Abscessive pneumonia

It occurs most often during sepsis, especially as a complication of staphylococcal pneumonia.

Staphylococcal pneumonia

 * Now rare, more often in infants than in older children,
 * is severe for the progressive course with a tendency to complications– abscesses and pyopneumotorax,
 * Staphylococcus aureus, has various toxins and enzymes (hemolysin, leukocidin, staphylokinase, plasma coagulase),
 * the routes of spread of the infection are bronchogenic or hematogenous.

Pathophysiology

 * Inflammation deposits merge, the aureus multiplies rapidly, destroys the surroundings, causes the formation of small abscesses,
 * rupture of abscesses deposited subpleurally results in pyopneumothorax,
 * partial obstruction of small bronchi can lead to the formation of pneumococci,
 * septic thrombi may form in the pulmonary veins.

The clinical picture

 * Sudden high fever, shortness of breath,
 * may be staphyloderma at the same time,
 * in infants it occurs peracutally as a septic toxicological form,
 * physical finding: initially a finding typical of pneumonia, in case of empyema or pyopneumothorax then respiratory weakness,
 * laboratory tests: marked leukocytosis, neutrophilia, shift to the left, anaemia, high sedimentation and CRP, blood culture is often positive,
 * heart + lung x-ray: initially small bronchopneumonic lesions, rapidly expanding and gradually merging,
 * exudate formation,
 * abscesses - form cavities with a wide rim (after emptying the contents into the bronchus, they are filled with air),
 * complications: only rare with targeted ATB therapy, in younger infants - staphylococcal pericarditis, meningitis, osteomyelitis, metastatic abscesses, sepsis.sepse.

Diagnosis

 * Difficult in the initial stage,
 * a history of past staphyloderma or mastitis of the mother helps us with dif. dg.,
 * further: clinical picture, X-ray S + P, cultivation,
 * differential diagnosis: pneumonia, which may be complicated by empyema (agents: streptococcus, klebsiella, hemophilus).

Therapy

 * Antistaphylococcal ATB - oxacillin, vancomycin (3-4 weeks),
 * Ig or antistaphylococcal serum also helps to manage it,
 * empyema - drainage of the cavity (max. 7 days),
 * the prognosis - severe, high mortality - is influenced by the patient's premorbid condition and complications.

Related Articles

 * Pneumonia ▪ Atypical pneumonia ▪ Bacterial pneumonia
 * Pneumonia in infants ▪ Pneumonia in older children