LUNG ABSCESS
By:
Christopher Ekpo
CSON-COHS
UTECH
Necrosisof the pulmonary tissue and
formation of cavities containing necrotic
debris or fluid.
Athick-walled abscess, courtesy,
emedicine.com
The formation of multiple small (< 2 cm)
abscesses is occasionally referred to as
necrotizing pneumonia or lung gangrene.
Both lung abscess and necrotizing
pneumonia are manifestations of a
similar pathologic process
(Kamangar, 2009).
A male predominance for lung abscess is
reported in published case series.
Occur more commonly in elderly
patients.
A case series from an urban centre with
high prevalence of alcoholism reported a
mean age of 41 years.
Mostpatients with primary lung abscess
improve with antibiotics, with cure rates
documented at 90-95%.
Hostfactors associated with a poor
prognosis include advanced age,
debilitation, malnutrition, human
immunodeficiency virus infection or other
forms of immunosuppression, malignancy,
and duration of symptoms greater than 8
weeks
(Mwandumba & Beeching, 2000).
Themortality rate for patients with
underlying immunocompromised status
or bronchial obstruction who develop
lung abscess may be as high as 75%
(Pohlson, McNamara, Char &
Kurata, 1985).
A retrospective study reported the overall
mortality rate of lung abscesses caused by
mixed gram-positive and gram-negative
bacteria at approximately 20%
(Hirshberg, Sklair-Levi, Nir-Paz, Ben-Sira,
Krivoruk & Kramer, 1999).
Canbe classified based on the duration
and the likely etiology.
Acute abscesses are less than 4-6 weeks
old.
Chronic abscesses are of longer duration
Primary abscess is infectious in origin,
caused by aspiration or pneumonia in the
healthy host;
Secondary abscess is caused by a
preexisting condition (eg, obstruction),
spread from an extrapulmonary site,
bronchiectasis, and/or an
immunocompromised state.
Lung abscesses can be further
characterized by the responsible
pathogen, such as:
Staphylococcus lung abscess and
Anaerobic or Aspergillus lung abscess.
Aspiration of material from the G.I. tract
into the lungs.
Infectious agents- klebsiella,
staphylococcus aureus, (may result in
multiple abscesses), Pseudomonas
aeruginosa, S aureus, Streptococcus
pneumoniae.
Non-infectious causes include the
following:
Bronchiectasis,
Lung cancer,
Lung infarction,
Pulmonary embolism,
Sarcoidosis.
Alcoholism
Seizure disorders,
Stroke,
Drug overdose,
General anaesthesia,
Neuromuscular diseases.
Others are: periodontal disease,
dysphagia
Most frequently, the lung abscess arises
as a complication of aspiration
pneumonia caused by mouth anaerobes.
Thepatients who develop lung abscess
are predisposed to aspiration and
commonly have periodontal disease.
A bacterial inoculum from the gingival
crevice reaches the lower airways and
infection is initiated because the bacteria
are not cleared by the patient's host defense
mechanism.
Thisresults in aspiration pneumonitis and
progression to tissue necrosis 7-14 days
later, resulting in formation of lung abscess.
Other mechanisms for lung abscess
formation include bacteremia or
tricuspid valve endocarditis, causing
septic emboli (usually multiple) to the
lung.
Lemierre syndrome, an acute
oropharyngeal infection followed
by septic thrombophlebitis of the internal
jugular vein, is a rare cause of lung
abscesses.
Superior segments of the lower lobes &
posterior segments of the upper lobes
most affected.
Fibrous tissue forms around abscess to
attempt to wall it off.
Abscess may erode into bronchial system
with production of foul-smelling sputum.
Lung abscess, courtesy ecureme.com
May grow towards pleura causing
pleuritic pain.
Right lung more frequently involved than
left because of the dependent position of
right bronchus.
Multiple abscesses may occur
sometimes.
Cough- mucopurulent, foul-smelling,
blood streaking sputum.
Fever
Malaise
Headache
Anaemia
Weight loss
Dyspnoea
Weakness
Pleuritic chest pain
Prostration
Night sweats
Chest X-ray: reveal solitary cavitary
lesion with fluid.
C.T. scan: if cavitations not clearly seen
on CXR.
Direct bronchoscopic visualization:
exclude tumour or foreign body.
Sputum culture and sensitivity test.
CXR showing lung abscess, courtesy,
familymedicinehelp.com
CXR
showing lung abscess, courtesy
emedicine.com
Appropriate antibiotics: Penicillin,
Clindamycin, metronidazole, etc. IV. until
clinical condition improves then P.O.
Chest physiotherapy
Postural drainage
Rest
Adequate fluid, good nutrition.
Rarely required for patients with
uncomplicated lung abscesses.
Indications are failure to respond to
medical management, suspected
neoplasm, or congenital lung
malformation.
Procedure performed is either
lobectomy or pneumonectomy.
Assessment:
-complete health history
-physical examination:
Patients with lung abscesses may have
low-grade fever in anaerobic infections
and temperatures higher than 38.5°C in
other infections.
Assessment cont’d.
Generally, patients
with in lung abscess
have evidence of gingival disease.
Clinical
findings of concomitant
consolidation may be present (eg,
decreased breath sounds, dullness to
percussion, bronchial breath sounds,
coarse inspiratory crackles).
Assessment cont’d.
Evidence of pleural friction rub and signs
of associated pleural effusion, empyema,
and pyopneumothorax may be present.
Signs include dullness to percussion,
contralateral shift of the mediastinum,
and absent breath sounds over the
effusion.
Digital clubbing may develop rapidly.
Review laboratory & Xray findings.
Interventions:
Position client for comfort.
Monitor vital signs.
Administer medications as ordered by
the physician- antimicrobials, analgesics
etc.
Perform oral hygiene.
Encourage rest and limitation of physical
activity during febrile periods.
Monitor chest tube functioning if in place.
Carry out drainage procedures to hasten
resolution.
Measure and record the volume of sputum.
Evaluate for signs of hypoxia.
Provide high protein and high calorie diet.
Monitor weight weekly.
Adequate fluid intake if not contraindicated.
Haemoptysis.
Empyema.
Bronchopleural fistula.
Pleuralfibrosis
Respiratory failure
NEEDS/DIAGNOSES
OXYGEN
Ineffective breathing pattern RT.
presence of suppuration AEB dyspnoea,
mucopurulent, foul-smelling sputum.
RCA
Activity intolerance RT. imbalance
between oxygen supply and demand
AEB dyspnoea, verbalization of
weakness,etc.
Assignment
Identify the needs and formulate
appropriate nursing diagnoses.
List the interventions/ rationale
Chalkboard illustration required
involve learners here
Hirshberg, B., Sklair-Levi, M., Nir-Paz, R.,
Ben-Sira, L., Krivoruk, V &
Kramer, M.(1999).
Factors predicting mortality of patients
with lung abscess. Chest,115,(3),746-50
Kamangar, N.(2009). Lung Abscess.
Retrieved from:
http://www.emedicine.medscape.com/ar
ticle/299425
Mwandumba, H.& Beeching, N.(2000).
Pyogenic lung infections: factors for
predicting clinical outcome of lung
abscess and thoracic empyema.
Curr Opin Pulm Med.6,(3),234-9
Pohlson, E., McNamara, J., Char, C.&
Kurata, L. (1985).Lung abscess: a
changing pattern of the disease.
Am J Surg. 150,(1),97-101.
