Jose Alfonso Z Pabelico, MD

 Pulmonary parenchymal necrosis and cavitation

resulting from infection
 Predisposing conditions:
 Aspiration- most common
 Esophageal dysmotility, seizures, other neurologic conditions
causing bulbar dysfunction
 Periodontal diseases
 Alcoholism
 Microbiology:
 Anaerobic bacteria – most common
 Aerobic bacteria (S. aureus, Klebsiella pneumoniae,
Nocardia sp., & gram-negative bacteria)
 Nonbacterial pathogens ( fungi & parasites)
 Multiple isolates
 Clinical Manifestations:
 Symptoms (nonspecific)
 cough, purulent sputum production, pleuritic chest pain,
fever and hemoptysis
 Acute presentation- aerobic infection
 Indolent presentation- anaerobic infection
 Signs (nonspecific)
 rales, consolidation, fetid breath & poor dentition
 Clinical Manifestations:
 Chest Xray and CT scan:
 One or two thick-walled cavities in dependent areas of the
lung (upper lobes and posterior segments of lower lobes)
 Air-fluid level
 Malignancy -> cavitary lesions in nondependent regions
(RML or anterior segments of the upper lobes)
 Laboratory studies:
 Leukocytosis, anemia and elevated ESR
 Diagnosis:
 Diagnosis based on clinical symptoms, identification of
predisposing conditions and CXR findings
 Ddx: TB, malignancy, infected bullae
 Identification of causative organism
 Anaerobic bacteria -> difficult to isolate

 Blood, sputum and pleural fluid cultures

 Bronchoscopy with BAL/brush -> controversial (risk for

rupture)
 Bronchoscopy w/o BAL/brush -> to identify bronchial
obstruction, malignancy, TB
 Trantracheal/ tranthoracic aspiration-> less common
 Treatment:
 Antibiotic treatment
 Choice
 Clindamycin 150-300mg q 6hrs -> standard

 Carbapenems & B-lactam/B-lactamase inhibitor combinations

 4-6 weeks of antibiotic treatment

 Treatment failure -> noninfectious etiology
 Surgery -> limited role
 Indications: refractory hemoptysis, inadequate response to
medical therapy and need for tissue diagnosis
 Outcome:
 Favorable- > 90-95% cure rate -> anaerobic infection
 Less favorable -> immunocompromised patient, w/
comorbidities and infections w/ P. aeruginosa, S. aureus, K.
pneumoniae