Abscessing pneumonia treated with antibiotics. Lung abscess: symptoms, forms, diagnosis and treatment. Options for the course of pneumonia

If the process of inflammation in the lungs develops due to entry into the organ anaerobic bacteria- this is dangerous form pneumonia causing many complications. One of them is abscess pneumonia - when pathological process accompanied by the destruction of lung tissues and the formation of foci of suppuration in them.

Basically, the abscess form of pneumonia is provoked by the following pathogens:

1. golden staphylococcus aureus;
2. hemolytic streptococcus;
3. anaerobic bacteria;
4. pneumococci.

Each of the listed pathogens causes destruction, tissue necrosis in the lungs. Because of this, the formation of a focus of suppuration occurs. The fundamental factor under the influence of which pathogens penetrate into the lungs is the influx of sputum in large quantities from the pharynx and the formation of purulent foci. This form pneumonia is primarily characteristic of people with drug and alcohol addiction, for patients after a stroke, for patients with epilepsy, dysphagia and with impaired consciousness.

The lymphogenic form of the disease can develop under the influence of:

• sepsis;
• advanced furunculosis;
• osteomyelitis;
• endocarditis.

Sometimes an abscess occurs as a result of the penetration of a foreign body into the bronchi or is formed with lung cancer. Abscessing inflammation of the lungs is often accompanied by blood pathologies, periodontal disease and diabetes mellitus. It is important to diagnose the pathogen in time, take tests for its resistance to antibiotics in order to prescribe a highly effective therapy.

It happens that the integrity of lung tissues is violated due to the influence of toxins, staphylococcal enzymes on them.

Symptoms of the disease

The acute course of abscessing pneumonia can be divided into 2 types:

1. turbulent current accompanied by high temperature up to 40 degrees, respiratory failure and severe intoxication. Usually this condition is characteristic of lesions of staphylococcus or pneumococcus.
2. Slow course - occurs as a complication of a respiratory viral infection. First, a small-focal lesion of the bronchi is detected, and pus begins to accumulate only after 2-3 weeks. After suppuration, the general condition becomes much worse, the temperature increases, the complexity of the respiratory processes and the insufficiency of the heart and blood vessels appear, the skin becomes very pale. When listening to the lungs, small bubbling sobs are diagnosed, and in the heart zone the tones are muffled. Due to the intestinal paresis that accompanies the disease, bloating occurs.

classic clinical course abscessing pneumonia can be divided into 3 stages, each of which has its own characteristic features:

1. Infiltration.
2. Rupture of an abscess in the bronchi.
3. Scar formation at the site of suppuration.

The first stage is accompanied severe symptoms abscess in lung

• blanching of the skin and blue on the cheek from the side of the affected lung;
• chills and fever;
• increased sweating;
• dry cough with scanty discharge of purulent sputum;
• pain in the chest on the affected side - it is so strong that it makes the patient occupy forced posture on the side on the affected side;
• shortness of breath and difficulty breathing;
• frequent pulse.

After 2 - 3 weeks from the moment of infection, spontaneous resolution of the abscess may begin - the second stage of pneumonia. The patient has violent attack coughing, when it ends, 100 - 500 ml of sputum leaves. Subsequently, this volume gradually decreases until scarring occurs. With proper drainage of the cavity, the patient's well-being quickly improves after the first attack of sputum discharge, the symptoms subside.

Important! With a successful outcome, the disease lasts for 6 to 8 weeks. Early diagnosis and selection suitable therapy makes it possible to further reduce these periods.

Classification

The disease can be accompanied by various clinical manifestations, the localization of the purulent focus is also different, in connection with which such forms of abscessing pneumonia are distinguished:

• central inflammation - localized at the roots of the lung;
• peripheral inflammation - localized in the lung tissue, closer to the walls chest.

According to the prevalence of inflammation, the disease can also be divided into several types:

• single;
• plural;
• segmental;
• equity.

Diagnostic methods

Data after a physical examination by a doctor will be as follows:

• weakening of breathing;
• shortening the time of percussion sound;
• wet hoarseness;
• tachycardia;
• tachypnea.

Blood tests showed leukocytosis, an increase in ESR.

Important! The main role for the correct diagnosis is given to radiography. A standard examination helps to visualize small cavity formations against the background of infiltration.

Also, if abscess pneumonia is suspected, it is often realized CT scan. With an abscess, the images show a cavity formation with a large wall thickness, a characteristic content of gas and liquid.

For differentiation with other lung lesions and forms of pneumonia, a three-fold study of the composition of sputum for the presence of the causative agent of tuberculosis and atypical cancer cells is organized.

To properly highlight pathogenic flora and to establish the sensitivity of microbes to antibiotics, the diagnosis of sputum or bronchial washings is carried out - bacterial culture. In particular difficult situations to establish the causes of the disease, a transbronchial puncture is performed - diagnostic bronchoscopy.

Principles of treatment

Abscessing pneumonia is difficult to treat, it is a complex process that consists of various conservative methods and operational ways elimination of pathology. The main actions should be aimed at stopping inflammation, destroying pathogenic microbes and reducing the symptoms of intoxication.

Traditional treatment of abscessed pneumonia includes the following therapeutic methods of exposure:

1. Antibacterial therapy with drugs that the doctor selects after a full diagnosis. The duration of the course of treatment is from 4 weeks to 4 months.
2. Reception of mucolytics, bronchodilators, expectorant medicines. This is necessary to accelerate the discharge of purulent sputum from the cavities formed in the lung.
3. Antipyretic and anti-inflammatory medicines - help resist inflammation and restore normal temperature.
4. Implementation of detoxification for the body - needed to remove toxins resulting from the spread pathogenic microflora. In accordance with the severity of the condition, this method includes: blood irradiation with ultraviolet radiation, hemosorption, plasmaphoresis.
5. Symptomatic treatment - options for its organization depend on developing complications. According to indications, procedures are required to restore blood circulation, to relieve symptoms of respiratory and renal failure, and restore the functioning of the gastrointestinal tract.
6. Recovery general well-being. It consists in improving the functions of the immune system, replenishing vitamins and minerals that are lost during the period of illness.

It is possible to combine drugs with folk remedies in therapy. The main thing is not to carry out treatment only according to prescriptions. traditional medicine. Most effective recipe- honey with carrot juice. You should also pay attention to the diet - include more proteins, try to completely abandon fat at the stage of treatment.

Surgery

If a conservative treatment abscessing pneumonia is ineffective, then doctors are assigned to organize an operation - sanitation of inflammatory foci in the lungs. Drainage or puncture of abscesses is performed in order to remove the accumulated pus. Then the affected area is treated with antiseptics, antibiotics are introduced. After opening the walls of the cavity are cleaned of dead tissue, drainage is carried out, the wound is sutured, antibiotics are injected into it daily.

If the effect of the described procedure does not turn out, then an operation is required to remove the part of the lung affected by the abscess. It is called pneumotomy - it is carried out only with gangrenous abscesses or in the absence of the possibility of drainage.

Forecast and prevention

With timely therapy, purulent pneumonia recedes, a favorable outcome is noted in 75 - 85% of cases. Poor prognosis of the disease is typical for people in old age or with additional chronic pathologies, with immunodeficiency.

Infectious abscesses do not respond well to treatment, so in 15 - 25% of cases, patients die due to complications. In addition, complete recovery becomes impossible - tissue fibrosis develops, chronic abscesses form. When infected with this form of a child, it is extremely difficult, but due to young age and correct work protection of the body, the probability of a positive outcome remains high.

Important! The best prevention of abscess inflammation in adults is the management right image life, revision bad habits and dietary adjustments.

It is important not to start diseases of the organs respiratory system to be able to warn serious complications, life threatening person. Even mild cold should be a reason to see a doctor, especially for young children, since pneumonia in their body develops several times faster. Pathology will not go away on its own, only a doctor can timely detect the presence of abscesses and take measures to eliminate them.

Inflammation of the lungs from time immemorial has been one of the most topical diseases of all mankind. Nowadays, medicine has an impressive amount of antibiotics, vaccines and other drugs. Physicians have long developed efficient schemes therapy of patients with pneumonia, informative diagnostic methods and work on effective preventive measures this disease. And in most cases, with the right approach, such patients recover without complications and consequences. But these measures do not allow to cope with the problem of mortality from pneumonia worldwide.

Some statistics!

Every year the number of cases of this disease is growing. This problem is especially relevant in the "poor" countries of Asia and Africa, where there is still a problem with access to antibiotics and medical care in general.

Flu epidemics, the spread of HIV infection and other diseases that reduce immunity, and the development of resistance of many bacteria to various antibiotics add fuel to the fire.

A little about the structure of the lungs

The right lung is wider and shorter than the left, which is explained by its location in the left side of the thoracic cavity of the heart. The right lung has three lobes and 10 segments, while the left has two lobes and 9 segments. When describing segments, indicate the letter S and the segment number (for example, S1, 2, etc.). All segments and shares are separated from each other by partitions made of connective tissue.

Characteristics of the organs of the respiratory system, their role in pneumonia

Respiratory system	Scheme	Main functions	Possible changes in pneumonia
Upper respiratory tract: nasal cavity and paranasal sinuses; oropharynx; nasopharynx; larynx.		Through the upper respiratory tract, air enters the lower respiratory tract and lungs. In the upper respiratory tract, the air is purified and warmed.	Often pneumonia develops as a complication of upper respiratory tract infections, meaning the inflammation travels down into the lungs.
bronchial tree. The trachea is divided into two main bronchi, which further branch like branches of a tree, this is the bronchial tree. The bronchi are of different caliber (diameter), the smallest of them are the bronchioles.		The trachea and bronchial tree belong to the lower respiratory tract. Normally, sputum is constantly secreted in the bronchi - mucus with immune cells, this is necessary to clean the respiratory tract from infections, dust and other foreign particles. The bronchi are covered with ciliated epithelium, the cilia, with their movements, promote sputum and particles of dust, infections towards the upper respiratory tract. In the bronchial tree, air is distributed and enters the lungs.	Damage to the bronchial mucosa often accompanies pneumonia - bronchopneumonia. Bronchitis and pneumonia are similar in symptoms and manifestations, this is the most often required differential diagnosis.
Acinus - is the structural unit of the lung. Components of the acinus: bronchiole; blood vessel; alveolus.		Alveoli are sacs that end in the smallest bronchioles. Alveoli are normally filled with air. It is in them that gas exchange occurs - the entry of oxygen into the blood and the removal of carbon dioxide from it. Further, oxygen is carried with blood throughout the body to every organ, tissue and cell, from where carbon dioxide is collected, and so on in a circle.	With pneumonia, the inflammatory process occurs in the alveoli, which leads to disruption of gas exchange in the affected area, that is, breathing in them is not carried out in full.
Pleura- this is serosa that covers the lung. It has two leaves, like a bag of two layers forms a pleural cavity.		The main function of the pleural cavity is to prevent friction of the lungs during breathing against the walls of the chest cavity during respiratory movements. Normally, this cavity contains not a large number of liquids. On x-ray, the pleural cavity is not visible, you can only see pleural sinuses, they have no big sizes.	In severe cases of pneumonia, the pleura may also be involved in the process, pleuropneumonia develops. In this case, inflammatory fluid can enter the pleural cavity - pleurisy, air - pneumothorax , pus - pyopneumothorax .

Causes of pneumonia

infections

Infections that most commonly cause pneumonia include:

1. Bacteria:

• hemophilic bacillus;
• klebsiella.

• flu;
• adenoviruses;
• rhinoviruses;
• rhinosyncytial viruses and others.

• legionella.

• candida;
• pneumocystis;
• actinomycetes (aspergillosis).

• tuberculosis;

• helminthic invasion (roundworm, lamblia, etc.);
• foreign bodies in the bronchi and lungs;
• autoimmune diseases (when the immune system destroys its own tissues, mistaking them for others);
• chemical and thermal burns of the lungs (after a fire, inhalation of various chemical substances and aerosols).

Factors that increase the risk of developing pneumonia

• children and old age;
• the presence of chronic foci of inflammation (chronic tonsillitis, bronchitis, caries and much more);
• HIV infection and other immunodeficiencies;
• diseases of the digestive system;
• oncological pathologies;
• autoimmune diseases, and so on.

3. Environmental condition:

• hypothermia or overheating;
• drafts;
• dry or too humid air;
• dusty, polluted air;
• harmful production conditions.

5. Chronic bronchial diseases, including bronchiectasis and bronchial asthma.

7. Cardiovascular diseases that present with heart failure.

8. sedentary image life - leads to the so-called congestive pneumonia.

9. Diseases of the nervous system, accompanied by a violation of swallowing, lead to aspiration pneumonia.

Pneumonia (pneumonia): definition, causes, modes of transmission, consequences and complications - video

Types and forms of pneumonia

Hospital and community-acquired pneumonia

Typical and atypical pneumonia

Acute and chronic inflammation of the lungs

Bacterial inflammation of the lungs

Purulent pneumonia

Viral inflammation of the lungs

• Primary viral pneumonia caused directly by the virus. This variant of pneumonia always proceeds severely, and within a short time (several hours or days) can lead to severe complications including pulmonary edema. Most often, such inflammation of the lungs develops against the background of the flu. It is difficult that antibiotics for such pneumonia are ineffective.
• Secondary viral pneumonia associated with the addition of a bacterial infection on the background of a viral one. That is, it is a mixed version of pneumonia.

Fungal pneumonia (mycosis)

One variant of fungal pneumonia is pneumocystis pneumonia, which occurs only in HIV-positive patients and indicates the development of the AIDS stage. And, unfortunately, this is one of common causes death of HIV-infected people.

Aspiration pneumonia

Unilateral and bilateral pneumonia

Focal pneumonia

Croupous inflammation of the lungs

Interstitial pneumonia

Symptoms of pneumonia

Group of symptoms	Symptom	Development mechanism	How is it manifested?
Symptoms of intoxication	Increase in body temperature	Bacteria that live and multiply in the lungs release toxins and other waste products into the bloodstream that poison the body. At the same time, toxins act on the central nervous system, heart and blood vessels, liver, kidneys and other organs.	With pneumonia, the temperature can be either low, up to 38 o C (subfebrile), or very high. Sometimes the thermometer rises to 40-41 o C. Fever is often accompanied by chills. In more severe cases, a delusional state is possible.
	Weakness, general malaise		The patient cannot get out of bed, wants to sleep constantly.
	Headache		It can be strong or aching, usually occurs against the background of an increase in body temperature.
	Decreased appetite		Up to the complete refusal of food.
chest symptoms	Cough	Cough is a protective reflex of the body, which is aimed at removing from bronchial tree sputum, foreign particles or allergens. With inflammation of the lungs, a large amount of sputum (lung mucus) is produced, which contains anti-inflammatory immune cells, microbes and their waste products. Mucus irritates the nerve receptors of the bronchi and causes coughing. The lungs don't hurt. But the pleura can be involved in the inflammatory process. Pleurisy always gives pain in the chest. Also, with concomitant bronchitis with a strong cough, bronchial receptors may be irritated and chest pain may occur. Also, pain in the chest can be associated with tension in the respiratory muscles, namely the intercostal muscles and the diaphragm. This occurs due to severe coughing and shortness of breath (rapid and labored breathing).	Cough with pneumonia at first dry, that is, without sputum. And on initial stage cough is very rare and does not bring much discomfort. Then it becomes more frequent, becomes exhausting, does not bring relief. After a few days, the cough becomes wet, with thick sputum. Over time, sputum discharge becomes easier. In adults, the cough may be wet from the start. Interestingly, with pneumonia, coughing is more of a concern in daytime days and is greatly enhanced in the evening, and at night it may not bother at all.
	Sputum		Sputum for different types of pneumonia may differ. Light thick or with gray tint sputum may be due to viral pneumonia. yellow-green sputum - with bacterial pneumonia. Purulent fetid sputum - with a lung abscess or fungal pneumonia. rusty phlegm - with croupous pneumonia. Sputum streaked with blood may appear with any inflammation of the lungs, which is accompanied by a strong dry cough, but is more common with fungal pneumonia and tuberculosis. Foamy sputum may indicate the development of a complication of pneumonia - pulmonary edema.
	Chest pain or back		With pleurisy pains are localized in the area of ​​the affected half of the chest, can be given to the back, arm, stomach. The pain syndrome is aggravated by coughing, deep breathing, physical activity. With bronchitis pains are located in the sternum, greatly aggravated by coughing. With overstrain of the respiratory muscles pain occurs throughout the chest, aggravated by coughing and deep breathing. Also, the muscles of the abdomen, neck and shoulder girdle can hurt.
Symptoms associated with respiratory failure	Dyspnea	With inflammation of the lungs, the affected alveoli do not participate in respiration. With extensive pneumonia, respiratory failure occurs, that is, the body does not receive the necessary amount of oxygen. In response to this, breathing quickens, the body tries to replenish the oxygen necessary for life. From lack of air, hypoxia occurs, the functions of some organs are disrupted. Against the background of respiratory failure, heart failure can also develop.	Breathing in pneumonia rapid, noisy, may be accompanied by a sensation of wheezing in the chest. Inspiratory dyspnea (difficulty inhaling) can be observed, as well as mixed dyspnea, that is, difficulty in both inhalation and exhalation. Shortness of breath can be observed both during physical exertion, including coughing, and at rest. The severity of respiratory failure depends on this. With the development of heart failure, shortness of breath is accompanied by arrhythmia, edema, pain in the heart, "jumps" in blood pressure.
	hypoxia		Severe pallor of the skin; cyanosis (cyanosis) in the eyelids and nasolabial triangle; weakness, dizziness; heart palpitations and other manifestations.

Pneumonia usually begins acutely, rarely gradually, with the onset and intensification of classic symptoms.

Options for the course of pneumonia:

• easy flow;
• moderate severity;
• severe course.

How to recognize the onset of pneumonia?

But many with colds do not immediately go to the doctor, trying to cope with the disease on their own with the help of folk remedies and the recommendations of pharmacists. We define the main indications for a mandatory visit to the doctor:

• high body temperature, which is poorly controlled by antipyretics;
• cough against the background of flu symptoms;
• the presence of weakness, loss of appetite;
• frequent cough, which is accompanied by chest pain;
• difficulty breathing, shortness of breath with little or no physical exertion;
• the appearance of unusual sputum.

Inflammation of the lungs - clinical manifestations and symptoms (fever, cough, chest pain, shortness of breath, etc.). Asymptomatic pneumonia. Hospital and community-acquired, aspiration, atypical pneumonia - video

Diagnosis of pneumonia

Medical examination

• Possible catarrhal changes (redness of the throat, discharge from the nose);
• the skin is often hyperemic or pale, moist to the touch;
• there may be blueness around the eyes and mouth;
• increased breathing more than 20-24 per minute;
• difficulty in breathing, inhalation and / or exhalation is possible;
• rales are heard over the affected areas of the lungs (crepitations, wet or dry rales);
• when tapping the chest (percussion), there is a dullness of sound over the inflamed area;
• heart palpitations (more than 90 beats per minute);
• Functional heart murmurs are possible.

X-ray for pneumonia

Pneumonia on x-ray is manifested by the presence of darkening of the lung tissue, it looks like white spots. Such changes can be in one or both lungs.

X-ray changes in pneumonia:

1. The presence of irregularly shaped lung tissue infiltration, without clear boundaries, which can be of various sizes:

• focal pneumonia - single changes up to 1 cm in diameter;
• segmental pneumonia - infiltration, occupying 1 segment of the lung;
• lobar or croupous pneumonia - infiltration can occupy a whole share;
• total pneumonia - pulmonary changes occupy the entire lung;
• abscessing pneumonia - the presence of enlightenment (dark spots) against the background of infiltration, a horizontal level of fluid (pus) can be detected;
• interstitial pneumonia - bilateral lung damage is more common, looks like a linear pattern, may resemble a fine mesh, usually located in lower sections both lungs.

3. Changes in the root of the lung. The root of the lung is the main bronchus pulmonary artery and vein, intrathoracic The lymph nodes, normally on x-ray looks like a smooth arc. With pneumonia, the root will retain its shape, but their heaviness appears, which is associated with the expansion of blood vessels. Rarely, mainly in childhood, intrathoracic lymph nodes may increase, while lung root deforms and expands.

4. Aperture changes. With lobar or segmental pneumonia, the lobe of the lung is compacted, so the diaphragm on the affected side rises.

5. Changes in the pleura usually occur with pleuropneumonia in the area affected by pneumonia, while the sinuses of the pleural cavity are not visible, the level of fluid in the pleural cavity and the displacement of the heart to the healthy side can be determined.

A photo: Plain radiograph of the chest organs in a direct projection with pneumonia.
1. Infiltration of lung tissue in the lower lobe of the right lung.
2. Strengthening of the lung pattern.
3. Heaviness of the root of the lung.
4. High standing diaphragm dome.

Diagnosis: Lower lobe pneumonia of the right lung (croupous pneumonia).

Is fluorography (FG) prescribed for suspected pneumonia?

Is computed tomography (CT) used to diagnose pneumonia?

A photo: computed tomography (CT) of the lungs in interstitial pneumonia.

Do I need a control X-ray after pneumonia?

X-ray of the lungs is usually recommended to be repeated after 10-21 days. In the absence of improvement in the general condition during treatment, an x-ray can be performed at an earlier date to determine further therapy tactics.

In the dynamics against the background of treatment, pneumonia gradually resolves. Usually by day 21 full recovery lung tissue. After inflammation of the lungs, areas of pneumosclerosis may remain (the formation of connective tissue, in fact, a "scar").

Complete blood count for pneumonia

Sputum analysis for pneumonia

Sputum is examined by smear and microscopy, which can provide a preliminary diagnosis. Also this study can detect tuberculosis bacilli.

After microscopy, sputum is sown on nutrient media, and after a few days a culture of the pathogen is obtained, which is examined and the type of microorganism is accurately determined. With the right approach, sputum is examined not only for bacteria, but also for viruses and fungi.

Isolation of a bacterial culture allows a drug sensitivity test, that is, it is determined which antibiotics will be effective and which ones do not make sense to prescribe. This test will help to choose an effective therapy in the absence of positive effects from the first antibiotics.

A general sputum analysis is also carried out, in which the content of immune cells is detected and the nature of inflammation is determined.

How to distinguish pneumonia from bronchitis and tuberculosis?

Inflammation of the lungs or tuberculosis?
Tuberculosis is also inflammation of the lungs, only specific, caused by Koch's wand.

Main criteria differential diagnosis tuberculosis and pneumonia:

• Tuberculosis often has an asymptomatic or oligosymptomatic course, symptoms appear gradually, while with inflammation of the lungs, the disease begins acutely, violently, quickly.
• With tuberculosis, "we see a lot, we hear little", that is, with large changes on radiographs, wheezing in the lungs is practically absent.
• Pneumonia often affects the lower, and tuberculosis upper lobes lungs, but this is a subjective sign.
• A blood test for pneumonia is almost always inflammatory, while a blood test for tuberculosis can be normal.
• The X-ray picture in tuberculosis may have its own characteristics (the presence of infiltrates, caverns, foci of varying intensity).
• In tuberculosis, sputum analysis can detect Mycobacterium tuberculosis (acid-fast bacteria or AFB).
• With a negative result of the sputum test for tuberculosis, time will help to finally distinguish these two diseases, that is, the absence of radiological dynamics after receiving the course antibacterial pneumonia after 10-14 days. During this time, pneumonia will resolve or, in severe cases, become complicated, and nothing will happen to tuberculosis.

Diagnosis of pneumonia: x-ray, blood and urine tests, sputum culture. How to distinguish pneumonia from bronchitis or from the flu, from tuberculosis - video

What is a lung abscess? This is an inflammatory process, accompanied by the formation of cavities filled with pus. Pathogenic microorganisms are brought into the lungs through the bronchial tract. At risk for this disease are people who develop inflammation in oral cavity.

Abscessing pneumonia appears as a result of the entry into the body of bacteroids, various streptococci, Pseudomonas aeruginosa, pneumococci, fungi, Klebsiella and other pathogenic or opportunistic microflora.

Inflammation develops after a pathogen enters the bloodstream or bronchi. Risk of occurrence inflammatory process increases if a person drinks alcohol, smokes often and a lot, exposes his body to hypothermia. This group also includes people with a weakened immune system, a violation of the circulation of blood in the lungs, chronic diseases, flu and bronchial problems.

Usually the disease develops in the following cases:

• if the contents of the stomach enter the respiratory tract;
• as a result of the development of pneumonia;
• if bronchial obstruction occurs, as a result, mucus stagnation and the development of an infectious process occur;
• when blood is infected, inflammation in the lungs can also occur and not only.

Classification

Lung abscesses are classified depending on what pathogen caused the pathogenic process, how the infection occurred, where the purulent cavity is located in the lungs, how many foci are found in the tissues, and an abscess is located in one or two lungs.

Depending on the location, there are:

• central;
• peripheral.

From the cause:

• primary. In this situation, an abscess forms after an injury to the sternum;
• secondary. Inflammation is the result of various diseases.

It is also possible to divide purulent formations depending on the duration of the development of the inflammatory process:

• spicy. This process lasts 1.5-2 months and, most often, ends with recovery;
• chronic. The disease develops over 6 weeks or more. This process is characterized by alternating periods of exacerbations and remissions.

From the nature of the course of the pathological process:

• easy flow. The symptoms characteristic of the disease are not too pronounced;
• medium severity. Symptoms are expressed quite clearly;
• heavy. Symptoms of the disease are expressed in a sharp form, often the appearance of various kinds of complications.

The classification of lung abscess allows you to correctly prescribe treatment and help patients in a timely manner.

Symptoms

First of all, you should know that the inflammatory process takes place in two stages: first, an abscess is formed, and then the purulent cavity is opened.

With the formation of a purulent cavity, the following symptoms appear:

• pain in the sternum, which is noticeably worse when coughing or sneezing;
• feverish state;
• dry type cough;
• nausea;
• headache;
• weakness;
• lack of appetite;
• high body temperature.

Inspection shows that the chest in the process of breathing moves unevenly. The side with the lung that has undergone abscess formation moves more slowly than the healthy half.

If the disease has affected both lungs, then the entire chest moves asymmetrically.

The first period of the disease lasts for 7-10 days, but can take up to a month. It also happens that the first period develops faster than a week, and is followed by a second period.

lung abscess symptoms of the second period usually have the following manifestations:

• the abscess is opened and the pus comes out through the bronchial passages;
• a feverish state occurs;
• the cough turns from dry to wet, sputum is coughed up quite strongly and often. In 24 hours, more than a liter of sputum with pus comes out (this amount varies depending on how big the inflammation was).

Fever and intoxication after the release of most of the sputum gradually decreases, and the patient feels much better. The suppression of the inflammatory process in the lungs can be confirmed by a blood test, which should be prescribed by a doctor.

It is not always possible to separate these two periods for a number of reasons. The most likely cause of this phenomenon may be that sputum is secreted through a draining bronchus of small diameter. If abscessing pneumonia is caused by putrefactive microorganisms, then the patient should be in a separate room because of the sharply unpleasant smell of sputum.

Also this disease confirmed by the accumulation and settling of sputum in the container. With prolonged standing, it exfoliates into detritus, liquid (due to great content saliva) purulent sputum and frothy serous fluid.

Treatment

An abscess can be treated conservatively or surgically, depending on the stage of the disease.

If you start taking antibiotics on time a wide range at the first stage of the disease, it is possible to achieve Get well soon in the majority of patients.

Conservative treatment includes the following components:

• good patient care;
• providing nutrition that includes proteins and vitamins;
• the use of antibiotics several times a day;
• if the abscess affects the bronchus, then the pus is constantly removed using a special tool, or by postural drainage. After that, antibiotics are injected into the purulent cavity;
• sometimes a blood transfusion is done to boost the immune system;
• prescribe anabolic steroid drugs;
• apply immunotherapeutic methods of treatment: the introduction of toxoids or vaccines;
• protein preparations are also administered parenterally: albumin or protein.

With conservative treatment, about 70% of people recover, in 20% of patients, abscessing pneumonia changes from acute to chronic, 5% die, and 5% need surgery. Treatment for a lung abscess may take extreme measures: surgical intervention is carried out at pulmonary hemorrhage or rapid development inflammatory process. In other cases, it is necessary to continue treatment until the onset positive result. Long term treatment is not an indication for surgery. Surgical treatment is recommended to start only if the conservative does not give any positive results.

Surgery

Treatment of abscessing pneumonia is carried out in two ways: pneumotomy or resection.

An acute lung abscess is an indication that surgery is urgently needed. This will avoid more difficult surgeries in the future. Pneumotomy should be performed if conservative treatment fails within two months and antibiotics introduced into the purulent cavity do not heal it.

If the sputum disappears, blood tests return to normal, and body temperature drops to normal, then the patient may still be ill. The operation should be carried out when the pus does not come out of the cavity.

Pneumotomy is carried out simultaneously, if the purulent cavity is overgrown and two-stage, if infection has not yet occurred. The operation is also performed when the abscess lies deep enough. Usually, such purulent inflammation is difficult to detect, since it is small.

At autopsy purulent formation, the walls of the cavity are cleaned of necrotic tissue, and drains are introduced into the cavity. The wound is sutured, and antibiotics are injected into the cavity every day.

When opened, the cavity becomes smaller and the wound begins to heal. As soon as the patient stops feeling antibiotics, drains should be removed. Final healing occurs when a thin rubber strip is placed in the wound.

Complications

What is a lung abscess and what complications are possible with it? Often abscessing pneumonia breaks into the pleural cavity, and this gap leads to the accumulation of pus. If it penetrates into the cavity communicating with the pleura, then pyopneumothorax develops. This often results in pleuropulmonary shock. Mediastinal displacement may also occur, causing disruption of blood flow and hypoxemia. If you do not provide timely assistance to the patient with these complications, this can lead to death.

In addition, bleeding may occur if the vessels have been damaged. In this case, when expectorating sputum, sometimes blood appears in it.

The inflammatory process quickly turns into gangrene, or several purulent cavities are formed. Sometimes metastatic abscesses form in other organs. If pus enters healthy lung, then it develops purulent pneumonia.

Surgery for bleeding and progressive inflammation processes is carried out, but the risk of complications increases markedly. Usually a lobectomy is performed, sometimes a pneumonectomy. If there is a lot of dead tissue in the lungs, then pneumotomy is performed, despite the fact that residual cavities appear after it, which can be eliminated by additional surgical interventions.

Chronic abscess pneumonia is treated only surgically. The operation is carried out during the period of remission. The most commonly used lobectomy, and in some exceptional cases you have to remove the lung completely. If there are contraindications to surgical treatment, then the purulent cavity is periodically sanitized. This activity should be combined with breathing exercises and drainage, as well as to carry out strengthening therapy that will allow the patient to live for many years.

Diagnostics

Diagnosis of a lung abscess is carried out when the first specific symptoms. The pathogenesis of this disease early stages development is similar to focal pneumonia so they are often confused. Most likely symptoms manifested in abscesses are: cough with copious sputum, chest pain, which intensifies if the pathogenic process affects the pleura, fever, accompanied by profuse sweating. Percussion, auscultation and X-ray methods make it possible to determine pneumonia even before the opening of the abscess in the lungs.

If, with abscessing pneumonia, the purulent cavity opens, then it is much easier to diagnose the disease. Diagnosis is made on the basis of sputum. An x-ray is also taken, which shows a cavity containing gas and liquid.

In addition, sometimes surgeons use the puncture method. But in this case, the risk of purulent pleurisy is very high, so it is best to use the above diagnostic methods. They are tested and safe regarding puncture.

Abscessing pneumonia is a rather dangerous disease, difficult to treat. If you suspect an abscess in the lungs, you should immediately consult a doctor.

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Titles

Abscessing pneumonia is an inflammation of the lungs complicated by an abscess and caused by the multiplication of anaerobic bacteria that have entered the bronchi from the oral cavity. Lung abscess - a cavity of a purulent or dry nature, resulting from the expansion of the lungs due to the formed pus.

This process may be preceded by serious chronic diseases, as well as various diseases blood, diabetes, a long course of taking certain medications. Abscessing pneumonia is divided into primary and secondary. In the first case, pneumonia occurs in the aerobronchogenic way, in the second - from other purulent foci. Most often, this type of pneumonia occurs in the first few months of a child's life.

Initially, patients with this type of pneumonia are diagnosed with periodontal disease.

At improper treatment periodontal disease, bacteria that multiply from the gap in the gums penetrate into the lower respiratory tract. If there is also a weakening of the immune system, then an infection develops inside the bronchi, the formation of an inflammatory process, and then the death of lung tissue.

From the history of abscess pneumonia

At the beginning of the 20th century, a third of the sick people died. British physician David Smith's suggestion that the source of the lung infection could be in the mouth turned out to be correct. He noted that when opening the chest, the same microorganisms are found on the lungs as in the gingival fissure.

This type of pneumonia was dangerous before the production of antibiotics. As already noted, one third of the patients died, the second third constantly suffered from relapses, and only the last third fully recovered.

When tetracycline and penicillin appeared, the first improvements were outlined. As a result long-term use these medicines patients with mild form of abscess pneumonia eventually felt better.

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Causes of abscess pneumonia

The main cause of this type of pneumonia is an infection caused by anaerobic microorganisms, staphylococci or Klebsiella. In addition, abscess pneumonia can occur due to contact infection or penetration foreign bodies into the respiratory tract.

The source of the formation of cavities with air in pneumonia caused by staphylococcus has not been fully discovered to date. In some cases, their formation is associated with the course of the fisculo-necrotic process, in which air enters the bronchi. Experts say that this is a reaction to a staphylococcal pathogen.

In newborns, the causes of the formation of abscess pneumonia are trauma during childbirth, premature birth, improper prescription of antibiotics, asphyxia.

The main factor in the entry of harmful microorganisms into the lung tissue is the penetration a large number a secret from the oropharynx when a variety of purulent foci are found in the body, which have access to the lymphatic or blood channels. In this way, people who have alcohol or drug addiction survivors of a stroke, suffering from epilepsy and other disorders of consciousness.

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The main symptoms of pneumonia abscessing

The acute course of abscessing pneumonia is divided into two types:

1. It manifests itself rapidly, with a high temperature in the range of 38.5-40 degrees, respiratory failure and the formation of toxicosis. Most often, infection occurs with pneumococcus or staphylococcus aureus.
2. The slow course of the disease, usually resulting from a respiratory viral infection. First, it is diagnosed as a small-focal disease of the bronchi, and purulent deposits form after 2-3 weeks. After the formation of pus, the general condition worsens, body temperature rises, shortness of breath occurs and cardiovascular failure, pallor skin. When listening to the region of the lungs, small bubbling sobs are detected, and in the region of the heart, heart tones can be muffled. As a result of paresis of the intestine, bloating is observed.

At medical examination a protrusion of the chest is found from the part where the infection occurred. In addition, there is an increase in the spleen and liver, urination occurs abruptly, the stool is either liquid or difficult, and tachycardia occurs. Haunted by a painful cough, rolling in attacks. Vomiting may occur.

In addition, from the side of the chest is not visible respiratory movement or there is a significant lag during inhalations and exhalations. With the help of an x-ray, you can see that all organs are displaced towards a healthy lung.

From the 4th to the 7th day, pleural complications develop; a blood test can detect moderate anemia, which increases with increasing purulent inflammation. Urinalysis reveals a slight kidney damage, in some cases pyelonephritis occurs.

If abscess pneumonia occurs against the background of mixed infection, then the symptoms are similar to bacterial purulent inflammation of the lungs, and the formation of cavities occurs due to tissue necrosis.

If purulent pleurisy is suspected, then a puncture of the pleural cavity is urgently taken not only for diagnostic purposes, but also for therapeutic purposes.

Pyopneumothorax and its varieties, which develop due to a bronchial fistula, are an indication for drainage of the pleural cavity.

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Abscess pneumonia: treatment

Purulent pneumonia is quite difficult to treat, so it is necessary to use both therapeutic drugs and surgical methods elimination of purulent lesions.

The primary focus of treatment is to eliminate toxic injury body, replenishment of the proper level of vitamins, salts, proteins and minerals, elimination oxygen starvation all organs, increased immunity.

The doctor most often prescribes two types of antibiotics, depending on the nature of the harmful organisms that hit the lungs, and their compatibility with each other. The course of antibiotics can be 7-10 days or 12-14, after which they are replaced with other types. On average, taking antibiotics can take 1-1.5 months, and in some cases more. Sometimes treatment is delayed for 4 months.

To increase the patient's immunity and replenish his strength, vitamin complexes are prescribed, which include vitamins E, B1, C and A. In addition, the patient receives daily intravenous injections of special drugs that improve blood flow in the lungs and expand the bronchi.

The patient is prescribed a sparing regimen, including:

• elevated position of the bed in the head area;
• the use of drugs against flatulence;
• frequent nasal lavage;
• nutrition should be fractional (children who are breastfed are best fed with fresh expressed milk);
• removal of accumulated sputum;
• in the presence of toxicosis, restorative therapy is carried out by installing a catheter with subsequent administration of drugs.

To eliminate purulent foci, therapeutic bronchoscopy is used, expectorants, bronchodilators and inhalations with special drugs are prescribed. In severe cases, drainage and lung puncture are used with active pumping out of purulent contents. After the therapy, most patients recover completely, the rest develop a chronic abscess of the affected lung or fibrosis, in especially severe cases, a fatal outcome is possible. further morbidity and deaths most often associated with the occurrence of various kinds of complications.

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The article talks about such a type of pneumonia as purulent. The causes of occurrence, the course of the disease, and therapeutic measures are described.

Purulent pneumonia is more often a complication of primary inflammation of the lungs, when purulent foci form in them. Rarely, such pneumonia develops initially. The disease is characterized by an extremely severe course, accompanied by high risk lethal outcome.

For purulent, or abscessing, pneumonia, the formation of areas of necrosis and fusion in the lung tissue is characteristic. The main feature that distinguishes purulent pneumonia from a pulmonary abscess, is the nature of abscesses.

With an abscess, the abscess is single and has a large size - the diameter of the cavity is at least 2 cm. If there are many such foci, and they are small in size, this is pneumonia with suppuration (pictured).

The reasons

The disease develops due to infection of the lung tissue with microorganisms that can cause its necrosis and the formation of abscesses.

These bacteria include:

• golden staphylococcus aureus;
• wand Friedlander;
• Pneumococcus;
• hemolytic streptococcus;
• fusobacteria.

Predisposing factors for the penetration of microorganisms into lung tissue and the formation of purulent inflammation there:

• entry of the contents of the oropharynx into the bronchi and further into the lungs;
• chronic foci of infection in the path of pulmonary blood flow;
• malignant tumors of the lungs;
• diabetes;
• long-term use of corticosteroid drugs.

Ulcers are formed under the action of microbial toxins and enzymes.

Clinical picture

Initially, the disease develops like ordinary pneumonia. That is, the following symptoms are present:

• increased body temperature;
• severe cough with phlegm;
• pain in the chest area from inflammation;
• dyspnea;
• night sweats;
• general weakness, lethargy;
• loss of appetite and weight loss;
• respiratory events.

In the presence of predisposing factors, serous-purulent pneumonia begins to develop within a few days.

It is characterized by the following features:

• a sharp rise in temperature to 40-41 * C, chills;
• severe weakness of the patient, refusal to eat;
• increase in respiratory failure;
• when coughing, copious sputum of a gray-yellow color with a putrid odor is separated;
• increasing pallor of the skin, cyanosis of the lips and the tip of the nose;
• possibly impaired consciousness.

Purulent pneumonia in adults quickly leads to the development of complications:

• the transition of inflammation to the pleura;
• damage to the membranes of the heart and the development of pericarditis with myocarditis;
• mediastinitis;
• sepsis.

The duration of the disease can be up to a month or more, depending on the extent of damage to the lung tissue.

Diagnostics

After the initial examination, if an inflammatory process is detected, the therapist refers the patient to a pulmonologist.

The doctor takes a number of measures to establish an accurate diagnosis:

1. Clinical examination. It is necessary to carefully listen to the chest area. Auscultation revealed weakened breathing, moist rales. Percussion reveals a shortening of the percussion sound.
2. x-ray. It is considered the main method in the diagnosis of respiratory diseases. In this case, it is not effective enough, since not all lung damage is detected.
3. CT. Allows visualization of small cavity formations. The price of the procedure is quite high, therefore it is carried out according to the indications and as additional method examinations.
4. Blood analysis. Signs of inflammation are found - an increase in ESR, an increase in the number of leukocytes.
5. Sputum analysis. Abscessing pneumonia is characterized by mucous sputum with impurities of pus and blood. The analysis also allows you to determine the type of pathogen and its susceptibility to antibacterial drugs.

Differential diagnostics is also carried out to exclude tuberculosis and lung cancer.

Treatment

For the treatment of such severe pneumonia as purulent, a set of measures is required to cleanse the lungs of abscesses. After stabilization of the patient's condition, additional treatment is carried out.

Medical therapy

Purulent inflammation requires massive antibiotic therapy. First, broad-spectrum drugs are prescribed. Once the causative agent is identified, a more appropriate drug can be selected. It is also necessary to prescribe expectorants and detoxification agents.

Table number 1. Tactics of medical treatment of pneumonia:

The duration of the medication is determined by the doctor, it depends on the severity of the condition. After stabilization of the patient and cessation of fever, injection forms are replaced by oral ones.

Additional Treatment

With purulent inflammation of the lungs, sanitation bronchoscopy is actively used. Its essence lies in the fact that the bronchi are washed with disinfectant solutions. With the help of bronchoscopy, blood and pus are also removed from the lungs, medicinal product directly to the affected area. How the procedure is carried out, you can see in the video in this article.

After stabilization of the patient's condition, auxiliary methods of therapy are prescribed.

Table number 2. Helper Methods treatment of purulent inflammation of the lungs:

Patients with abscessing pneumonia require high-calorie food to replace the loss of protein. The patient should be in a well-ventilated room with frequent wet cleaning so as not to complicate the disease with new infections.

The prognosis of severe pneumonia depends on the severity of the patient's condition and the presence of complications. Mortality in the uncomplicated form reaches 15%, with the development of complications, the number of adverse outcomes increases several times.

Purulent pneumonia is serious danger for the life of the patient. Therefore, having felt the first symptoms of the disease, it is necessary to seek medical care and not refuse hospitalization, since the disease can be cured only in a hospital setting.