Lung abscess and related rubrics

Dr Shweta Jha

ABSTRACT: Lung abscess is one of the major suppurative pleuro-pulmonary diseases, the other two being bronchiectasis and empyema thoracis.

It continues to cause significant morbidity and mortality despite considerable advances made in the diagnosis and its management.

KEYWORDS: Suppurative, bronchiectasis, pleuro-pulmonary, empyema thoracis, periodontal, aspiration, necrotizing, pneumonia, sarcoidosis, egophony

INTRODUCTION: Lung abscess is a localised area of necrosis of lung tissue with suppuration. It is of two types:

• Primary lung abscess that develops in an otherwise normal lung (e.g. aspiration of infected material).
• Secondary lung abscess that develops as a complication of some other disease of the lung or another site.

DEFINITION:

• Lung abscess is a circumscribed collection of purulent and necrotic material (pus) within the lung parenchyma.
• It is a necrotizing lung infection characterised by pus-filled cavitary lesion
• Microbial infection of the lungs leads to necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid.

EPIDEMIOLOGY:

• Frequency – most in patients having a predisposition to either aspiration or systemic/ local immune suppression
• Sex – male predominance
• Age – more common in elderly patients due to increased incidence of periodontal disease and increased prevalence of dysphagia and aspiration

BACKGROUND:

• The formation of multiple small (<2cm) abscesses is occasionally referred to as necrotizing pneumonia or lung gangrene
• Duration defines the infection as acute versus chronic, with the dividing line usually 4 – 6 weeks.

ETIOLOGY:

• Aspiration of infected foreign material;
• Preceding bacterial infection
• Bronchial obstruction
• Septic embolism
• Miscellaneous

1. Infection in pulmonary infarcts
2. Trauma to lungs
3. Direct extension from a suppurative focus in mediastinum

PREDISPOSING FACTORS:

• Factors predisposing to aspiration

1. Impaired consciousness
2. Oesophageal disorders

• Immune- suppression

1. Chronic lung disease
2. Diabetes mellitus

• Mechanical bronchial obstruction

1. Tumour
2. lymphadenopathy

INFECTIOUS CAUSES:

• Aerobic organisms
• Anaerobic organisms
• Fungi
• Mycobacteria

NON- INFECTIOUS CAUSES:

• Lung cancer
• Pulmonary embolism
• Lung infarction
• Sarcoidosis

CLINICAL FEATURES:

• Productive cough
• Fever
• Night sweats
• Weight loss
• Purulent, foul-smelling sputum

SIGNS:

• Temperature ≥ 38◦C
• Crackles over affected area
• Egophony

DIAGNOSIS:

• Chest X-Ray
• CT – Scan
• Cultures

1. Anaerobic – sputum (putrid)
2. Empyema – pleural fluid
3. Aerobic – bronchoscopic aspirates

COMPLICATIONS:

• Recurrent haemoptysis
• Metastatic abscesses
• Sepsis

RUBRICS FOR LUNG ABSCESS:

1. SYNTHESIS REPERTORY

• CHEST – ABSCESS – Lungs – accompanied by – Lungs; inflammation of
• CHEST – INFLAMMATION – Lungs – chronic – accompanied by – Lungs; abscess of
• CHEST – ABSCESS – Lungs – left
• CHEST – ABSCESS – Lungs
• CHEST – SUPPURATION of lungs

2. HOMOEOPATHIC MATERIA MEDICA AND REPERTORY DR. WILLIAM BOERICKE

• RESPIRATORY SYSTEM – LUNGS, Abscess
• RESPIRATORY SYSTEM – CHEST, Affection, after operation, for hydrothorax, empyema

3. MURPHY’S REPERTORY

• CHEST – ABSCESS, sensation of, on left, between pectoralis major and minor, hard and sensitive to touch, drawing pains in every direction, worse on motion of arm
• LUNGS – ABSCESS, lungs
• LUNGS – ABSCESS, alcoholics, in
• LUNGS – ABSCESS, left
• LUNGS – ABSCESS, thirst, with

4. COMPLETE REPERTORY 

• CHEST – ABSCESS – general – lungs
• CHEST – ABSCESS – general – lungs, left
• CHEST – ABSCESS – general – lungs, cancerous affections, in
• CHEST – ABSCESS – general – lungs, drunkards, in
• CHEST – ABSCESS – general – lungs, thirst, with
• CHEST – ABSCESS – general – lungs

5. PHATAK’S REPERTORY

• CHEST AND LUNGS – abscess of lung

6. ROBERTS H. REPERTORY

• INTERNAL CHEST – Suppurating behind sternum

7. WARD J., REPERTORY

• CLINICAL – Abscess pectoral

8. PULFORD A. and T.D., REPERTORY OF PNEUMONIA

• CHEST – abscess lungs

CONCLUSION:
Lung abscess is a necrotizing lung infection characterised by a pus-filled cavitary lesion, and is most commonly caused by aspiration of oral secretions by patients who have impaired consciousness, with a male predominance and an older age group. Diagnosis is based primarily on chest x-ray. It is also important to distinguish lung abscess from similar conditions like necrotizing pneumonia, wherein, the former implies a cavity of at least 2cm in diameter, and the latter represents multiple, small cavities each of which is less than 2cm in diameter.

REFERENCES:

• Munjal YP. API textbook of medicine. 9th ed. Vol. 2. Mumbai, mumbai: Dr. Yash Pal Munjal for and on behalf of The Association of Physicians of India; 2012
• Porter RS, editor. The Merck manual. 19th ed. United States: Gary Zelko; 2011
• Lung Abscess Clinical Presentation: History, Physical Examination, Complications [Internet]. Lung Abscess Clinical Presentation: History, Physical Examination, Complications. 2019 [cited 2020Jan27]. Available from: https://emedicine.medscape.com/article/299425-clinical
• Schroyens F. Synthesis: repertorium homeopathicum syntheticum. 9.1 ed. Noida, UP: B. Jain Publishers; 2016.
• Boericke W. Boerickes new manual of homoeopathic materia medica with repertory including Indian drugs, nosodes, uncommon rare remedies, mother tinctures, relationships, sides of the body, drug affinities, & list of abbreviations. New Delhi: B Jain Publishers; 2007.
• Murphy R. Homoeopathic medical repertory. 3rd ed. New Deli: B. Jain; 1998
• Zandvoort Rvan, Stefanovic A, Kroschewski-König F. Repertorium universale das große Repertorium der homöopathischen Arzneimittel ; Ruppichteroth: Similimum-Verl.; 2003.
• Phatak SR. Concise repertory of homeopathic medicines. New Delhi: B. Jain; 2016.
• Repertory Compilation 1.0 (English-10 vol) (RC10)

Dr Shweta Jha
PG Scholar In Dept Of Practice Of Medicine
Father Muller Homoeopathic Medical College And Hospital, Mangalore
drshweta328@gmail.com