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
  1. HOMOEOPATHIC MATERIA MEDICA AND REPERTORY DR. WILLIAM BOERICKE
  • RESPIRATORY SYSTEM – LUNGS, Abscess
  • RESPIRATORY SYSTEM – CHEST, Affection, after operation, for hydrothorax, empyema
  1. 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
  1. 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
  1. PHATAK’S REPERTORY
  • CHEST AND LUNGS – abscess of lung
  1. ROBERTS H. REPERTORY
  • INTERNAL CHEST – Suppurating behind sternum
  1. WARD J., REPERTORY
  • CLINICAL – Abscess pectoral
  1. 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

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