Absolute pneumonia (Abscessive Pneumonia) is a destructive inflammatory process, accompanied by the formation of multiple purulent foci in the lung tissue. Symptoms vary depending on the pathogen. Classic manifestations of abscessed pneumonia include febrile fever, chills, severe intoxication, cough with offensive phlegm, anorexia, and weight loss. Confirmatory diagnostic methods are radiography and CT of the lungs. In the treatment of abscessed pneumonia, drug methods are combined (antibiotics, infusion therapy, immunotherapy), impact on the focus of infection (sanitation bronchoscopy, thoracocentesis), extracorporeal hemocorrection (ultraviolet irradiation of blood, hemosorption).
General information about Abscessive Pneumonia
Abscess pneumonia is a complication of pneumonia of various etiology, characterized by the formation of intrapulmonary purulent-necrotic cavities. In pulmonology, the term “abscess pneumonia” refers to the period during pneumonia, during which, against the background of infiltrative changes, clinical and radiological signs of destruction of the pulmonary parenchyma are determined.
The conditional difference between a lung abscess and abscess pneumonia is considered to be the size of a purulent cavity: in the first case, its diameter exceeds 2 cm.If there are small and multiple foci of destruction in the lung tissue or a solitary cavity with a diameter of less than 2 cm, they speak of abscessed pneumonia. Most often, bacterial and aspiration pneumonia is complicated by suppuration.
The reasons of Abscessive Pneumonia
In the etiology of abscessed pneumonia, the leading role belongs to Staphylococcus aureus , Klebsiella pneumonia (Friedlander’s bacillus) and other enterobacteria; somewhat less often, pneumococcus and hemolytic streptococcus , anaerobic bacteria (fusobacteria, peptostreptococcus) become pathogens . These microorganisms are capable of causing destruction and necrosis of lung tissue, followed by the formation of a limited purulent cavity.
The main factors contributing to the entry of pathogens into the lung tissue are the aspiration of a significant amount of oropharyngeal secretion and the presence in the body of purulent foci in contact with the bloodstream or lymphatic bed.
- The aspiration mechanism of the occurrence of abscess pneumonia is most often observed in persons suffering from alcoholism and drug addiction, epilepsy, stroke, impaired consciousness, dysphagia, GERD, etc.
- Metastatic hematogenous or lymphogenous abscess formation of the lungs, as a rule, is a consequence of severe furunculosis, endocarditis, osteomyelitis.
- Possible causes of abscess formation can be foreign bodies of the bronchi, lung tumors.
Patients with abscessed pneumonia in history often have indications of background pathology (blood diseases, diabetes mellitus, periodontal disease), long-term treatment with glucocorticoids and cytostatics.
Pathogenesis of Abscessive Pneumonia
In the pathogenesis of abscessed pneumonia, the greatest importance is attached to the species class of the pathogen with its antigenic properties, the sensitivity of the microorganism to antibiotics, concomitant diseases of the respiratory tract and the body as a whole, disrupting local and general reactivity.
The destruction of lung tissue is associated with the fact that pathogens (especially staphylococcus aureus) produce a large amount of enzymes and toxins that have a cytolytic effect and cause necrosis of the alveolar septa. This leads to the formation of multiple cavities filled with air and serous-hemorrhagic exudate, which do not have clear boundaries around the foci of decay. In the future, these cavities can either evolve into a large purulent focus (lung abscess), or merge, giving rise to abscess pneumonia.
Symptoms of abscess pneumonia
In most cases, the onset of the disease is not much different from the usual focal pneumonia . The patient is worried about cough, fever, chest pains with a tendency to intensify when breathing; radiographically determined focal infiltration in the lungs. In children, the addition of abdominal, neurotoxic or asthmoid syndromes is possible.
Under unfavorable conditions, the condition quickly deteriorates and at the next stage, the actual abscess pneumonia develops. This stage is accompanied by an increase in signs of intoxication (hyperthermia up to 40 ° C with chills, adynamia, anorexia) and respiratory failure (shortness of breath with the participation of auxiliary muscles in the act of breathing, cyanosis).
Since at this time micro-abscesses are already forming in the lung tissue, sputum with a putrid odor , sometimes mixed with blood , is noted . The patient is adynamic, inhibited; pale gray skin; confusion may occur. With the further development of the disease, a lung abscess occurs, during which the stages of formation and drainage of the abscess are distinguished.
Among the local purulent complications that aggravate the outcome of abscessed pneumonia are pleural empyema, pyopneumothorax, mediastinitis. Metastasis and generalization of infection lead to the development of bacterial pericarditis, purulent arthritis, sepsis, etc. Atelectasis of the lung may result from partial or complete obstruction of the bronchus. With vascular erosion, there is a risk of pulmonary hemorrhage. With an extremely rapid and severe course of septic pneumonia, multiple organ failure may develop, requiring intensive therapy.
The examination is carried out by a pulmonologist and includes the following diagnostic measures:
- Objective examination . Physical data are characterized by weakening of breathing, shortening of percussion sound, the presence of wet wheezing, tachypnea, tachycardia.
- Radiography of the lungs . The fundamental role in establishing the diagnosis is played by the results of X-ray examination. At the same time, standard radiography of the lungs does not always allow visualizing small cavities against the background of pneumonic infiltration.
- CT scan of the chest . Therefore, if you suspect abscess pneumonia, it is advisable to resort to CT. In the case of the formation of a lung abscess, a thick-walled cavity formation with the presence of a characteristic level of liquid and gas is determined on the images.
- Laboratory research . Blood tests show signs of pronounced systemic inflammation (significant leukocytosis, increased ESR, CRP).
As part of differential diagnosis, excluding tuberculosis and lung cancer, a three-time study of sputum for VC (causative agents of tuberculosis) and atypical cells is carried out. To isolate pathogenic flora, bacterial culture of sputum or bronchial lavage water is carried out with the determination of antibiotic sensitivity. In some cases, to clarify the causes of abscess pneumonia, diagnostic bronchoscopy is indicated .
Treatment of abscessed pneumonia
Abscess pneumonia is difficult to treat and requires a combination of therapeutic and surgical methods. Patients require careful care, high-calorie nutrition with replenishment of protein loss.
- Antibiotic therapy. Etiotropic therapy is based on the sensitivity of the isolated pathogens to antibacterial agents. Its duration can range from 4 weeks to several months; the question of changing and combining drugs is decided by the pulmonologist individually, taking into account the clinical and radiological dynamics. Usually, benzylpenicillin + metronidazole, lincosamides (clindamycin, lincomycin), aminopenicillins (amoxicillin / clavulanic acid, ampicillin / sulbactam), etc. are used as starting therapy for abscess pneumonia.
- Complementary therapy. In order to improve the drainage of the purulent focus, expectorant, mucolytic, bronchodilator drugs, and drug inhalations are prescribed. With confirmed staphylococcal etiology of abscess pneumonia, the administration of hyperimmune antistaphylococcal plasma is effective.
- Infusion therapy. With severe hypoproteinemia, parenteral administration of albumin, plasma is carried out. At the same time, correction of respiratory failure, hypovolemia, violations of the water-mineral balance is carried out.
- Extracorporeal hemocorrection. For detoxification purposes, gravitational blood surgery is used (plasmapheresis, blood ultraviolet irradiation, hemosorption).
For the purpose of sanitizing purulent foci, therapeutic bronchoscopy is used, according to indications, puncture or drainage of an abscess with active aspiration of pus, rinsing the cavity with antiseptic solutions, the introduction of proteolytic enzymes and antibiotics is performed. In case of impossibility of conservative cure of the abscess, resection of the affected parts of the lung is indicated .
The prognosis of abscessed pneumonia is serious; mortality is high, 15–25%. In the event of complications, the presence of concomitant diseases and foci of purulent infection, the percentage of unfavorable outcomes is significantly higher. The course of abscessed pneumonia can end with recovery, the formation of pulmonary fibrosis, chronic lung abscess.