Friday, May 21, 2010

0 Lung Abscess

Lung abscess is defined as the death of lung tissue and the formation of cavities that contain dead cells, or fluids due to bacterial infection.

Most lung abscesses arise as a complication of aspiration pneumonia caused by anaerobic bacteria in the mouth. Patients with lung abscesses usually have a periodontal problem (the tissues around the teeth).
A number of bacteria originating from the gap down to the gums and cause lower respiratory infections. The body has a defense system against this kind of infection so that infection only occurs when the body's defense system is on the decline, such as those found at:
- Someone who is unconscious or very drowsy because of the influence of sedatives, drugs or alcohol abuse
- Patients with nervous system diseases.
If the bacteria can not be destroyed by the body's defense mechanism, then there will be aspiration pneumonia and within 7-14 days and then developed into necrosis (tissue death), which ended with the formation of an abscess.

Other lung abscess formation mechanism is bacteremia or endocarditis valve trikuspidalis, due to septic emboli in the lungs.

In 89% of cases, the cause is an anaerobic bacterium.
The most frequent are Peptostreptococcus, Bacteroides, Fusobacterium and Streptococcus Microaerophilic.

Another organism that is not too frequent cause of lung abscess are:
- Staphylococcus aureus
- Streptococcus pyogenes
- Streptococcus pneumoniae
- Klebsiella pneumoniae
- Haemophilus influenzae
- Actinomyces and Nocardia species
- Basil Gram negative.

Causes of non-bacteria can also cause lung abscesses, among others:
- Parasites (Paragonimus, Entamoeba)
- Fungus (Aspergillus, Cryptococcus, Histoplasma, Blastomyces, Coccidioides
- Mycobacteria.

Initial symptoms resemble pneumonia:
- Fatigue
- Loss of appetite
- Decreased body weight
- Sweating
- Fever
- Cough with phlegm.

Sputum may contain blood.
Foul-smelling sputum is often because the bacteria from your mouth or throat tend to produce foul odors.

When breathing, the patient could also feel chest pain, especially if there has been inflammation of the pleura.

Diagnosis of lung abscess can not be enforced only by symptoms that resemble pneumonia or physical examination alone.
Allegedly a lung abscess if symptoms that resemble pneumonia occurred in the following circumstances:
- Nervous system disorders
- Abuse of alcohol or other drugs
- Impairment of consciousness because of various reasons.

Chest X-rays often can show the existence of lung abscess. Lung abscess appears as a cavity with an irregular shape and inside it looks border air and liquids.
Lung abscess due to aspiration of the most frequently attacked the posterior segment of lung lobes or superior segment of lower lobe lung.
Lung abscess wall thickness varies, can be thin or thick, the boundary can be clearly or vaguely. The walls may be smooth or rough.
A clearer picture can be seen on CT scans.

Culturing the sputum from the lungs to help determine the organism causes abscesses.

For complete healing required antibiotics, either intravenously (through veins) as well as per-oral (by mouth).
This treatment was continued until the symptoms disappeared and chest X-rays showed that the abscess had healed. To achieve these improvements, antibiotics are usually given for 4-6 weeks. In the large cavity (diameter more than 6 cm), usually long-term therapy needs to be done.

Clinical improvement, ie decrease in body temperature, usually occurs within 3-4 days after administration of antibiotics. If within 7-10 days after administration of antibiotics fever does not go down too, meaning there has been a failure of therapy and diagnostic tests should be carried further to determine the cause of the failures.
Things that need to be considered in patients who respond poorly to antibiotic treatment is bronchial obstruction by foreign objects or tumors, or infections by bacteria, mycobacteria and fungi resistant.

In lung abscess without surgical complication is very rare. Indications of surgery is usually a failure of medical therapy, suspicion of tumor or deformity congenital lung.
The procedures performed are lobectomy or pneumonectomy.

The mortality rate due to lung abscess reached 5%. This figure is higher if patients have immune system disorders, lung cancer or a very large abscess.


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