DIAGNOSIS, TREATMENT AND PROGNOSIS OF

LUNG ABSCESS

Silvia Arga
1507101030223

dr. Dewi Behtri Yanifitri, Sp.P (K)

BAGIAN/ SMF PULMONOLOGI DAN KEDOKTERAN RESPIRASI

FAKULTAS KEDOKTERAN UNIVERSITAS SYIAH KUALA/
RSUD dr. ZAINOEL ABIDIN BANDA ACEH
2016
ABSTRACT
Abses paru biasanya disebabkan oleh bakteri
anaerobik atau campuran yang menginfeksi
saluran napas bagian bawah.
80-90 % pasien memiliki respon terhadap terapi
farmakoterapi
Jika gagal dibutuhkan drainase dengan tindakan
invasif (percutaneous, endoscopic or surgical)
atau pembedahan (segmentectomy, lobectomy or
rarely pneumonectomy)
Tingkat mortalitas dengan pembedahan (11-
28%), cara paling tepat untuk mencegah relaps
 DEFINITION-PATHOGENESIS

abses paru: kumpulan pus pada

parenkim paru yang disebabkan infeksi
bakteri dengan karakteristik adanya
kavitas yang dikelilingi jaringan
nekrotik inflamasi pada jaringan paru.

lung abscess < 2 cm in diamter is

referred as necrotizing pneumonia.
 DEFINITION-PATHOGENESIS

Primary lung abscess:

Biasanya terjadi pada pasien yang sehat
atau terjadi karena adanya aspirasi
(impared reflexes, bad oral hygiene, in
coma, after epileptic sizures)
Secondary lung abscess:
Biasanya muncul karena obstruksi
mekanik bisa karena massa,
Generalized immunosuppressions,
septic pulmonary emboli pada
endokarditis
 ETIOLOGIC AGENT
> 93% caused by anaerobic bacteria found in normal
oral and upper intestinal microbial flora (e.g.
Peptosterotococcus, bacteroides, prevotella,
fusobacterium spp)

Less commonly pathogens staphilococcus aureus

(MRSA), haemophilus influenza, streptococcus
pyogenes, nocardia and actinomyces species.

In more recent years higher percentages of aerobic

and microaerophillic streptococcus and gram negative
bacteria (klebsiella pneumonia)

HAP: pseudomonas and enterobacter (elderly)

 CLINICAL PRESENTATIONS

Clinical finding: non-spesific symptoms and signs

mimic tuberculosis (fever with night sweats, dull
chest pain, fatigue, anorexia, weight loss,
productive cough with fetid and occasionally
bloody sputum
Aerobic microorganisms clinical pogression is
more rapid and usually result in non resolving
pneumonia.
Viral infection (infulenza) in younger
characterized by cardiovaskular instability
(shock), netropenia, lung tissue necrosis with
abses formation and high mortality.
 RADIOLOGICAL FINDINGS

Solitary or multiple thick walled cvities with

abnormal margins that present either isolated or
within a consolidation area
Cavitation occurs when erosion of lung
parenchyma leads communication with bronchus,
resulting drainage of necrotic material, entry air
and creation of air-fluid level.
CT scan useful in excluding endobronchial
ostruction due to malignancy , enable distinction
between lung abscess and empyema.
 MICROBIOLOGICAL DIAGNOSIS-
ANTIMICROBIAL TREATMENT

Sputum cultures, blood cultures, pleural fluid

culture, bronchial secretion, fiberoptic
bronchoscopy with quantitave culutures (brush,
lavage), cultures of transthoracis needle
aspiration.

Sputum cultures (not suitable for detection

anaerobic bacteria, suitable for aerobic e.g.
Pseudomonas aeruginosa)

Blood cultures and pleural fluid cultures usually

negative
 TREATMENT
Clindamycin (600 mg iv/8 hr followed by 150-300
mg/6 hr p.o) : first choice for anaerobic bacteria.
Amoxicillin/claculanate, ampicillin/sulbactam :
effective in community acquired lung abscess
Combination of 2nd (cefuroxime, cefoxitin) or 3rd
generation of cephalosporin (ceftriaxone) with
clindamycin or metronidazole.
Linezolide (600 mg /12 hr iv): MRSA

Vancomycin (15 mg/kg/12 hr iv

Duration :3-6 weeks

 DRAINAGE

Early stage of lung abscess there exist direct

comunication of the tracheobronchial three with
abscess cavity, purulent materiak drained
automatically.
 PERCUTANEOUS DRAINAGE
Usually lung abscess with diameter 4-8 cm
A minimally invasive methode with fewe
complication and lower mortality rates in
comparison to surgical treatment
 ENDOSCOPIC DRAINAGE

Guidewire inserted into the cavity trough

bronchoscope, a 7 French pigtail catheter is
advanced, the cavity flushed daily with normal
saline through the catheter while antibiotic
infusions may also be administrated. Sometimes
with combination of laser to perforate abscesss
wall and lead catheter inside the cavity.
The catheter is removed after 4-6 day with
immediate imrovment clinical status and
radiological imaging within the first 24 hours
 SURGICAL INTERVENTIONS
First open surgical drainage was performed by
harold neuhof
In the 40s and 50s, surgical resection of the
involved part of the lung (segmentectomy,
lobectomy, or rarely pneumonectomy was
effective to preventing complication/relapses
Patiens who are refrred to a thoracic surgeon are
usually in a serious septic situation due to
chronic abscessive lesion not responding to
pharmaceutical treatment or combined with
transcutaneus drainage.
 CONCLUSION
Discovery of antimicrobial agents during 40s
modified management and outcome.
Patients 80-95% respon to antimicrobial therapy.

Failure of consevative management, manifestes

by sepsis persistent/complication, may
necessitate drinaged with invasive technique
(percutaneous, endoscopic, or surgical.
THANK YOU