Fever during focal infection is fever of unknown origin. Types of abscesses, their signs, treatment and complications Periods of abscess

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A lung abscess is a nonspecific inflammatory disease of the respiratory system, which results in the formation of a thin-walled cavity filled with pus in the lung cavity. An abscess most often occurs as a result of incomplete recovery after focal pneumonia, when melting and necrotization of lung tissue occurs in a limited area.

Less commonly, such a cavity may appear after blockage of a small bronchus by some foreign body; in this case, oxygen does not enter the blocked area, the tissue collapses, atelectasis is formed, which can easily become infected with the formation of an abscess. Even more rarely, a lung abscess is formed as a result of the introduction of infection from the source of inflammation into the lung tissue by hematogenous route.

Etiology of the disease

Abscess and gangrene of the lung occur when pathogenic microorganisms that can secrete toxins and enzymes that destroy tissue enter the patient’s lungs. The following microorganisms can cause damage to lung tissue:

Not every inflammatory process in the lungs is complicated by tissue necrosis and the development of a lung abscess; this can be caused by massive introduction of the infectious agent into the lungs, general weakening of the body, decreased immunity, or a number of chronic diseases. The risk group includes patients suffering from diabetes mellitus, hormonal disorders, bronchiectasis, older patients, premature babies and pregnant women.

Symptoms

There are two forms of the disease: acute lung abscess and chronic lung abscess.

If a small cavity has formed on the periphery of the organ, then such a lung abscess does not give characteristic symptoms and therefore is not diagnosed in time, which can lead to chronicity of the process or, less often, to independent resolution of the disease.

Acute abscess

In acute lung abscess, there are 2 clinical stages:

Period of abscess formation
Opening period

Period of abscess formation

During the period of formation, an acute lung abscess causes severe intoxication of the body, the patient complains of high body temperature - up to 41-42 degrees, loss of appetite, weakness, headache, and general deterioration of the condition. In addition, difficulty breathing, shortness of breath, dry cough, chest pain are characteristic; when breathing, asymmetry of the chest is noted - the affected side lags behind the healthy one.

The severity of the patient's condition depends on the size, number of abscesses and the type of pathogen that caused the disease. This period lasts about 7-10 days, but can proceed quickly - up to 2-3 days or, conversely, slow down - up to 2-3 weeks. The time for the formation of an abscess also depends on the size, type of pathogen and on the state of health and immunity of the patient - in weak, exhausted patients this process can drag on for several weeks.

Opening period

At this time, the abscess “ripens” and breaks through its membrane, pus is released through the respiratory tract and the patient’s condition improves sharply. The main symptom of resolution of the process is sputum, which in case of a lung abscess is sudden, the patient’s cough becomes wet and a large amount of purulent sputum is released - up to 1 liter, “he coughs up a mouthful of sputum.”

After this, the symptoms of intoxication decrease, body temperature drops, fever and sweating stop, and appetite is restored. During this period, the patient continues to experience weakness, shortness of breath and chest pain.

The duration of the disease depends on the condition of the bronchial drainage and the availability of adequate treatment. If the sputum is cleared well, the patient receives everything he needs, then within a few weeks the disease almost completely disappears, and then, within several years, the abscess cavity is scarred and complete recovery occurs. If the bronchial drainage is too narrow, sputum stagnates in the lung, the healing process slows down greatly, the condition either improves or worsens, and the disease can become chronic.

Chronic lung abscess

Occurs if the acute process is not completed within 2 months. This is facilitated by the characteristics of the abscess itself - large size (more than 6 cm in diameter), poor drainage of sputum, localization of the focus in the lower part of the lung; weakening of the body - disruption of the immune system, chronic diseases, and so on; errors in the treatment of acute abscess - incorrectly selected antibiotic or too small doses, late or insufficient treatment.

With a chronic abscess, the patient suffers from shortness of breath, cough with foul-smelling sputum, alternating deterioration and normalization of the condition, increased fatigue, weakness, exhaustion, and sweating. Gradually, due to lack of oxygen and constant intoxication of the body, bronchiectasis, pneumosclerosis, emphysema, respiratory failure and other complications develop. The appearance of the patient changes - the chest increases in size, the skin is pale, cyanotic, the terminal phalanges of the fingers thicken, taking on the appearance of “drumsticks”.

Treatment of lung abscess

Treatment of a lung abscess must begin with hospitalization and a powerful course of antibiotic therapy.

The patient should remain in bed, changing body position several times a day to improve the drainage function of the lungs. They also carry out therapeutic measures aimed at improving the drainage function of the lungs and restoring the general condition of the body.

Antibiotics are prescribed immediately after diagnosis, drugs with a broad spectrum of action are selected and large doses are administered intramuscularly or intravenously. The most commonly prescribed drugs are penicillins, cephalosporins or macrolides. In addition to antibiotics, bronchoscopy is performed with aspiration of the contents and washing of the abscess cavities and, if necessary, with the introduction of antibiotics directly into the lung. To reduce intoxication, solutions of glucose and sodium chloride are administered intravenously, and to improve the drainage function of the bronchi, aminophylline and other mucolytics are administered.

If the therapeutic measures are not effective or when treating a chronic lung abscess, surgical treatment is performed - the affected part of the lung is removed.

A lung abscess is an inflammation of a section of the tissue of the organ itself, formed due to purulent melting. A cavity filled with this liquid is formed in it. When the first signs of the disease appear, an urgent call to the therapist’s home is required.

Possible causative agents of acute lung abscess

The causative agent of the disease is usually pathogenic bacteria, especially Staphylococcus aureus. The disease can develop against the background of a general decrease in immunity and weakness of the body as a result of various foreign bodies entering the respiratory tract and lungs. In a state of severe intoxication or unconsciousness, vomit, mucus and other substances can enter the lungs, causing the development of an abscess. Against the background of chronic diseases and infections, with a long course of taking antidepressants or glucocorticoids, and with impaired bronchial drainage, a lung abscess develops quite often. Another method of infection is hematogenous. In this case, the infection enters the lungs during sepsis. This route of infection is extremely rare. Secondary infection can occur due to pulmonary infarction. Another fairly common cause of the disease is a wound to the chest area.

The first stage of an abscess is characterized by infiltration of lung tissue in a limited area. Then the abscess melts, gradually forming a cavity. At the next stage of the disease, infiltration along the edges of the cavity disappears. At this time, the cavity is covered with granulation tissue. If the disease is mild, the cavity closes, and an area of pneumosclerosis forms on it. If the cavity has fibrous walls, then the processes of pus formation inside tend to be self-sustaining. In this case, a chronic lung abscess develops. This stage of the disease is more common in men than women. Moreover, almost half of the patients drank alcohol in large doses.

What could be the reasons for the onset of a lung abscess?

1. Pneumonia caused by anaerobes or staphylococcus. Contact with a patient with subphrenic abscess.

2. Entry of any foreign body into the lungs or bronchi.

3. Infection of the tonsils and paranasal sinuses.

4. Numerous abscesses in the anamnesis, arising against the background of septicopyemia.

5. Emboli penetrating into the lungs from various foci of diseases: prostatitis, onitis; and with the lymphogenous method - from the infected oral cavity, boils from the lips.

6. Disintegration of a cancerous tumor in the lung or a complication of a pulmonary infarction.

Symptoms of the disease

Signs of a lung abscess, as a rule, do not take long to appear. The disease develops rapidly - the patient feels pain in the sternum, has an elevated temperature, and chills appear. Sputum from a lung abscess is released through the oral cavity after a bronchial rupture. The sputum smells unpleasant and may contain blood. When listening, it is clear that breathing is weakened; after a breakthrough, it becomes bronchial with accompanying moist rales. The formation of a thin-walled cyst or pneumosclerosis is an approach to a favorable outcome of the disease. It should be expected approximately 2 months after infection. A chronic lung abscess may occur, the reasons for this lie in improper treatment or lack thereof.

The first stage of the disease lasts about a week. The onset of the disease can take up to three weeks. It happens that a purulent cavity takes only 2 days to develop; such an onset of the disease is considered rapidly rapid.

The second stage of an abscess is characterized by rupture of the cavity and its purulent contents. Fever develops, a dry cough gives way to a wet expectorant cough. The patient constantly coughs and coughs up pus in large quantities. The amount of pus varies depending on the volume of the cavity and can reach 1 or more liters.

The final stage of the disease is characterized by a decrease in symptoms of intoxication and fever. The patient feels much better. Blood tests taken at this stage indicate that the infection has subsided.

The difficulty is that it is not always possible to clearly distinguish the stages of the disease. If the draining bronchus is small, sputum will not be discharged in large volumes, as it should be. Although if the collected sputum stands for some time in a glass container, it will separate. The top layer will become foamy, the middle layer will become liquid, and the bottom layer will become thick and gray.

Complications of lung abscess

When the pleura or its area is involved in the course of the disease, abscess complications may occur. Complications of the disease occur against the background of purulent pleurisy. Pulmonary hemorrhage may occur in the event of purulent melting of the vascular walls. The infection can easily spread to healthy areas of the lung, forming numerous purulent foci. It is possible for the infection to spread to the adjacent healthy lung. If the infection spreads hematogenously, abscess foci may appear on other organs, which can cause bacteremic shock and spread of the disease throughout the body. Lung abscess is fatal in five percent of cases out of a hundred.

How to diagnose the disease

At the first signs of a disease such as a lung abscess, a full diagnosis is carried out; all tests must be taken: blood, urine. In a blood test, the doctor will see pronounced leukocytosis, an increase in the permissible level of ESR, and toxic granularity of neutrophils. The analyzed blood improves by the beginning of the second stage of the abscess. When the disease becomes chronic, the level of hemoglobin in the blood decreases noticeably. The biochemistry of the blood changes: the amount of seromucoid, haptoglobins, fibrin increases, and the amount of albumin in the blood decreases.

A urine test will show how albuminuria and microhematuria change.

The more complex the course of the disease, the higher they grow.

To make a correct diagnosis, an analysis of sputum must be performed. It is tested for the presence of fatty acids, atypical cells, elastic fibers, and also for the presence of tuberculosis bacteria.

The causative agent of the disease is detected using sputum bacterioscopy. Then sensitivity and response to antibiotics are determined.

The most accurate and fastest way to make this diagnosis is to perform a fluoroscopy of the lungs. If diagnosis is difficult, perform MRI of the lungs, CT scan of the lungs, bronchoscopy and other procedures prescribed by the doctor. If pleurisy is suspected, pleural puncture is mandatory.

Treatment of lung abscess

If test results confirm a lung abscess, treatment is performed immediately. Depending on the severity of the abscess, the doctor prescribes appropriate therapy. Conservative or surgical treatment is possible. Both methods of therapy are carried out in a hospital under the supervision of pulmonologists.

To defeat a lung abscess, treatment of the disease is carried out conservatively, which implies mandatory drainage of sputum, i.e. The patient must take a position that is convenient for the removal of sputum several times a day. Bed rest is necessary for a favorable outcome of the disease. As soon as the laboratory assistant determines the sensitivity of the microorganisms, the doctor prescribes antibiotic treatment. A transfusion of the necessary components of donor blood is prescribed. In some cases, the patient is transfused with his own blood, taken in advance. These procedures are prescribed to restore the functions of the immune system. The attending physician also decides on the advisability of prescribing globulins to the patient.

In some cases, when natural drainage slightly improves the patient's condition and sputum discharge, he is prescribed bronchoscopy with aspiration of the cavities. During this procedure, the cavity is washed and treated antiseptically. In difficult cases, the antibiotic is injected directly into the purulent cavity. In 75-80 percent of cases, a purulent lung abscess is single and localized in segments of the right lung.

If there are no results from conservative treatment or life-threatening complications occur, they resort to a surgical solution to the problem: the doctor removes part of the diseased lung under anesthesia.

Abscess and gangrene of the lung are the most common acute suppurative diseases of the lungs.

Disease prevention

Preventive measures in the case of this disease are not always effective. But you should know about some rules:

It is necessary to treat pneumonia, bronchitis and other respiratory diseases in a timely manner;

Preventing foreign bodies from entering the lungs and bronchi;

Timely treatment of purulent diseases, boils on the body and especially abscesses in the oral cavity;

Do not abuse alcoholic beverages.

Forecast

The prognosis of this disease with proper and timely treatment is favorable. Often a lung abscess goes away over time: the infiltration around the cavity becomes thinner. Over time, the cavity is no longer detectable. Within 8 weeks the disease goes away (if it does not drag on or become chronic).

In the absence of proper treatment, an acute lung abscess will become chronic with corresponding exacerbations and remissions. This nosological form is characterized by the formation of a certain cavity in the affected organ, and around it there is an irreversible process of change in the parenchyma and bronchial tree. These metamorphoses take the form of deforming bronchitis, proliferation of connective tissue, and in the future they can develop into bronchiectasis. The transition from an acute form of a lung abscess to a chronic form is observed in 2.5-8% of cases.

Pathogenesis and etiology of the disease

If a chronic lung abscess is confirmed, the patient's medical history begins long before it. Chronic abscesses occur due to the same pathogens that provoke acute suppuration in the lungs. These include staphylococcus with a predominance of strains that are resistant to most antibiotics, including the most modern ones. There are also similar, in terms of resistance to medical influences, microorganisms with a significant role in the etiology of chronic lung abscesses. These are gram-negative rods such as Protea, Escherichia, Pseudomonas, etc. A mycological study, which has a clear focus, reveals in a large proportion of patients the presence of pathogens of deep mycoses that are isolated from sputum. Moreover, only by identifying serological markers of an active fungal infection can their etiological significance be proven. These conditions make etiotropic therapy of chronic abscesses a difficult task.

The transition from the acute form of pulmonary abscess to the chronic form is due to the following main factors:

there is either too much destruction in the lung (more than 5 cm), or there are too many of them;
the process of drainage of the destruction cavity was ineffective or was inadequate, and therefore connective tissue developed in the surrounding parenchyma, and a fibrous capsule was formed, which will subsequently prevent the cavity from decreasing in size;
in the abscess cavity there are sequesters that block the mouths of the draining bronchi, and also constantly maintain suppuration inside the cavity and inflammation around it;
conservative treatment of acute lung abscess provoked the formation of a dry residual cavity, as well as its epithelization from the mouths of the draining lungs;
nonspecific nature of the body's resistance and compromised immunity;
Pleural adhesions have formed in the segments of the lungs affected by the abscess, which prevents early decline and obliteration of the cavity.

Due to chronic hypoxia and purulent intoxication, due to a deficiency of non-gas exchange pulmonary functions and due to a malfunction of the endocrine, nervous and other regulatory systems of the body, a long-term chronic suppurative process is accompanied by various disorders:

compensatory and reserve circulatory capabilities are reduced;
pulmonary hypertension is observed;
microcirculation in organs and tissues is disrupted;
secondary immunodeficiency is acquired;
changes occur in energy and protein metabolism.

Clinic and diagnosis of chronic abscess

Chronic lung abscess symptoms have the following:

persistent cough;
chest pain;
prolonged feeling of lack of air;
chronic purulent intoxication;
complications from other organs and systems of the body are possible.

It is difficult to accurately determine a chronic lung abscess; symptoms can be expressed to any degree, it depends on the severity or stage of the disease, the phase of its course (remission or exacerbation), the nature of changes in the lung tissue, and the degree of impairment of the bronchial drainage function. It is noteworthy that over the past 20 years, methods of treating acute pulmonary suppuration have improved so much that the frequency of transitions to the chronic form has decreased significantly, and their clinical manifestations have become much weaker.

Complications of chronic abscess

Most often, chronic lung abscess is accompanied by the following complications:

pulmonary hemorrhage;
secondary bronchiectasis;
sepsis.

In most cases, they appear during exacerbation of the disease or its long-term treatment. Recently, amyloidosis of parenchymal organs has become much less common.

Treatmentchronic abscess

If a chronic lung abscess is diagnosed, treatment occurs only through surgery.

The conservative method of treatment for the lion's share of patients consists of preoperative preparation. These measures may even become the only possible way of treatment if surgical intervention is impossible for some reason. This method is characterized by the following activities:

sanitation of the tracheobronchial tree and destruction cavity;
relief of exacerbation of purulent destruction;
correction of impaired body functions to increase its reserve capabilities, which will help withstand surgical aggression.

Postoperative treatment of people who have suffered a chronic lung abscess is very complex and time-consuming. Such patients require special attention, since a whole chain of interrelated complications may arise after surgery. Postoperative complications in this category of patients can be various:

General: circulatory decompensation, thromboembolic complications.
Pulmonary and bronchopleural, such as pneumonia, pleural empyema, bronchial fistulas, incompetence of the bronchial stump.
General surgical: postoperative wound infection, postoperative bleeding.

In the postoperative period, which lasts a day or two, it is mainly necessary to provide all the conditions for the restoration and maintenance of the main life-supporting systems of the body, weakened by the illness and surgical intervention. These include the respiratory system and the circulatory system. When the respiratory process has stabilized and hemodynamics have improved, it is time to switch intensive therapy to the prevention of infectious complications. It must be accompanied by corrective and supportive therapy. The early stage of the postoperative period is considered successfully completed if the operated lung has expanded, blood counts have returned to normal, and the patient can easily stand up and walk. More time after surgery, after symptomatic therapy, they begin local treatment and eliminate complications that could not be eliminated earlier. At the same time, the respiratory and circulatory systems are stabilized, and metabolic processes return to normal.

Over the past few decades, surgical intervention in patients with chronic lung abscesses has begun to show much better results. But even successful surgical treatment of the lungs does not exclude deaths. Unfortunately, the mortality rate for patients in this category is still high and reaches 15%. Most often, patients die due to bleeding, cardiac and respiratory failure, as well as due to pleural empyema. By analyzing the statistics of fatal outcomes of patients with chronic lung abscesses after resections, we can draw conclusions about methods for improving treatment results. To do this, it is necessary to prepare patients for surgery as thoroughly as possible, to make the surgical technique more advanced, and to promptly prevent and treat developing postoperative complications.

Before opening into the draining bronchus abscess lungs is manifested by fever with Then,chills, malaise, dry cough, sometimes chest pain of an uncertain nature. After a cavity breaks through into the bronchus, a cough appears, accompanied by the release of purulent sputum with an unpleasant odor, sometimes with an admixture blood. Before the abscess empties, dullness of percussion sound and weakening of breathing in the affected area may be detected. After the formation of a cavity above it, ringing coarse rales and bronchial breathing with an amphoric tinge are heard. With percussion, you can detect a sound with a tympanic tint. Before a cavity forms, diagnosing a lung abscess is difficult. Pulmonary suppuration should be suspected in cases of prolonged pneumonia with a prolonged increase in body temperature and persistent leukocytosis. When an abscess ruptures into the bronchus radiographically a cavity is discovered in the former darkened area.

Treatment

Attention! Wikipedia does not give medical advice.

Penicillin up to 1,500,000 units/day IM, preferably in combination with streptomycin-500,000-1,000,000 units. If there is no effect within several days, broad-spectrum antibiotics are used: sigmamycin, ceporin, etc. The prescription of expectorants is indicated. When the abscess is located in the lower lobes of the lungs, it is advisable to drain the drainage position, lifting the foot end of the bed. Timely treatment usually leads to recovery. If treatment is ineffective within 6-8 weeks, the patient must be hospitalized in a surgical hospital for bronchoscopic drainage or surgery. Gangrene of the lungs is rare, characterized by a severe course, severe intoxication, and chocolate-colored coughing. sputum with a foul odor. Assign antibiotics broad spectrum of action parenterally; if they are ineffective, surgical treatment is indicated.

Chronic lung abscess

Occurs as an outcome of the unfavorable course of acute abscess or bronchiectasis. It has a denser capsule with development fibrosis lung tissue around it. The patient, along with X-ray signs of a cavity in the lungs, has an increase in temperature, cough with purulent sputum, fingers in the form of drumsticks, nails in the form of watch glasses. The disease progresses in waves, with periodic exacerbations of acute fever and an increase in the amount of typical three-layer sputum. With a long course, complications are possible: amyloidosis,cachexia, septicomypyemia with abscess brain and etc.

Treatment

In case of exacerbation of a chronic abscess, therapeutic measures are similar to those taken for an acute abscess. The best results are observed when antibiotics are administered directly into the lesion through catheter or in the form aerosols. For better sputum discharge, enzyme preparations and bronchodilators are indicated. Prescribe a high-calorie diet with added vitamins.

Prevention

Timely vigorous treatment of respiratory tract infections, especially pneumonia, prevention aspirations, especially after injuries, operations, etc.

Lung abscess

Lung abscess is an abscess localized within the lung parenchyma. Divided into acute and chronic (duration more than 2 months). Localization: more often - the posterior segment of the upper lobe (S 2), the upper segment of the lower lobe (S6).

Etiology

Contact spread of infection in pleural empyema, subphrenic abscess

Aspiration pneumonia

Purulent pneumonia with lung destruction caused by Staphylococcus whitefish or Streptococcus pyogenes

Pulmonary infarction

Septicopyemia

Septic emboli entering hematogenously from foci of osteomyelitis, otitis, prostatitis

Lymphogenic infection with boils of the upper lip, phlegmon of the floor of the mouth

Disintegration of a cancerous tumor in the lung.

Risk factors

Alcoholism

Drug use

Epilepsy

Pulmonary neoplasms

Immunodeficiency conditions

Diabetes

Foreign bodies in the respiratory tract

Gastroesophageal reflux

Surgeries on the stomach and esophagus.

Pathomorphology

Development of purulent, gangrenous and necrotic processes in the central parts of the affected area

Separation from the surrounding lung tissue with the formation of a purulent cavity

Abscess wall - cellular elements of inflammation, fibrous and granulation tissue with good vascularization

An acute abscess with perifocal inflammatory infiltration of the lung tissue can become chronic with the formation of a dense pyogenic membrane (formation of an abscess capsule).

Clinical picture

General signs of acute and chronic abscesses

Tachypnea

Tachycardia

Asymmetrical respiratory movements of the chest

Dullness of percussion sound over the abscess area

Reducing breath sounds

Various moist rales

Amphoric breathing with good drainage of the abscess cavity

Three-layer sputum:

yellowish mucus

aqueous layer

pus (at the bottom).

Acute lung abscess

Chest pain

Cough with purulent (smelly) sputum

Often hemoptysis

Hectic temperature curve.

Chronic lung abscess

Periodic exacerbation of the purulent process

During remission:

paroxysms of barking cough

increase in the amount of purulent sputum with changes in body position

Possible hemoptysis

Fatigue

Weight loss

Night sweats

Signs of right ventricular failure: fingers in the form drumsticks and etc.

The sudden release of a large amount (a mouthful) of foul-smelling sputum is a sign of a breakthrough of the abscess cavity into the bronchus. A temporary improvement in the patient's condition is typical.

Laboratory research

Blood - neutrophilic leukocytosis with a shift to the left, anemia, hypoalbuminemia

Sputum microscopy - neutrophils, various types of bacteria

Pleural fluid - neutrophilic cytosis.

Special studies

X-ray examination of the chest organs in frontal and lateral projections

Acute abscess

Against the background of darkening (parenchyma infiltration) - a cavity with a fluid level

Presence of effusion in the pleural cavity

Chronic abscess - a cavity with dense walls surrounded by an infiltration zone

Bronchoscopy with aspiration of pus to determine the microflora and its sensitivity to antibiotics. Transthoracic puncture.

Differential diagnosis

Bronchiectasis

Empyema of the pleura

Tuberculosis

Fungal pulmonary infections

Granulomatosis Wegener

Silicosis

Subphrenic or hepatic abscess with rupture into the bronchus

Bronchogenic or parenchymal cysts (congenital). TREATMENT

Diet. Energy value - up to 3,000 kcal/day, high protein content (110-120 g/day) and moderate restriction of fats (80-90 g/day). Increase the amount of foods rich in vitamins A, C, group B (decoctions of wheat bran, rose hips, liver, yeast, fresh fruits and vegetables, juices), salts Ca, P, Cu, Zn. Limit table salt to 6-8 g/day, liquid. Conservative therapy

Energy value - up to 3,000 kcal/day, high protein content (110-120 g/day) and moderate restriction of fats (80-90 g/day). Increase the amount of foods rich in vitamins A, C, group B (decoctions of wheat bran, rose hips, liver, yeast, fresh fruits and vegetables, juices), salts Ca, P, Cu, etc. Limit table salt to 6-8 g/day, liquid.

Antibiotic therapy until clinical and radiological recovery

The choice of drug is determined by the results of bacteriological examination of sputum, blood and determination of the sensitivity of microorganisms to antibiotics

Drugs of choice

Clindamycin 600 mg IV every 6 to 8 hours, then 300 mg orally every 6 hours for 4 weeks, or

benzylpenicillin sodium salt 1-2 million units/day IV every 4 hours until the patient’s condition improves, then phenoxymethylpenicillin 500-750 mg 4 times a day for 3-4 weeks, or

combination of a penicillin antibiotic with metronidazole 500 mg orally 4 times a day

At Bacteroides:

cefoxitin

Augmentin

chloramphenicol

imipenem

For Fusobacterium:

first generation cephalosporins.

Detoxification and symptomatic therapy.

Transbronchial drainage during bronchoscopy.

Percutaneous puncture and drainage of the abscess cavity under ultrasound or fluoroscopy control. Surgery

Indications

Ineffectiveness of antibiotic therapy

Pulmonary hemorrhage

Inability to rule out lung cancer

Abscess size more than 6 cm

Breakthrough of an abscess into the pleural cavity with the development of empyema

Chronic abscess.

Types of surgery

Simultaneous pneumotomy - in the presence of adhesions between the visceral and parietal layers of the pleura above the abscess cavity

Two-stage pneumotomy - in the absence of adhesions

Drainage of an abscess after puncture through the chest wall or insertion of drainage using a trocar

For chronic abscesses, removal of a lobe or the entire lung.

Complications

Process dissemination

Brain abscess

Meningitis

Perforation into the pleural cavity with the occurrence of pleural empyema

Pneumothorax

Pulmonary hemorrhage. Course and prognosis

Transition to a chronic form with inadequate treatment of acute abscess; X-ray control is required 3 months after recovery

The prognosis is favorable: in most cases, obliteration of the abscess cavity and recovery are noted.

Classification, pathogenesis and clinical signs of abscess. Treatment of animals with abscesses. Diagnosis and stages of development of phlegmon. Pathogenesis and main forms of sepsis, methods of therapy. Features of purulent-resistent fever as a preseptic condition.

Clinical forms of the animal body’s reaction to infection (abscess, phlegmon, purulent-resorptive fever, sepsis)

AbscessWith - Abscessus

An abscess is a limited purulent inflammation of loose tissue, accompanied by the formation of a cavity filled with pus. With an abscess, purulent processes prevail over necrotic ones.

Classification

By etiology there are abscesses aseptic And septic or infectious.

Aseptic abscesses develop after the introduction (injection) of certain irritating chemicals under the skin, in particular, sterile turpentine, kerosene, chloral hydrate, calcium chloride, which cause tissue necrosis. Necrotic tissues are lysed by neutrophilic leukocytes to form pus that does not contain microbes.

All other abscesses are septic. They most often arise as a result of the introduction into tissue of pyogenic microorganisms: streptococci, Escherichia coli, Pseudomonas aeruginosa, as well as pathogens of putrefactive infections.

Abscesses can also develop with common infectious diseases, such as tuberculosis, actinomycosis, and botryomycosis.

By course of inflammatory processes there are abscesses hot and cold . The former are usually caused by pyogenic microorganisms, and the latter by pathogens of a specific infection.

By localization abscesses are divided into superficial and deep

Superficial abscesses can be located in the skin and subcutaneous tissue. Deep abscesses can be intermuscular, subfascial, or retroperitoneal. Deep abscesses are often encapsulated (when they are overgrown with a connective tissue capsule and can remain among the muscles or internal organs for years) and serve as foci of dormant infection.

Depending on the ways of spreading infection abscesses are distinguished:

metastatic - which spread hematogenously or lymphogenously and, as a rule, occur during sepsis with metastases;

numb - which spread along the anatomical continuation. As a rule, in this case, the source of infection is located higher, and pus accumulates lower. Pus usually gets here through the interfascial spaces. An example is the development of an infection in the croup area with the formation of an abscess in the thigh and lower leg.

By intensity of the inflammatory process there are abscesses benign and malignant . Benign abscesses are well demarcated, while malignant abscesses are capable of developing into phlegmon due to a weak demoralization shaft. The microorganisms that cause such abscesses are usually highly virulent.

Depending on the stages of development of surgical infection distinguish between abscesses ripe and ripening . Maturing abscesses are abscesses that are at the stage of fixation and localization of the pathogen, and mature abscesses are at the stage of removing the stimulus.

Patogenesis and clinical signs

As you already know from the pathogenesis of surgical infection, the first stage of the first phase is the stage of fixation of the pathogen. At the site of pathogen penetration, serous-fibrinous or fibrinous inflammation appears with all the signs - swelling, increased local temperature, redness, pain and dysfunction. All these signs are clearly expressed in skin and subcutaneous abscesses and are smoothed out in the case of deep abscesses, in which slight swelling may develop from raising the muscle, but an increase in local temperature and redness will not be observed. The presence of a deep abscess can be assumed by severe pain on palpation over the site of inflammation, by dysfunction and by a disturbance in the general condition (increased temperature, pulse rate and respiration).

In the first stage, it is difficult to distinguish aseptic inflammation from septic inflammation. In cold abscesses of any etiology, in the first stage, inflammatory abscesses are either not expressed at all (with a septic abscess) or weakly expressed (with abscesses caused by a specific infection).

In the second stage of septic inflammation - the stage of abscess development in skin and subcutaneous abscesses, a spherical swelling appears, hot and painful. When palpating the swelling, fluctuation is noted. A demorcification shaft is palpated around the abscess. With deep abscesses, fluctuation is rarely palpated, but a feeling of oscillation is possible.

At the stage of removal of the irritant in superficial abscesses, the swelling, as a rule, has the temperature of the surrounding tissues, is not painful, and fluctuation is well expressed. In the focus of greatest tension, one or more softening spots appear, which after some time ulcerate and pus pours out.

With deep abscesses, this stage is characterized by a decrease in pain above the abscess. Deep abscesses, as a rule, open into the intermuscular space, into the cavity, which can cause a deterioration in the general condition.

At the stage of a mature abscess, temperature, pulse, and respiration are within the physiological norm.

With gas or anaerobic abscesses, which occur quite often in cattle, high body temperature, depression, weak development of the demortification shaft and rapid development of the process are noted. On palpation, very strong tissue tension and crepitus are noted. Upon opening, the exudate is bloody with gas bubbles.

Diagnostics

Diagnosis of superficial abscesses is not difficult. The diagnosis is made according to clinical signs depending on the stage of septic inflammation. The diagnosis is clarified by puncture (pus is used as puncture). For deep abscesses, puncture is the main diagnostic method. Hematological examination is also carried out.

It is necessary to differentiate abscesses from phlegmon, hematoma, lymphatic extravasation, neoplasm, hernia. With phlegmon, diffuse swelling without a deformation shaft is noted. A hematoma develops very quickly, immediately after injury, and an abscess forms within a few days. Lymphatic extravasation and neoplasms develop slowly and are not accompanied by inflammatory phenomena. With hernias, there is a hernial ring, and when the swelling is auscultated, peristaltic sounds of the intestines are heard.

When treating animals with abscesses, treatment should be appropriate to the stage of the abscess. In the first stage, before suppuration appears, it is necessary to direct treatment to neutralize the pathogen. At this stage apply:

Novocaine blockade with antibiotics (based on the principle of a short novocaine block)

Sulfonamide drugs

General antibiotic therapy

Light warmth. But heat is used very carefully and only until suppuration appears or until there is a sharp increase in temperature, pulse, and respiration. It is not recommended to use heat at all for deep abscesses, as it may open into the internal environment of the body and develop sepsis.

Ultraviolet irradiation in erythemal doses

Monochromatic laser radiation. After using 1-2 sessions of laser irradiation, relief and even resorption of the resulting abscess occurs.

With the appearance of suppuration, pus is removed from the abscess cavity as early as possible so that the demarcation shaft does not reabsorb and phlegmon or sepsis does not develop. This is especially true for deep abscesses. Those. it is necessary to follow the rules of ancient doctors: “Ubi pus, ibi evacvia citissime”: - where there is pus, remove it quickly. There are different ways to remove pus from abscesses.

For large superficial abscesses, it is recommended to first make a puncture using a needle with a rubber tube and aspirate some of the pus. After this, the abscess is opened with a wide incision, without affecting the demarcation shaft. The abscess cavity is washed with antiseptic liquids, preferably oxidizing ones - these are 3% solutions of hydrogen peroxide, solutions of potassium permanganate or sodium hypochlorite in a concentration of over 1000 ng/l. You can use drugs of the nitrofuran series - in particular furatsilin 1:5000, etocridine lactate 1:500 (1000). Subsequently, the abscess cavity is powdered with antibiotics or other bacteriostatic powders. You can insert loose drainage with hypertonic salt solutions or Vishnevsky ointment into the abscess cavity

From small abscesses, pus can be aspirated, the cavity can be washed with antiseptic solutions, and novocaine with antibiotics can be injected inside. As a result, resorption of the abscess wall may occur, but this is extremely rare.

For superficial encapsulated abscesses. if they are located in the operable area, then they can be removed and stitches placed on the wound. Extirpation must be carried out very carefully, since the abscess capsule varies in thickness and can be torn.

abscess treatment diagnosis phlegmon sepsis

For malignant abscesses, they are opened, dead tissue is partially excised, and prolonged rinsing with antiseptics is used. To enhance the rejection of dead tissue, enzymes are used by soaking the drains - trypsin, fibrinolysin, procel. You can treat the inner surface of the abscess with a defocused beam of a high-energy laser.

Phlegmon

PHLEGMON ( Phlegmona )-- This is a diffuse, spreading, acute purulent, less often putrefactive, inflammation of loose tissue with a predominance of necrotic processes rather than suppurative ones.

You see, already in the definition there is a very big difference between an abscess and phlegmon. In the first case it is limited, in the second it is diffuse inflammation.

Classification

According to the etiology, phlegmon is divided into:

aerobic putrid

anaerobic mixed

In addition, there may be aseptic phlegmon, which is caused by the introduction under the skin of acutely irritating substances, in particular calcium chloride, chloral hydrate, turpentine. There are also primary and secondary e phlegmon.

Primary ones occur after injuries, after injections of medicinal substances without maintaining the sterility of the instrument. Secondary phlegmon develops as a complication of a localized, acute infection (boil, abscess, ostiomyelitis, etc.), and can also occur metastatically and as a result of a dormant infection.

According to the nature of the exudate, phlegmons are:

serous - with purulent infection

gas - for anaerobic infection

purulent-putrefactive.

According to the distribution of phlegmon there are:

delimited

progressive

According to localization, phlegmon is divided into:

subcutaneous

submucosal

intermuscular

subfascial

pararectal

perichondrial

paraarticular

pararenal

Pathogenesis and clinical picture

The development of phlegmon occurs according to the general pattern of development of septic inflammation.

To the first stage Phase I involves diffuse impregnation of tissues with serous exudate. Connective tissue is especially saturated. The exudate is first transparent and then cloudy, as a large number of leukocytes appear in its composition. At this stage, a diffuse swelling is noted, which has an unclear configuration, its borders are uneven, and in the form of protrusions. There is severe pain and tissue tension. The general condition is depressed, high body temperature, especially with anaerobic phlegmon.

To the second stage- the stage of localization in many places of aerobic swelling, which becomes very dense, foci of suppuration and progressive tissue necrosis are formed. A demarcation barrier is formed along the periphery. The general condition is even more depressed. The temperature is very high and breathing is rapid. Hyperleukocytosis in the blood.

In the case of anaerobic or gas phlegmon, due to the formation of gases, the central part of the swelling becomes cold, painful, and gas sensation is felt on palpation. When there is a wound or incision, a liquid, unpleasant-smelling, foaming exudate is released. There is no demarcation shaft. If a putrefactive infection is mixed with an anaerobic infection, then the exudate has a fetid odor and contains a lot of tissue fragments.

During the stage of removal of the irritant during aerobic phlegmon, abscesses form. With a large area of phlegmon, there may be several abscesses. The skin in these places becomes thinner, and pus breaks out or into the body cavity. The general condition is improving somewhat.

With spreading phlegmon, as well as gas, there is no pus. Edema tissues - loose connective tissue and muscles - become necrotic. The muscle tissue turns into a brownish-red mass with an unpleasant odor. The skin also undergoes necrosis.

The diagnosis of phlegmon is made on the basis of clinical signs, hematological examination and puncture results.

The prognosis for serous, subcutaneous purulent and submucosal purulent cases is favorable with appropriate treatment. With deep purulent phlegmons, spreading purulent, gas and putrefactive ones, it is often unfavorable, less often cautious. Because sepsis is possible.

Treatment. In the first stage, for serous and purulent phlegmon, the same treatment is used as for abscesses. The only difference is that if it is impossible to make a short novocaine blockade with extensive phlegmon, novocaine is administered intravenously.

At the same stage, with high tissue tension, skin incisions are made to reduce interstitial pressure.

In the second and third stages, as soon as foci of abscess formation appear, they are opened. The cuts should be multiple, not very wide, but deep enough.

If the affected area is large, the incisions should be placed in a checkerboard pattern or parallel to each other - the so-called “lamp incisions”. Dead tissue is removed, leaks are eliminated, and counter-opening holes are made. Local antimicrobial therapy is then applied, as for abscesses. At the first appearance of signs of anaerobic and putrefactive phlegmon, they are immediately opened. Since anaerobes are highly virulent, phlegmon is opened in a separate room and with personal hygiene. An autopsy is performed until healthy tissue appears - before signs of bleeding appear. This is necessary for oxygen access. You can use oxygen injection under the skin in the affected area and into the muscles, as well as around the phlegmon.

In addition to local treatment, intensive general therapy is used:

antibiotic therapy 20-30 thousand units per kg of live weight

intravenous alcohol injection

antitoxic substances (urotropine, caffeine, calcium chloride)

means that increase the body's resistance: prodiglosan, T-activin, pyrogenal, auto- and heterohemotherapy, blood irradiation with ultraviolet rays 1 mg/kg of live weight.

Sepsis or general infection

There are many definitions of sepsis, but all of them are not entirely successful, since they do not reflect all the processes occurring in the body. (In translation, sepsis means “blood poisoning”)

Currently, the following definition is mainly used: sepsis is a difficult-to-reversible infectious-toxic process, accompanied by profound neuro-dystrophic changes and a sharp deterioration of all body functions resulting from the penetration of the pathogen and the absorption of toxins from the primary infectious focus. Sepsis often leads to the death of the animal.

Etiology. As can be seen from the definition, in order for sepsis to occur, a focus of surgical infection or a septic focus is necessary. Sometimes there may not be a visible septic focus. This means that sepsis arose due to the focus of a dormant infection. This type of sepsis is cryptogenic. They can be purulent wounds, malignant abscesses, phlegmons, boils, carbuncles with a large amount of soft tissue, the presence of pockets and drainages.

Mandatory for the occurrence of sepsis is a strong pathogenic microorganism and a sharp decrease in the resistance of the animal organism.

No specific causative agent of sepsis has been identified. Sepsis can be caused by various representatives of anaerobic, aerobic and putrefactive infections. Most often in sepsis, hemolytic and non-hemolytic streptococcus, Staphylococcus aureus, Escherichia coli and various anaerobes are found. It should be noted that the detection of a pathogen in the blood does not indicate sepsis; it can also be present with a local surgical infection. Conversely, bacteremia is often not detected in sepsis.

Pathogenesis of sepsis

Microorganisms that enter the blood, microbial toxins and cellular decay products absorbed into the blood are a strong irritant to the nervous system, which leads to its degenerative changes. As a result of neuro-dystrophic changes, as well as severe intoxication of the body, they cause metabolic disorders - acidosis develops, and the amount of gamma globulins in protein metabolism, the main component of nonspecific humoral immunity, decreases. The content of vitamin C in the body decreases, which reduces the antitoxic function of the liver. Liver degeneration and atrophy may occur. Hematopoiesis is disrupted. In sepsis, as a result of decay products and bacteria entering the vascular bed, sensitization of the body occurs. Blood circulation is disrupted, peripheral vessels become overfilled with blood, which means blood pressure drops. So-called septic bleeding, hemorrhages, thrombosis, phlebitis, and inflammation of the lymphatic vessels may occur.

Circulatory disorders lead to disruption of the secretory and motor functions of the gastrointestinal tract. All this leads to exhaustion, muscle atrophy, and degeneration of parenchymal organs. Animals lie dormant and bedsores appear. If treatment is not provided, animals die.

Classification of sepsis

By the nature of the pathogen

aerobic

anaerobic

putrefactive

mixed

Based on the location of the primary septic focus, sepsis is divided into:

arthrogenic (primary focus in skstavs)

osteogenic

odontogenic (for dental caries)

pyogenic (furuncle, carbuncle, abscess, phlegmon)

ungulatory (for purulent-necrotic lesions of the hooves)

gangrenous

peritoneal (due to purulent peritonitis)

gynecological, urogenic, oral, cryptogenic.

Based on the clinical picture and pathological changes, sepsis is divided into:

pyemia - or general purulent infection with metastases;

septicemia or general purulent infection without metastases;

and septic-pyemia - a mixed form of sepsis.

In the course of sepsis, it can be lightning fast - the death of the animal occurs on the first day; acute, subacute and chronic. Some authors distinguish: chronic sepsis into a separate clinical form of sepsis - chroniosepsis.

Let us now consider the main forms of sepsis.

Pyemia ( Piaemia ) - or general purulent infection with metastases. With this form of bacterioemia in the blood - pus. This is the mildest form of sepsis. With it, the body still has protective reserve forces and tries to localize the infection in various organs in the form of abscesses.

Pyaemia most often occurs in cattle and small ruminants, dogs, pigs, and less commonly in horses. Sepsis with metastases in cattle often occurs with open bone fractures, with infections associated with heavy work, with traumatic pericarditis and endometritis.

In horses when washed and wounded. In pigs, sepsis with metastases can occur after castration, in dogs after open fractures, crushing of soft tissues.

Metastasis or spread of infection to other organs and tissues in cattle and pigs usually occurs through the lymphatic route. Microbes settle in tissues where there is slow blood flow - skin, joints, internal organs.

Clinical signs

Changes in the septic focus (abscess, phlegmon) represent a picture of a progressive infection. There are grooves and pockets, and a lot of dead tissue. Local foci of infection spread into deeper tissues. For example, if the phlegmon is subcutaneous, then it turns into interfascial, then intermuscular.

Characteristic changes are noted in the general condition of the body. It is the hardest. The animal lies down and refuses food. Breathing is rapid, pulse is small and frequent. High body temperature. It takes on the appearance of relapsing fever. In the evening the temperature rises above 40 C, and in the morning it may drop to normal. A sharp rise in temperature is preceded by trembling, and a drop is preceded by sweating of the animal. Fever can also be of an intermittent type - the temperature can be normal for 2-3 days. This suggests that at this time toxins and microbes do not penetrate the blood. Each new attack of fever and muscle tremors indicates the entry of new portions of microbes and their toxins into the blood. If there is continuous absorption from metastatic foci, a constant type of fever is observed with daily fluctuations of 1C. When the body's defenses are depleted, a perverted type of fever is possible - the temperature is within normal limits, but the blood pressure is low and the pulse is increased.

A sharp downward drop in the temperature curve with a simultaneous rise in the pulse curve is a reliable sign of approaching death, therefore the crossing of these curves is called the death cross (crux mortis).

There is hyperleukocytosis in the blood, a shift of the leukogram to the left. the number of eosinophils and monocytes decreases. Young forms of leukocytes appear. The number of red blood cells decreases.

The mucous membranes, as a rule, are jaundiced, as liver function is impaired and hemolytic processes occur.

With metastases in the intestines, profuse diarrhea may occur.

The presence of convulsions and paralysis indicates metastases in the nervous tissue, and the appearance of signs of bronchopneumonia indicates metastases in the lungs.

Septicemia or general purulent infection without metastases. Sometimes it is called rotten blood.

With septicemia, as a rule, microbes are not detected in the blood. There is a general poisoning of the body with waste products of microorganisms and toxic substances formed as a result of tissue breakdown. With this form of sepsis, the body's defenses are completely suppressed.

Septicemia is observed with penetrating wounds of the abdominal wall, postpartum infection, septic peritonitis, with purulent putrefactive and purulent arthritis, deep intermuscular phlegmon.

Clinical signs. First of all, a serious general condition - the animal lies down, refuses food and quickly loses weight.

Fever of a constant type. The high temperature persists throughout the illness and can only decrease before death.

the pulse is greatly accelerated, thread-like and may not be palpable with a fatal outcome, the heart beat is pounding.

The limbs are cold due to impaired peripheral circulation.

The skin becomes dry, its elasticity disappears, skin folds straighten slowly. The mucous membrane of the eyes is brick-red due to multiple hemorrhages, or dirty yellow due to the high content of bilirubin in the blood.

General weakness and shortness of breath are pronounced. Bedsores appear early.

In animals, symptoms of intoxication of the central nervous system quickly increase - anxiety appears, in dogs - aggressiveness, animals can eat food that is not typical for them. Then comes deep depression.

In the blood, unlike sepsis with metastases, there is no leukocytosis. This indicates the complete suppression of all resistance of the body. At the same time, a sharp neutrophil shift to the left is observed in the leukogram. The number of red blood cells decreases sharply, hemoglobin drops, because toxic hemolysis occurs. Eosinophils and monocytes completely disappear. The content of Y-globulins in the blood drops sharply, and the content of bilirubin increases. In the primary septic focus there is purulent-necrotic, putrefactive or gangrenous tissue breakdown.

The prognosis for septicemia is unfavorable. In the fulminant form the animal dies in 1-2 days, in the acute form - in 5-7. Death occurs when the temperature drops or, conversely, when the temperature rises excessively.

Septicopyemia - a mixed form of sepsis is characterized by the formation of metastases and severe intoxication. The clinical picture shows signs of both pyaemia and septicemia.

Treatment for sepsis. It is a very difficult matter, but necessary. In case of sepsis, the doctor is put in a hopeless position - he must treat the animal, because forced cutting is excluded. Meat is not suitable for human or even animal consumption.

Treatment for sepsis should be comprehensive: general and local if there is a septic focus. In this case, all types of treatment should begin simultaneously and as early as possible.

Local treatment is carried out in the same way as for local surgical infection, trying to use the strongest antimicrobial drugs. Sometimes, in order to save an animal, it is necessary to amputate parts of the body with a septic focus (a finger in cattle and pigs, a limb in dogs and cats)

General treatment should pursue the following goals: suppression of the vital activity of microorganisms (antimicrobial therapy), neutralization and removal of toxins from the body, increasing the body's resistance.

Antimicrobial therapy includes:

The use of antibiotics, both intramuscularly and intravenously. For sepsis, antibiotics of the penicillin, gentomycin, polymyxin, and erythromycin group are recommended.

The use of sulfonamide drugs - norsulfozole and nitrofurans.

Intravenous administration of 33-40% alcohol.

Among the means that relieve intoxication of the body and accelerate the introduction of toxins, the following can be used:

IV administration of fluids that reduce intoxication: - polydesis, hemodesis, polyhemodesis in a 30% concentration per 300-500 ml IV.

The use of agents that enhance the removal of toxins from the body - in particular hexamethylenetetraamine or methenamine intravenously at a 40% concentration, 50-60 ml per animal.

Therapy aimed at increasing the body's defenses (or resistance)

Providing rest and nutritious food. Eliminate concentrates from the diet and introduce easily digestible foods rich in carbohydrates and vitamins.

2. IV administration of glucose to increase the antitoxic function of the liver in standard doses. It is better to combine the administration of glucose with the administration of calcium chloride in a dose of 150-200 ml to large animals. Calcium normalizes the ratio of potassium and calcium, has an antitoxic and antihistamine effect.

Vitamin therapy. Particularly indicated is the intravenous administration of 5% ascorbic acid in a dose of 200-300 ml, and the intramuscular administration of B vitamins.

Horses are indicated for fluid administration according to Kadykov.

camphor 4.0

ethyl alcohol 200.0

glucose 120.0

isotonic NaCL solution 700 ml

200 ml is administered intravenously daily:

Transfusion of compatible blood gives good results. It reduces intoxication, reduces anemia, activates the immune system and hematopoiesis.

Currently, in the clinic we widely use ultraviolet and laser irradiation of blood in doses of 1 ml per kg of live weight.

To combat dehydration of the body, the administration of an isotonic NaCL solution and plasma substitutes (polyglucin) are used.

In order to relieve sensitization and overstimulation of the nervous system, 0.25-0.5% novocaine is used intravenously.

Symptomatic treatment is prescribed according to the manifestation of symptoms characterizing damage to a particular organ.

Purulent-resistant fever (PRF)

This can be said to be a preseptic condition, but it differs from sepsis.

Purulent-resistent fever develops as a result of the absorption of microbial toxins and tissue decay products. As a result, the body temperature steadily rises, the pulse and breathing become more frequent. But unlike sepsis, there are no functional changes in the leukogram. Sometimes there may be a neutrophil shift to the left, but monocytes and eosinophils do not disappear. If the septic focus is eliminated, then the GRL disappears. If left, sepsis develops.

Aseptic resistive fever should be distinguished from RHF. It occurs as a result of closed injuries without the intervention of infection. And it is the result of the absorption of cell decay products as a result of death under the influence of a traumatic factor. Body temperature rises, but pulse and breathing are within normal limits.