Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004

Abstract

Objective: To relate the experience of the staff at a health care facility specializing in the management of patients with aspiration lung abscess. Methods: Diagnostic aspects and therapeutic results of 252 consecutive cases of lung abscess seen in patients hospitalized between 1968 and 2004. Results: Of the 252 patients, 209 were male, and 43 were female.The mean age was 41.4 years, and 70.2% were alcoholic. Cough, expectoration, fever and overall poor health were seen over 97% of patients. Chest pain was reported by 64%, 30.2% presented digital clubbing, 82.5% had dental disease, 78.6% reported having lost consciousness at least once, and 67.5% presented foul smelling sputum. In 85.3% of the patients, the lung lesions were located either in the posterior segments of the upper lobe or in the superior segments of the lower lobe, and 96.8% were unilateral. Concomitant pleural empyema was seen in 24 (9.5%) of the patients. Mixed flora was identified in the bronchopulmonary or pleural secretions of 182 patients (72.2%). All patients were initially treated with antibiotics (mainly penicillin or clindamycin), and postural drainage was performed in 98.4% of cases. Surgical procedures were performed in 52 (20.6%) of the patients (drainage of empyema in 24, pulmonary resection in 22 and drainage of the abscess in 6). Cure was obtained in 242 patients (96.0%), and 10 (4.0%) died. Conclusion: Lung abscess occurred predominantly in male adults presenting dental disease and having a history of loss of consciousness (especially as a result of alcohol abuse). Most of the patients were treated clinically with antibiotics and postural drainage, although some surgical procedure was required in one-fifth of the study sample.

Etiology and Outcome of Community-Acquired Lung Abscess

“…Patients requiring surgical procedures account for 5.1–41.2% of all patients with lung abscess [5,6,7,11,12,13]. Pulmonary resection is required in patients with failure to improve, suspicion of cancer and hemoptysis.…”

“…Antimicrobial use has improved the prognosis, but mortality was estimated at 2.0–38.2% in previous reports published from 1969 to 2005 [2,3,4,5,6,7,8,9,10,11,12,13], and lung abscess remains an important respiratory disease. Anaerobes comprise 60–80% of lung abscess etiologic pathogens, and anaerobes and microaerophilic streptococci account for the majority of these microorganisms [1].…”

Absceso pulmonar primario en pediatría. Reporte de casos y revisión de la literatura

“…Los lóbulos más afectados son los del pulmón (7) derecho . Tal como corroboramos en nuestra serie, donde un 80% de los abscesos se ubicó en el lado derecho, aunque el mecanismo para ello no fue claro ya que la patogenia en nuestra serie fue diversa (16) (NAC y vía hematógena) .…”

“…No se registraron óbitos ni reingresos. principalmente al aparato respiratorio, encontrán- (7) dose fiebre, tos y dificultad respiratoria . Es frecuente su asociación con neumonías adquiridas en la (15) comunidad .…”

“…Los secundarios ocurren en presencia de situaciones s u b ya c e n t e s t a l e s c o m o f i b r o s i s q u í s t i c a , inmunodeficiencias primarias, malformaciones, (3,4) entre otras . Mc Cracken reporta 30 casos en 20 años, pudiendo presentarse por aspiración o (5)(6)(7) diseminación hematógena, y con peor pronóstico . Hasta 90% son polimicrobianos.…”