Lung Abscess

  • Clinical Manifestations: most present with indolent symptoms that evolve over a period of weeks or months.
    • Common symptoms: fever, cough, and sputum production
    • Less common: pleurisy, hemoptysis
  • Pathogens:
    • Typically polymicrobial
    • Commonly Anaerobic (Bacteroides, Fusobacterium, Prevotella) – expected, as above, to have an indolent course
    • Also, MRSA, streptococcus, klebsiella, nocardia, coccidiomycosis, and cryptococcus
    • Approximately one-third of patients died, another one-third recovered, and the remainder developed debilitating illness with recurrent abscesses, chronic empyema, bronchiectasis, or other sequelae.
  • Diagnosis:
    • Imaging (i.e. CT)
    • Would NOT attempt sampling the fluid bronchoscopically due to risk of forming a bronchopleural fistula
  • Therapy:
    • Medications:
      • Consider treating empirically due to likely polymicrobial nature
      • Beta-lactam + beta-lactamase inhibitor
      • Clindamycin
      • Linezolid if there is concern for MRSA (vancomycin is an alternative agent)
      • Metronidazole does not work
    • Surgery: Rarely required, except for a few situations
      • Large size (>6cm)
      • Obstructed bronchus
      • Resistant organism (i.e. Pseudomonas)