Lung Abscess
Firza Alexander Gronthoud in Practical Clinical Microbiology and Infectious Diseases, 2020
Lung abscess develops most commonly in patients with a predisposing factor such as aspiration from the oropharynx. In the majority of cases, it is polymicrobial oropharyngeal flora, with anaerobes being a common finding; however it may also complicate infection with particular organisms such as Staphylococcus aureus, Fusobacterium spp. or Klebsiella pneumoniae or as a consequence of embolic disease (particularly in patients with right-sided endocarditis or infected deep venous thrombosis from intravenous drug use). Presentation is with systemic features such as fever and weight loss, together with cough, shortness of breath and possibly chest pain. It may present acutely after a severe/necrotizing pneumonia or as a more chronic presentation. Important differential diagnoses are tuberculosis and lung cancer.
Benzylpenicillin (Penicillin G)
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Nocardia spp. are Pen G resistant (Gutmann et al., 1983). Rhodococcus equi is a Gram-positive aerobic coccobacillus. It was previously known only as an animal pathogen, but is now well described as a cause of infections, especially among the immunocompromised, including patients with AIDS, in whom it usually causes a necrotizing pneumonia. Rhodococcus equi is Pen G resistant but is generally susceptible to vancomycin, erythromycin, aminoglycosides, and chloramphenicol (Emmons et al., 1991). The rare human pathogen Rothia dentocariosa is usually, but not always, Pen G sensitive (Pape et al., 1979; Schafer et al., 1979; Anderson et al., 1993; Sudduth et al., 1993).
Necrotizing pneumonia
Alisa McQueen, S. Margaret Paik in Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
A simple parapneumonic effusion is fluid within the pleural cavity without loculations. Fibrin deposition in the pleural space can lead to a loculated parapneumonic effusion and is best visualized on ultrasound or CT. Empyema is a purulent parapneumonic fluid collection. Lung entrapment with pleural rind formation is seen with an organized multiloculated empyema. Necrotizing pneumonia is usually a result of localized infection and is associated with aspiration. Lung abscess can be the result of aspiration of foreign body or heavily infected oral secretions.
Current and future treatment options for community-associated MRSA infection
Published in Expert Opinion on Pharmacotherapy, 2018
A. Khan, B. Wilson, I. M. Gould
Management of necrotizing pneumonia is complicated by the reduced penetration of antibiotics into necrotic tissue, as well as their weakened activity in anaerobic conditions [80]. There are differing approaches to antimicrobial therapy, as demonstrated by guidance in the UK compared to across the Atlantic. What is clear is that flucloxacillin, even when combined with clindamycin or rifampicin, is not recommended due to its potential for increasing PVL production, as demonstrated in vitro [81]. In the UK, the HPA guidelines on managing PVL-associated staphylococcal pneumonia advises combining antibiotic therapy to include an agent which inhibits toxin production, with reports showing better outcomes [80]. Combinations of clindamycin with rifampicin [82], linezolid with rifampicin[83], vancomycin with rifampicin, and vancomycin with clindamycin have all been effective, but with widely differing durations of parenteral treatment, sometimes up to 4 weeks [84]. Rifampicin should never be used alone as resistance is rapidly selected, but it demonstrates excellent tissue penetration, reaching intracellular staphylococci, and also has synergy with other antibiotics [80]. There is some evidence that rifampicin decreases serum levels of linezolid though this is not reflected in UK dosing recommendations [85,86].
Bilateral pneumatoceles resulting in spontaneous bilateral pneumothoraces and secondary infection in a previously healthy man with COVID-19
Published in Baylor University Medical Center Proceedings, 2021
Piruthiviraj Natarajan, James Skidmore, Olufemi Aduroja, Vamsi Kunam, Dan Schuller
The patient presented 2 days later with worsening dyspnea, increasing oxygen requirement, and hemoptysis. Chest film revealed a large left tension pneumothorax, small right pneumothorax, pneumomediastinum, and subcutaneous emphysema (Figure 2). He underwent an emergent left thoracostomy tube placement. Subsequent CT scan of the chest showed resolving pneumothoraces, extensive bilateral necrotizing pneumonia with pneumatoceles, and large cysts with air fluid levels (Figure 1b). The sputum culture grew K. aerogenes and P. aeruginosa; the antimicrobials were narrowed to cefepime. He subsequently underwent two separate left-sided chemical pleurodesis at the bedside with intrapleural doxycycline 4 days apart, as the first attempt resulted only in partial resolution. He was discharged home after a 16-day hospital stay to complete a total of 3 weeks of IV cefepime and was subsequently switched to oral ciprofloxacin for 3 months until near complete radiological resolution of the air fluid levels in the pneumatoceles (Figure 1c). Several months from his initial presentation, the patient is still convalescent at home and requires supplemental oxygen with minimal activity. Repeat CT of the chest during an outpatient visit is shown in Figure 1d.
Respiratory comorbidities in severe asthma: focus on the pediatric age
Published in Expert Review of Respiratory Medicine, 2023
Amelia Licari, Beatrice Andrenacci, Maria Elisa Di Cicco, Maddalena Leone, Gian Luigi Marseglia, Mariangela Tosca
ABPA management requires long-term OCS treatment with slow tapering for at least 4–6 months, eventually coupled with antifungal drugs as a steroid-sparing strategy, contemporary lowering fungal burden [12,15,97]. Since azoles increased both steroid concentrations with a higher risk of Cushing syndrome, their use as add-on-therapy must be carefully weighed in Pediatrics [97]. Surgical treatments are limited to forms with necrotizing pneumonia and aspergillosis. Recently, anti-IgE treatment has been proven effective in reducing asthma attacks in adults with ABPA [98], and it is also a promising treatment for pediatric SAFS [98]. Finally, other monoclonals such as anti-IL33, IL-1-receptor-like-1-antagonists (ST2-antagonists), anti-IL17 receptor alfa (anti-IL17Rα), and anti-endothelin 1 receptor are currently under study as future, specific therapeutic targets [99,100].
Related Knowledge Centers
- Cough
- Fever
- Klebsiella Pneumoniae
- Liquefactive Necrosis
- Staphylococcus Aureus
- Streptococcus Pneumoniae
- Lung
- Infection
- Gangrene
- Bad Breath