Of Lung Abscess.
Or

Write In Brief Signs, Symptoms, And Treatment Of Lung Abscess.

Answer. It is a localized pyogenic infection of the lung characterized by the *suppuration, destruction of lung parenchyma with cavitation, and formation of abscess.

Lung Abscess Symptoms

1. In most of the patients, the disease commences with high­grade fever, chills and rigors, pleuritic chest pain, and cough.
2. After some days, as the abscess cavity ruptures into a patent bronchus, the patient suddenly starts expectorating large quantities of sputum.
3. Sputum is very large in volume, purulent, foul smelling, greenish yellow in color or it is often blood-tinged.
4. The expectation of cough varies with posture, i.e. more in lying down position than compared to sitting position.
5. In a few of the cases, the lung abscess is more insidious in onset with low­grade fever, malaise, weight loss, anorexia, and a deep­seated chest discomfort.
6. As the disease becomes chronic patient starts to lose his/her weight.

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Lung Abscess Clinical Signs

1. During the general examination, there is the presence of anemia, fever, clubbing of fingers, halitosis, and oronasal sepsis.
2. In most of the patients, there may be signs of consolidation,i.e. coarse crepitations/crackles or rales, dullness on percussion, increased vocal fremitus, vocal resonance, bronchial breathing, and pleural rub.
3. In case of ruptured pyogenic abscess producing amphoric or cavernous bronchial breathing heard over the area involved, signs of pleural effusion, i.e. dull percussion note with absent breath sounds will be present.
4. Signs of septicemia, i.e. fever, perspiration, tachypnea, and tachycardia are present.

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Lung Abscess Investigations

1. Blood examination: There can be the presence of normocytic normochromic anemia.
   1. Leukocytosis is present in infective abscesses. Raised ESR is also present.
2. Examination of sputum: It consists of the isolation of infective microorganisms by Gram’s stain and acid­fast bacilli by Ziehl­Neelsen stain, Aerobic and anaerobic cultures, and sensitivity, malignant cells are detected by the special stains.
3. Urine examination: This is carried out for proteinuria, pus cells, and cases.
   • Albuminuria is indicative of amyloidosis which is a complication of chronic lung abscess.
4. Chest X-ray: It shows radiolucency in the area of consolidation.
   • A wall or border of cavity completely surrounds the radiolucent area and air-flid level is seen.
   • Associated involvement of pleura is noted by obliteration of CP angle.
5. Fiberoptic bronchoscopy: This is done to rule out bronchogenic causes of lung abscess.
   • It also excludes malignancy, obtains specimens for studies, and removes the secretions.
6. CT scan of the thorax may detect lung abscess with certainty.

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Management lung abscess

1. General measures:

1. Bed rest
2. Oxygen is given
3. High high-protein diet is taken
4. Exercise is avoided.

2. Specific antimicrobial treatment:

1. Intensive antimicrobial therapy is employed depending on the sputum culture and drug sensitivity of the organism
2. Most of the patients with lung abscesses respond to oral ampicillin 500 mg QDS or cotrimoxazole 960 mg BD. Along with this oral metronidazole 400 mg 8 hourly is given along with other antibiotics.
3. The duration of antibiotic therapy is variable. Some of the patients require antibiotic therapy for 4 to 6 weeks. Injectables should be given in emergency situations. Clindamycin 600 mg IV 8 hourly is given

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3. Postural drainage:

1. Percussion therapy or “clapping” over the site of the abscess with the patient in the postural drainage position is often effective in dislodging and expelling secretions from the cavity.
2. Bronchoscopy: Suction is applied to the orifices of the bronchi leading to segments presumed to be involved in the process in the hope of initiating or promoting drainage. In addition, any foreign material is removed and a careful search is made for a tumor.
3. Oxygen inhalations: When sputum is foul because it checks the anaerobic organisms
4. Head elevation: The patient bed should be inclined to 45°from horizontal plane in cases of altered mentation, on mechanical ventilatory support.

4. Surgical resection: If at the end of 3 weeks, there is no clinical and radiological improvement, then segmental resection of the lung, lobectomy, or pneumonectomy is done.