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Acute abscess and gangrene of a lung

Table of contents
Acute abscess and gangrene of a lung
Diagnosis and researches of diseases
Treatment

Acute abscess of a lung  — it is purulent - necrotic damage of a lung at which there is a bacterial and/or autolytic proteolysis of necrotic masses and forming of the cavity delimited from viable pulmonary fabric.

Lung gangrene  — violently progressing putrefactive and necrotic defeat of a share or all lung.

Epidemiology

Epidemiological researches on prevalence of abscess of a lung and gangrene of a lung in Russia were not carried out.
Abscess of a lung and gangrene of a lung meet at the men of middle age (who are especially abusing alcohol) more often.

The factors contributing to development of abscess of a lung:
• chronic diseases of lungs:
— chronic obstructive bronchitis (at smokers);
— bronchiectasias;
— bronchial asthma;
• pneumonia, mainly at persons with reduced immunity:
— abusing alcohol;
— addicts;
— HIV-positive people;
• acute respiratory viral infections;
• diabetes mellitus;
• a severe craniocereberal injury, stay in an unconsciousness, etc.
gangrene of a lung develops generally at persons with heavy disturbances of immunity.

Classification of diseases

Allocate the following kliniko-morphological forms of abscess of a lung:
• idle time (purulent);
• gangrenous (with sequesters).
• gram-negative sticks:
— representatives of Enterobacteriaceae family;
— Pseudomonas aeruginosa;
• neklostridialny anaerobic microorganisms;
• Haemophilus influenzae;
• Mycoplasma pneumoniae;
• mushrooms.

On prevalence of process distinguish:
• hemilesions:
• lung abscess:
— single abscess of a lung;
— multiple abscesses of a lung;
• lung gangrene:
— share;
— subtotal;
— total;
• bilateral defeats:
— multiple abscesses of a lung;
— gangrenes of lungs;
— abscess of one lung, gangrene
another;
— abscesses and gangrene of one lung, pneumonia from the opposite side.

Etiology and pathogeny of a disease

The following microorganisms can be causative agents of acute abscess of a lung:
— gram-positive cocci:
— Staphylococcus aureus;
— Streptococcus pyogenes;

Lung gangrene, as a rule, is caused by associations of microorganisms among which surely there is an anaerobic microflora.
On the basis of a kliniko-morphological form and anamnestic data it is possible to assume the probable causative agent of abscess of a lung and gangrene of a lung.
Main ways of penetration of microflora to pulmonary fabric:
— bronchogenic:
— aspiration (microaspiration of a secret of a stomatopharynx, aspiration of a large number of contents of upper respiratory tracts and/or stomach);
— inhalation (inhalation of the aerosol containing microorganisms);
• hematogenous (at sepsis);
• traumatic (not getting and getting thorax injury);
• from the next bodies and fabrics:
— contact;
— lymphogenous.

 

Kliniko-morfologichesky form (anamnestic data) Simple abscess

Probable S. pneumoniae H. influenzae S. aureus activators
Enterobacteriaceae

Bilateral multiple cavities (injection sepsis)

S. aureus, including penicillin - and Methicillinum - resistant strains

Set of abscesses with the small level of liquid (it is frequent against flu)

S. aureus

Abscess of aspiration genesis

Anaerobe bacterias of S. aureus
Enterobacteriaceae

Gangrenous abscess (abscess with the wrong contours, destruction against a lung heart attack)

Anaerobe bacterias
P. aeruginosa S. aureus
Klebsiella pneumoniae Enterobacteriaceae

Lung gangrene

Anaerobe bacterias
P. aeruginosa K. pneumoniae S. aureus

Besides, abscess of a lung can develop in case of accession of consecutive infection against:
• bronchial tube obturation (foreign body or tumor);
• thromboembolisms of branches of a pulmonary artery.
The disease, as a rule, begins against one - or bilateral pneumonia, most often aspiration.
The significant role in a pathogeny of abscess of a lung and gangrene of a lung belongs to local disturbance of microcirculation against is purulent - destructive diseases of lungs. The decrease in perfusion of a lung caused by microfibrinferments leads to strengthening of proteolysis and destructive process, increase of intoxication and expansion of a zone of destruction. Development of the IDCS can be extreme manifestation of disturbance of a hemostasis.

Clinical signs and symptoms of an illness

The most characteristic symptom of abscess of a lung and gangrene of a lung is cough with a phlegm otkhozhdeniye.
Cough can disturb mainly in the mornings (in process of accumulation of a phlegm) or to be dry, pristupoobrazny, painful.
The phlegm can be:
• purulent, is more often — with a smell, is more rare — inodorous; white, dirty-green or grayish-white color; two - or three-layered;
• putrefactive, with a pungent hardly transferable smell; dirty-gray or chocolate color; three-layered (it is characteristic of lung gangrene);
• with blood impurity.
Quite often there is a pain on the party of defeat connected with breath, cough.
Often at patients an asthma is noted. In the beginning it is caused by difficulty of breath, then arteriovenous shunting of blood, reduction of volume of the ventilated pulmonary fabric.
The expressed intoxication symptoms are characteristic:
• the fervescence, quite often gektichesky character which is followed by oznoba;
• encephalopathy;
• disturbance of functions of parenchymatous bodies;
• increased fatigue;
• loss of appetite to anorexia;
• decrease in body weight.
Along with the above-named symptoms the clinical picture can include the manifestations characteristic of development of complications of abscess of a lung and gangrene of a lung:
• from a pleural cavity:
— serous pleurisy;
— pleura empyema;
— pheumothorax;
— pyopneumothorax;
• from a chest wall:
— the pro-butting empyema;
— phlegmon of a chest wall;
— outside thoracic fistulas;
— pericardis:
— serous;
— purulent;
• bleeding, pneumorrhagia;
• IDCS;
• respiratory distress syndrome of adults;
• sepsis;
• multiorgan insufficiency.

Options of a course of acute abscess of a lung and gangrene of a lung
• The phase course of a disease (is more characteristic of lung abscess):
The 1st phase — the accruing clinic of pneumonia and weight of intoxication; the 2nd phase — break in bronkhignoyny contents with sharp strengthening of cough and department of a large number of a purulent phlegm; the 3rd phase — reduction of expressiveness of intoxication, intensity of cough and department of a purulent phlegm.
• Steadily heavy long (2 — 3 weeks) the course of pneumonia with gradual increase of frequency of cough, the increasing daily quantity of the separated purulent or putrefactive phlegm, possible accession of complications.
• The gradual decrease in weight of pneumonia, intoxication which is replaced sharply accruing intoxication, strengthening of cough with department of a purulent or putrefactive phlegm, accession of complications.
• Decrease in weight of pneumonia, intoxication, a cough urezheniye with insignificant quantity of a purulent phlegm at fast emergence in lungs of cavities with insignificant levels of liquid.
• The sudden quickly progressing course of process, heavy intoxication with sharp increase in quantity of a purulent or putrefactive phlegm, accession of complications (is more characteristic of lung gangrene).
Depending on expressiveness of clinical manifestations mark out the following severity of a course of abscess of a lung:
• a lung (symptoms of damage of the lower airways without signs of respiratory insufficiency);
• moderately severe:
— symptoms of damage of the lower airways + respiratory insufficiency;
— symptoms of damage of the lower airways + respiratory insufficiency + the expressed intoxication;
— the expressed proteolysis of pulmonary fabric with fast formation of cavities against not expressed symptoms of damage of the lower airways;
• heavy:
— symptoms of damage of the lower airways + respiratory insufficiency + sepsis;
• extremely heavy:
— the septic shock remaining despite adequate infusional therapy;
— multiorgan insufficiency.
Heavy and extremely heavy current is characteristic of gangrene of a lung.



 
"Acute (obliterating) bronchiolitis   Acute bronchitis"