RESUMO
BACKGROUND: Data are scarce regarding epidemiology and management of critically ill patients with lung abscesses. RESEARCH QUESTION: What are the clinical and microbiological characteristics of critically ill patients with lung abscesses, how are they managed in the ICU, and what are the risk factors of in-ICU mortality? STUDY DESIGN AND METHODS: This was a retrospective observational multicenter study, based on International Classification of Diseases, 10th Revision, codes, between 2015 and 2022 in France. In-ICU mortality-associated factors were determined by multivariate logistic regression. RESULTS: We analyzed 171 ICU patients with pulmonary abscesses. Seventy-eight percent were male, with a mean age of 56.5 ± 16.4 years; 20.4% misused alcohol, 25.2% had a chronic lung disease (14% COPD), and 20.5% had a history of cancer. Overall, 40.9% were immunocompromised and 38% qualified for nosocomial infection. Presenting symptoms included fatigue or weight loss in 62%, fever (50.3%), and dyspnea (47.4%). Hemoptysis was reported in 21.7%. A polymicrobial infection was present in 35.6%. The most frequent pathogens were Enterobacteriaceae in 31%, Staphylococcus aureus in 22%, and Pseudomonas aeruginosa in 19.3%. Fungal infections were found in 10.5%. Several clusters of clinicoradiologic patterns were associated with specific microbiological documentation and could guide empiric antibiotic regimen. Percutaneous abscess drainage was performed in 11.7%; surgery was performed in 12.7%, and 12% required bronchial artery embolization for hemoptysis. In-ICU mortality was 21.5%, and age (OR: 1.05 [1.02-1.91], P = .007], renal replacement therapy during ICU stay (OR, 3.56 [1.24-10.57], P = .019), and fungal infection (OR, 9.12 [2.69-34.5], P = .0006) were independent predictors of mortality after multivariate logistic regression, and drainage or surgery were not. INTERPRETATION: Pulmonary abscesses in the ICU are a rare but severe disease often resulting from a polymicrobial infection, with a high proportion of Enterobacteriaceae, S aureus, and P aeruginosa. Percutaneous drainage, surgery, or arterial embolization was required in more than one-third of cases. Further prospective studies focusing on first-line antimicrobial therapy and source control procedure are warranted to improve and standardize patient management.
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Coinfecção , Abscesso Pulmonar , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Estudos Retrospectivos , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/epidemiologia , Abscesso Pulmonar/terapia , Estudos Prospectivos , Estado Terminal , Hemoptise , Staphylococcus aureus , Unidades de Terapia IntensivaRESUMO
OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) support for elective cardiothoracic surgery is well established. In contrast, there are not much data regarding the usefulness and outcome of ECMO in non-elective major lung resections for infectious lung abscess. METHODS: All patients undergoing non-elective major lung surgery for infectious lung abscess at 5 centres in Germany, UK and Spain were enrolled in a prospective database. Malignant disorders and intrathoracic complications of other procedures were excluded. RESULTS: There were 127 patients. The median age was 59 years (interquartile range 18.75). The mean Charlson index of comorbidity was 2.83 (standard deviation 2.57). Surgical procedures were lobectomy (89), pneumectomy (20) and segmentectomy (18). ECMO was used for 10 patients (pneumectomy 2, lobectomy 8) and several more received pre-ECMO treatment. Mortality was 17/127. Intraoperatively no ECMO-associated complications were encountered. EMCO [1/10 vs 16/117; odds ratio (OR): 0.70, 95% confidence interval (CI) 0.08-5.91, P = 0.74] and the extent of pulmonary resection were not associated with higher mortality. Preoperative sepsis (OR: 17.84, 95% CI 2.29-139.28, P < 0.01), preoperative air leak (OR: 13.12, 95% CI 4.10-42.07, P < 0.001), acute renal failure (OR: 7.00, 95% CI 2.19-22.43, P < 0.01) and Charlson index of comorbidity ≥3 (OR: 10.83, 95% CI 2.36-49.71, P < 0.01) were associated with significantly higher mortality. CONCLUSIONS: The application of ECMO is widening the possibilities for successful surgical management of infectious, non-malignant lung abscesses. Particularly, patients with marginal functional operability benefit from the availability and readiness to use ECMO. Mortality is determined by the burden of pre-existent comorbidity, severe sepsis and septic shock.
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Oxigenação por Membrana Extracorpórea , Abscesso Pulmonar , Sepse , Cirurgia Torácica , Procedimentos Cirúrgicos Torácicos , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Abscesso Pulmonar/epidemiologia , Abscesso Pulmonar/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVE: Little is known about the prognosis of infections in patients with ankylosing spondylitis (AS) compared with patients without AS. The purpose of this study was to examine whether AS is associated with poorer outcomes in patients who are hospitalised with pneumonia. METHODS: In a population-based cohort study including patients with hospitalised pneumonia with and without AS, we compared 90-day rates of mortality, all-cause readmission (90 days post-discharge) and pulmonary complications including pulmonary embolism, empyema and pulmonary abscess. We used Cox regression analyses to compute crude and adjusted HRs while adjusting for sex, age and level of comorbidity. RESULTS: A total of 387 796 patients (median age 71 years) were hospitalised for pneumonia in Denmark between 1997 and 2017. Among these, 842 (0.2%) had AS (median age 65 years). The 90-day mortality was 12.5% in patients with AS and 15.5% in patients with non-AS pneumonia, with crude and adjusted 90-day HRs of 0.79 (95% CI 0.66 to 0.96) and 0.95 (95% CI 0.79 to 1.16), respectively. The 90-day post-discharge readmission rate was 27.3% in patients with AS and 25.4% in patients without AS, with a corresponding adjusted readmission HR of 1.12 (95% CI 0.98 to 1.27). Relative risk of pulmonary complications among patients with AS compared with patients without AS decreased over the study period, with adjusted HRs of 1.63 (95% CI 0.82 to 3.27) in 1997-2006 falling to 0.62 (95% CI 0.31 to 1.23) in 2007-2017. CONCLUSIONS: AS is not associated with increased mortality following hospitalisation for pneumonia. Furthermore, no increased risk of readmission or pulmonary complications in patients with AS was detected in recent study years.
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Pneumonia Associada a Assistência à Saúde/mortalidade , Hospitalização/estatística & dados numéricos , Espondilite Anquilosante/mortalidade , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Empiema/epidemiologia , Feminino , Pneumonia Associada a Assistência à Saúde/etiologia , Humanos , Abscesso Pulmonar/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Embolia Pulmonar/epidemiologia , Fatores de Risco , Espondilite Anquilosante/complicações , Espondilite Anquilosante/epidemiologia , Adulto JovemRESUMO
Objective In Japan, the aging demographic structure is becoming pronounced, and the full-blown graying of society appears not far off, which indicates an increasing population that will require healthcare contact. Klebsiella spp. are major pathogens in healthcare-associated infections, and their importance is increasing. The aim of this study was to clarify the characteristics of Klebsiella spp. chest infections by evaluating the differences in the characteristics of chest infections caused by Klebsiella spp. and pneumoniae. Methods We conducted a retrospective study of consecutive patients hospitalized with pneumonia, lung abscess/necrotizing pneumonia, and empyema due to Klebsiella spp. and S. pneumoniae for 15 years at our institution in Saitama, Japan. Patients Patients with chest infections due to Klebsiella spp. (K group, n=76) and S. pneumoniae (S group, n=446) were included. Results The K group more frequently was male, older, coinfected by Pseudomonas aeruginosa, and had diabetes mellitus, a history of upper digestive system surgery, alcohol drinking habit, a smoking habit, and an impaired premorbid performance status than the S group. The percentages of lung abscesses or necrotizing pneumonia (31.6% vs. 0.9%) and empyema without pulmonary parenchymal shadow (3.9% vs. 0.7%) were higher in the K group than those in the S group. Severity on admission and mortality did not differ between the groups; however, patients in the K group required a longer duration of antibiotics administration and hospital stay than those in the S group. Conclusion Klebsiella spp. chest infections have some marked characteristics when compared with pneumococcal infections, and our results serve to differentiate Klebsiella spp. infection from pneumococcal infection.
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Infecções por Klebsiella/epidemiologia , Pneumopatias/epidemiologia , Infecções Pneumocócicas/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Coinfecção , Comorbidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Empiema/epidemiologia , Empiema/microbiologia , Feminino , Nível de Saúde , Humanos , Japão , Infecções por Klebsiella/patologia , Abscesso Pulmonar/epidemiologia , Abscesso Pulmonar/microbiologia , Pneumopatias/microbiologia , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/patologia , Pneumonia/epidemiologia , Pneumonia/microbiologia , Estudos Retrospectivos , Fatores Sexuais , Streptococcus pneumoniaeRESUMO
AIM: The aim of the study was to describe the epidemiology and clinical characteristic of children hospitalized with pneumonia complicated by lung abscess, as well as to evaluate the long-term sequelae of the disease. METHODS: A retrospective review of medical records of all patients treated for pulmonary abscess in two tertiary centers was undertaken. Pulmonary function tests and lung ultrasound were performed at a follow-up. RESULTS: During the study period, 5151 children with pneumonia were admitted, and 49 (0.95%) cases were complicated with lung abscess. In 38 (77.5%) patients, lung abscess was treated solely with antibiotics, and in nine cases (16.3%) surgically. In 21 (51.21%) children complete radiological regression was documented. The mean time for radiological abnormalities regression was 84.14 ± 51.57 days, regardless of the treatment mode. Fifteen patients were followed up at 61.6 ± 28.3 months after discharge. Lung ultrasound revealed minor residual abnormalities: pleural thickening, subpleural consolidations and line B artefacts in 11 (73.3%) children. Pulmonary function tests results were abnormal in eight (53.3%) patients, the most frequent abnormality being hyperinflation. We did not find a restrictive disorder in any of the children. There were no deaths in our study. CONCLUSIONS: Lung abscess is a rare but severe complication of pneumonia in children. Most children recover uneventfully with no significant long-term pulmonary sequelae.
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Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/epidemiologia , Abscesso Pulmonar/epidemiologia , Abscesso Pulmonar/etiologia , Pneumonia/complicações , Pneumonia/epidemiologia , Antibacterianos/uso terapêutico , Pré-Escolar , Infecções Comunitárias Adquiridas/terapia , Feminino , Humanos , Incidência , Assistência de Longa Duração , Abscesso Pulmonar/terapia , Masculino , Pneumonia/tratamento farmacológico , Pneumonia/cirurgia , Radiografia , Testes de Função Respiratória , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de TempoRESUMO
AIM: The aim of this study was to evaluate the factors that could predict the development of local complications (parapneumonic effusion/pleural empyema, necrotizing pneumonia, and lung abscess) in children with community-acquired pneumonia (CAP). METHODS: Demographic, clinical, and laboratory data were prospectively collected and compared in children with noncomplicated and complicated CAP. RESULTS: Two-hundred and three patients aged from 2 months to 17 years were enrolled. There were 141 and 62 children with noncomplicated and complicated CAP, respectively. Significantly longer duration of fever and a higher level of acute phase reactants were demonstrated in complicated when noncomplicated to complicated CAP. Asymmetric chest pain as well as prehospital treatment with ibuprofen and acetaminophen were significantly more common in patients with complicated CAP (P < .001, P = .02 and P = .003, respectively). Preadmission cumulative dose of ibuprofen exceeding 78.3 mg/kg (median dose for the entire group) was associated with 2.5-fold higher odds ratio (OR) for CAP complications [OR 2.54 CI (1.31-4.94); P = .008)]. In contrast, pneumococcal vaccination was associated with lower odds ratio [OR.03 CI (.23-.89); P = .03] for local complications. CONCLUSIONS: Some clinical and laboratory data including chest pain, longer duration of fever, higher acute phase reactants, and especially preadmission treatment with ibuprofen or acetaminophen were associated with local complications of CAP. The results of this study highlight the association between the dose of ibuprofen and local CAP complications.
Assuntos
Infecções Comunitárias Adquiridas/complicações , Empiema Pleural/etiologia , Abscesso Pulmonar/etiologia , Derrame Pleural/etiologia , Pneumonia/complicações , Medição de Risco , Adolescente , Criança , Pré-Escolar , Empiema Pleural/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Abscesso Pulmonar/epidemiologia , Masculino , Razão de Chances , Derrame Pleural/epidemiologia , Polônia/epidemiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
Aspiration is well recognized as a cause of pulmonary disease and is not uncommon in patients with altered consciousness.The mortality rate of aspiration pneumonia is approximately 1% in outpatient setting and upto 25% in those requiring hospitalization. This study was done to see the pattern of pulmonary involvement and outcome of aspiration pneumonia in patients with altered consciousness admitted in medicine department of a tertiary care hospital in our country. This was a prospective observational study conducted among the 52 adult patients of aspiration pneumonia with altered consciousness admitted in the medicine department of Dhaka Medical College Hospital (DMCH), during June 2010 to December 2010. Aspiration pneumonia was confirmed by clinical examination and laboratory investigations. Hematologic measurements (TC of WBC, Hb%, ESR, platelet count), chest X-ray, blood gas analysis, blood urea, creatinine and random blood sugar, sputum for Gram staining, sputum for culture sensitivity and blood culture were done in all patients.Assessment of altered conscious patient was done by application of the Glasgow Coma Scale. Case record forms with appropriate questionnaire were filled for all patients. The mean±SD age was 57.42±13.63 years with ranged from 25 to 90 years. Out of 52 patients, 37(71.15%) patients were male and 15(28.85%) patients were female. Following aspiration 76.92% patients developed pneumonitis, 13.46% patients developed lung abscess and only 9.62% patients developed ARDS. Most (33) of the patients had opacity in right lower zone and 13 patients had opacity in the left lower zone, 6 patients had opacity in right mid zone. Only 10 patients had opacity in both lower zones. In this study overall mortality rate was 23%. If only one lobe was involved radiologically, mortality was 8.33%. If two or more lobes on one or both sides were involved, mortality was in the range of 25-91%.
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Abscesso Pulmonar/epidemiologia , Pneumonia Aspirativa/etiologia , Pneumonia/epidemiologia , Síndrome do Desconforto Respiratório/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bangladesh/epidemiologia , Transtornos da Consciência/complicações , Feminino , Hospitalização , Humanos , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico por imagem , Pneumonia/etiologia , Pneumonia/mortalidade , Pneumonia Aspirativa/complicações , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/mortalidade , Estudos Prospectivos , Radiografia , Valores de Referência , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/mortalidadeRESUMO
BACKGROUND: The Streptococcus anginosus group (SAG) play important roles in respiratory infections. It is ordinarily difficult to distinguish them from contaminations as the causative pathogens of respiratory infections because they are often cultured in respiratory specimens. Therefore, it is important to understand the clinical characteristics and laboratory findings of respiratory infections caused by the SAG members. The aim of this study is to clarify the role of the SAG bacteria in respiratory infections. METHODS: A total of 30 patients who were diagnosed with respiratory infections which were caused by the SAG bacteria between January 2005 and February 2015 were retrospectively evaluated. RESULTS: Respiratory infections caused by the SAG were mostly seen in male patients with comorbid diseases and were typically complicated with pleural effusion. Pleural effusion was observed in 22 (73.3%) patients. Empyema was observed in half of the 22 patients with pleural effusion. S. intermedius, S. constellatus and S. anginosus were detected in 16 (53.3 %), 11 (36.7 %) and 3 (10.0 %) patients, respectively. Six patients had mixed-infections. The duration from the onset of symptoms to the hospital visit was significantly longer in "lung abscess" patients than in "pneumonia" patients among the 24 patients with single infections, but not among the six patients with mixed-infection. The peripheral white blood cell counts of the "pneumonia" patients were higher than those of the "lung abscess" patients and S. intermedius was identified significantly more frequently in patients with pulmonary and pleural infections (pneumonia and lung abscess) than in patients with bacterial pleurisy only. In addition, the patients in whom S. intermedius was cultured were significantly older than those in whom S. constellatus was cultured. CONCLUSIONS: Respiratory infections caused by the SAG bacteria tended to be observed more frequently in male patients with comorbid diseases and to more frequently involve purulent formation. In addition, S. intermedius was mainly identified in elderly patients with having pulmonary infection complicated with pleural effusion, and the aspiration of oral secretions may be a risk factor in the formation of empyema thoracis associated with pneumonia due to S. intermedius.
Assuntos
Empiema Pleural/fisiopatologia , Abscesso Pulmonar/fisiopatologia , Pneumonia Bacteriana/fisiopatologia , Infecções Estreptocócicas/fisiopatologia , Streptococcus milleri (Grupo)/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Transtornos Cerebrovasculares/epidemiologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Drenagem , Empiema Pleural/epidemiologia , Empiema Pleural/terapia , Feminino , Humanos , Abscesso Pulmonar/epidemiologia , Abscesso Pulmonar/terapia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/epidemiologia , Derrame Pleural/fisiopatologia , Derrame Pleural/terapia , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/terapia , Estudos Retrospectivos , Distribuição por Sexo , Fumar/epidemiologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/terapia , Streptococcus anginosus/isolamento & purificação , Streptococcus constellatus/isolamento & purificação , Streptococcus intermedius/isolamento & purificaçãoRESUMO
BACKGROUND: The impact of chronic lung diseases on outcome in community-acquired pneumonia (CAP) is not well established. We aimed to investigate the outcome of adult CAP-patients with underlying chronic obstructive pulmonary disease (COPD), asthma or interstitial lung disease (ILD) in a case-control study. METHODS: We used a nationwide database including all hospitalisations in Switzerland from 2002 to 2010. Endpoints were the incidence of lung abscess, parapneumonic pleural effusion, empyema, acute respiratory distress syndrome, in-hospital mortality and length of stay. RESULTS: We found less disease-related complications of CAP in COPD (n = 17,075) and asthma (n = 2700) patients compared with their controls. This difference was mainly related to a lower incidence of pleural effusion (COPD: 4.3% vs 4.9%, p = 0.011; asthma: 3.4% vs 5.2%, p <0.001). In-hospital mortality was lower in the COPD and - much more pronounced - asthma cohorts (COPD: 5.8% vs 6.7%, p <0.001; asthma: 1.4% vs 4.8%, p <0.001). For ILD (n = 916), the complication rate was similar as compared to the control group, whereas in-hospital mortality was markedly higher (16.3% vs 6.8%, p <0.001). CONCLUSIONS: These rather unexpected results should be viewed as hypothesis generating, with various possible explanations for our findings. These include the possible influence of inhaled corticosteroid therapy, a possibly higher awareness of general practitioners and hospital physicians while treating patients with chronic lung diseases, a different infective agent spectrum or a different immune response.
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Pneumopatias/complicações , Pneumonia/complicações , Idoso , Idoso de 80 Anos ou mais , Asma/complicações , Asma/mortalidade , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/mortalidade , Empiema/epidemiologia , Empiema/etiologia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Abscesso Pulmonar/epidemiologia , Abscesso Pulmonar/etiologia , Pneumopatias/mortalidade , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/mortalidade , Masculino , Pessoa de Meia-Idade , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Pneumonia/mortalidade , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Síndrome do Desconforto Respiratório/epidemiologia , Síndrome do Desconforto Respiratório/etiologia , Estudos Retrospectivos , Suíça/epidemiologia , Resultado do TratamentoRESUMO
Anaerobes used to be the most common cause of community-acquired lung abscess, and Streptococcus species used to be the second most common cause. In recent years, this has been changing. Klebsiella pneumoniae is now an increasing cause of community- acquired lung abscess, but Streptococcus species continue to be major pathogens. Necrotizing pneumonia has generally been regarded as a rare complication of pneumococcal infection in adults. Type 3 Streptococcus pneumoniae was the single most common type implicated in necrosis; however, many other serotypes were implicated. This entity predominately infects children, but is present also in adults. Lung abscess in adults due to Streptococcus pneumoniae is not common. In this regard we present a case series of pulmonary cavitation due to Streptococcus pneumoniae and discuss the possible pathogenic mechanism of the disease.
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Bactérias Anaeróbias/isolamento & purificação , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Infecções Comunitárias Adquiridas/epidemiologia , Farmacorresistência Bacteriana , Humanos , Klebsiella pneumoniae/isolamento & purificação , Abscesso Pulmonar/epidemiologiaRESUMO
Streptococcusanginosusis a member of the Streptococcus millerigroup, known to cause suppurative infections of the deep tissues. There have been very few case reports of the bacteria presenting with concomitant lung and brain abscesses. We describe a patient with new, onset seizures, subsequently diagnosed with S. anginosuslungandbrain abscesses.
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Abscesso Encefálico/diagnóstico , Abscesso Encefálico/microbiologia , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/microbiologia , Infecções Estreptocócicas/diagnóstico , Streptococcus anginosus , Abscesso Encefálico/epidemiologia , Comorbidade , Humanos , Abscesso Pulmonar/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Crohn's disease and ulcerative colitis are inflammatory bowel diseases and they primarily involve intestines. Herein we report the case of a young man who, during a clinical recurrence of ulcerative colitis, presented with symptoms suggestive of a lung abscess. When the patient was re-evaluated because of unexplained shortness of breath, an area of infarction was detected that had led to the development of cavitation secondary to submassive embolism and foci of infection contained within. The patient was managed with subcutaneous heparin and he was asymptomatic during 2 months of follow-up. He completed six months of anti-coagulation therapy and any recurrence was not detected during 3 months of post-treatment follow-up.
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Colite Ulcerativa/epidemiologia , Infarto/epidemiologia , Abscesso Pulmonar/epidemiologia , Pulmão/irrigação sanguínea , Embolia Pulmonar/epidemiologia , Adulto , Colite Ulcerativa/tratamento farmacológico , Comorbidade , Humanos , Abscesso Pulmonar/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan. METHODS: A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state-owned tertiary care centre in Karachi, Pakistan. Out of the 41 patients hospitalized, 17 could not survive and were evaluated for clinical, radiological and microbiological factors to determine association with heightened mortality. RESULTS: Mortality due to lung abscess stood at 41.4% (17 of 41 cases). Adult male patients were found to have higher mortality with 13 out of 17 (43%) dead patients being male. A majority (21/41, 51.2%) of the cases belonged to the 41-60 year old age group. Highest mortality was seen in patients<20 years of age (3/4, 75%). Patients with blood sugar levels of >200 mg/dL (56%) succumb to disease. Patients with a positive history of smoking, diabetes mellitus, and alcohol intake expressed mortality rates of 44%, 56%, and 50% respectively; while 29.4% of the mortalities were positive for Pseudomonas aeruginosa on sputum culture. A significant association was found with elevated mortality and low haemoglobin levels at time of admission; mortality was 58% (p=0.005) in patients with Hb less than or equal to 10 mg/dL. CONCLUSIONS: The risk factors involved with heightened mortality included male gender and history of smoking, diabetes and alcohol intake. High blood sugar levels and detection of Pseudomonas aeruginosa on sputum cultures were also implicated. Anemia (Hb level less than or equal to 10 mg/dl) was statistically significant predictive factor for increased mortality.
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Abscesso Pulmonar/epidemiologia , Adulto , Feminino , Humanos , Abscesso Pulmonar/microbiologia , Abscesso Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa , Fatores de Risco , Escarro/microbiologia , Centros de Atenção Terciária , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
The purpose of this report is to present a series of 111 cases of pulmonary abscess observed over a 4-year period in Madagascar. There were 75 men (67.6%) and 36 women (32.4%) with a mean age of 38 years. Alcohol and tobacco use was found in 32.2% of cases. Thirteen patients (11.7%) used chewing tobacco and all patients were exposed to passive smoking. Eighty-eight patients (79.2%) had a history of bronchopulmonary disorders. Onset was progressive in 63% of cases. The main symptoms were fever (81.9%), pulmonary condensation (74.7%) and pleurisy (9.9%). Coughing was productive in 91.8% cases including 54% of patients having muco-purulent expectorations. In 49 patients (44.1%), chest radiography showed an opacity with a hydroaeric level. The abscess was solitary in 40 cases, multiple in 9, and bilateral in 5. In-hospital antibiotherapy was performed on a presumptive basis: tritherapy in 92 patients (82.9%), bitherapy in 18 (16.2%) and monotherapy in one (0.9%). Other treatment modalities inculuded respiratory kinesitherapy in 57 cases (51.3%), surgical drainage in four (3.6%) and pneumonectomy in one (0.9%). Outcome was favorable in 93 cases (8,7%) but there were 18 deaths (16.2%). This study emphasizes the value of achieving early diagnosis, identifying supporting factors and starting appropriate treatment promptly.
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Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Drenagem , Feminino , Humanos , Abscesso Pulmonar/epidemiologia , Madagáscar/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia Torácica , Terapia Respiratória , Fatores de Risco , Adulto JovemRESUMO
AIM: To identify the baseline characteristics associated with suppurative complications in children with community-acquired primary pneumonia. METHODS: A retrospective study included all children from 28 days to 15 years old, who presented with community-acquired pneumonia at two French hospitals from 1995 to 2003. Complicated pneumonia was defined by the presence of empyema and/or lung abscess. RESULTS: Of 767 children with community-acquired pneumonia, 90 had suppurative complications: 83 cases of pleural empyema and seven cases of lung abscess. The mean prevalence of complicated pneumonia was 3% during the 1995-1998 period, and then steadily increased following a linear trend to reach 23% in 2003. Children with complicated pneumonia were older and had a longer symptomatic period preceding hospitalization. They were more likely to receive antibiotics, especially aminopenicillins (p < 0.01), and nonsteroidal anti-inflammatory drugs, especially ibuprofen (p < 0.001). In multivariable analysis, ibuprofen was the only preadmission therapy that was independently associated with complicated pneumonia [adjusted OR = 2.57 (1.51-4.35)]. CONCLUSION: This study confirms an association between the use of prehospital ibuprofen and suppurative pneumonic complications.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Empiema/etiologia , Ibuprofeno/efeitos adversos , Abscesso Pulmonar/etiologia , Pneumonia/complicações , Adolescente , Fatores Etários , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas , Empiema/epidemiologia , Feminino , França/epidemiologia , Hospitalização , Humanos , Lactente , Abscesso Pulmonar/epidemiologia , Masculino , Análise Multivariada , Pneumonia/tratamento farmacológico , Pneumonia/microbiologia , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION: In western countries, community-acquired pneumonias due to Klebsiella pneumoniae (Kp) are rare and associated with a poor prognosis and a high mortality. The severity is in part linked to the virulence of Kp. Immuno-depression, sepsis and visceral abscesses are frequently found, constituting other classical risk factors for severity and contributing to the poor prognosis. The therapeutic strategy is based on third generation cephalosporins, aminoglycosides and quinolones. CASE REPORT: We report the case of a young adult, with undiagnosed diabetes, hospitalized as an emergency for septic shock complicating a community-acquired pneumonia due to Kp and associated with multiple brain and lung abscesses. After several weeks of treatment, initially with empirical then specific antibiotics, a favourable outcome was obtained. CONCLUSION: This case report underlines the particular severity of infections due to Kp and their main pathophysiological mechanisms. It is also an opportunity to highlight the potential responsibility of Kp in the presence of a pneumonia with lung abscesses and finally to update the principles of antibiotic therapy.
Assuntos
Infecções por Klebsiella/complicações , Klebsiella pneumoniae , Abscesso Pulmonar/etiologia , Amicacina/administração & dosagem , Amicacina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Infecções Comunitárias Adquiridas , Comorbidade , Diabetes Mellitus/epidemiologia , Hospitalização , Humanos , Infecções por Klebsiella/tratamento farmacológico , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/tratamento farmacológico , Abscesso Pulmonar/epidemiologia , Masculino , Pessoa de Meia-Idade , Piperacilina/administração & dosagem , Piperacilina/uso terapêutico , Radiografia Torácica , Choque Séptico/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVES: The objectives of this study were to discuss the clinical magnifications and therapies of tracheobronchial foreign body aspiration (FBA) in children causing life-threatening complications. METHOD: We retrospectively reviewed 38 cases of FBA with serious complications in children out of 749 cases of FBA in children that had been admitted to and treated in the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China, from June 1990 to December 2007. The complications included pneumothorax (14 cases); pneumomediastinum (6 cases); pulmonary abscess (7 cases); massive hemorrhage, tracheoesophageal fistula and exudative pleurisy, in 3 cases, respectively; and heart failure (2 cases). Each child's symptoms, including duration, physical findings, chest radiographs, including CT, and the nature of the foreign body causing the complications due to FBA were recorded. RESULTS: Among the 38 cases of FBA, the FBs in 36 cases were removed by bronchoscopy, and in 2 cases the FBs were removed via thoracotomy. Except for 1 case that resulted in death, the other 37 children were completely cured and discharged to home from the hospital. CONCLUSIONS: For children with FBA who experience severe and life-threatening complications from FBA, our recommendation is that emergency measures should be available during FBs removal. With correct judgment and management of the complications of FBA, the mortality rate can be reduced.
Assuntos
Brônquios , Broncoscopia/métodos , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Traqueia , Criança , Pré-Escolar , China/epidemiologia , Estudos de Coortes , Estado Terminal , Feminino , Corpos Estranhos/diagnóstico por imagem , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Hemotórax/epidemiologia , Hemotórax/etiologia , Humanos , Incidência , Lactente , Inalação , Abscesso Pulmonar/epidemiologia , Abscesso Pulmonar/etiologia , Masculino , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Aspiração Respiratória/diagnóstico por imagem , Aspiração Respiratória/etiologia , Aspiração Respiratória/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Fístula Traqueoesofágica/epidemiologia , Fístula Traqueoesofágica/etiologiaRESUMO
BACKGROUND: The aim of this study was to reevaluate the clinical significance of sonographic appearances, in particular the application of color Doppler ultrasound imaging, in discriminating peripheral air-fluid lung abscess from empyema. METHODS: We retrospectively studied patients who had had peripheral air-fluid lesions due to empyema or lung abscess and who had undergone color Doppler ultrasound and grayscale ultrasound examinations between January 2003 and October 2007. A total of 34 patients with confirmed lung abscess and 30 patients with empyema were identified. The four sonographic characteristics observed and analyzed were the wall characteristics of the lesions (wall width, luminal margin, outer margin, and chest wall angle), split pleura sign, internal echogenicity (suspended microbubble sign, complex-septated effusions, and passive atelectasis), and identification of color Doppler ultrasound vessel signals in pericavitary lesions (consolidation or atelectasis). RESULTS: Among the sonographic characteristics, complex-septated effusions and passive atelectasis were specific for empyema, but the sensitivity was only 40% (n = 12 of 30) and 47% (n = 14 of 30), respectively. The identification of color Doppler ultrasound vessel signals in pericavitary consolidation was the most useful and specific for identifying lung abscesses. In our series, if we define the identification of color Doppler ultrasound vessel signals in a pericavitary consolidation as a predictor for peripheral lung abscess, we can achieve sensitivity, specificity, positive predictive value, and negative predictive value of 94%, 100%, 100%, and 94%, respectively. CONCLUSIONS: Color Doppler ultrasound is a powerful tool for differentiating the peripheral air-fluid abscess from empyema, with high specificity and without any risk.
Assuntos
Empiema Pleural/diagnóstico por imagem , Abscesso Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Diagnóstico Diferencial , Empiema Pleural/diagnóstico , Empiema Pleural/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/epidemiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Probabilidade , Atelectasia Pulmonar/diagnóstico , Atelectasia Pulmonar/epidemiologia , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
El absceso pulmonar es la colección necrotizante supurativa en el parénquima pulmonar. Metodo: En el presente estudio se reportan los casos de absceso pulmonar del Hospital Nacional Dos de Mayo desde enero 2005 a junio 2006, que requirieron internamiento. Resultados: Se encontraron un total de 22 casos, siendo el 63 por ciento de sexo masculino. Los síntomas principales asociados fueron: malestar general, fiebre (100 por ciento) y tos con expectoración con mal olor (81 por ciento). El pulmón mßs afectado fue el derecho (68 por ciento), siendo el lóbulo superior el mßs afectado (59 por ciento). Se encontró factores de riesgo en el 63 por ciento de los casos, los mßs frecuentes el estado etílico y el estado convulsivo. Solo se pudo aislar el germen causante en un caso, en un paciente con VIH- SIDA. Conclusión: El absceso pulmonar es aún una enfermedad frecuente en nuestro medio, siendo importante el síntoma tos con expectoración de mal olor y el antecedente epidemiológico de factores de riesgo.
The Lung abscess is the suppurative necrotizing collection inside the lung parenchyma. In this study we report the cases of lung abscess between 2005 january to 2006 june that were hospitalized in the Hospital Nacional Dos de Mayo. Results: We found 22 cases, where the 63 per cent were males. The associated major symptoms were fever and illness (100 per cent) and cough with bad odor (81 per cent). The most affected lung was the right (68 per cent) and the most affected lobe was the superior one (59 per cent). We found risk factors in 63 per cent of the cases, with ethylic and seizure as majors ones. We can only isolate the germen in one patient, a HIV- AIDS risk factor. Conclusion: The lung abscess still frequent for us, with the symptom cough with bad odor as an important one and the epidemiologic risk factors as an antecedent.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Abscesso Pulmonar , Abscesso Pulmonar/epidemiologia , Fatores de RiscoRESUMO
To quantify the respiratory disease burden among agricultural workers, we examined the 1988-1998 National Center for Health Statistics (NCHS) "Multiple Cause of Death Data" and the 1988-1994 Third National Health and Nutrition Examination Survey data (NHANES III). Proportionate mortality ratios (PMRs) were determined for 11 respiratory conditions among 6 agricultural groups: crop farm workers, livestock farm workers, farm managers, landscape and horticultural workers, forestry workers, and fishery workers. Prevalence ratios (PRs) were determined for 12 respiratory conditions among 3 agricultural groups: farm workers, farm managers, and other agricultural workers. Disease categories groups were based on the 9th International Classification of Diseases and the agricultural groups on the NCHS or NHANES III industry and occupation codes, respectively. Crop farm workers and livestock farm workers had significantly elevated mortality for several respiratory conditions, with mortality for hypersensitivity pneumonitis being 10 and 50 times higher than expected. Landscape and horticultural workers had significantly elevated mortality for abscess of the lung and mediastinum and chronic airways obstruction. Forestry workers had significantly elevated mortality for pulmonary tuberculosis, chronic airways obstruction, and pneumonia. Prevalence of wheeze was elevated for female farm workers, shortness of breath was elevated for farm workers who had ever smoked, and hay fever was elevated for black, non-Hispanic farm workers. Prevalence of asthma was elevated for other agricultural workers who had ever smoked. Farm workers had a PR of 173 for obstructive respiratory abnormality. Continued improvement in occupational health surveillance systems for agriculture is essential to help guide prevention efforts for respiratory disease.