The Enigma of Recurrent Lung Abscess: Management and Outcomes in a School-Aged Child With a Review of Literature.
| Autor: | Bhende VV; Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND., Thacker JP; Pediatrics, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND., Mehta DV; Radiodiagnosis and Imaging, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND., Krishnakumar M; Anesthesiology, St. John's Medical College Hospital, Bengaluru, IND., Khara BN; Anesthesiology, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2024 Jul 01; Vol. 16 (7), pp. e63579. Date of Electronic Publication: 2024 Jul 01 (Print Publication: 2024). |
| DOI: | 10.7759/cureus.63579 |
| Abstrakt: | Pediatric lung abscess is a rare and poorly studied disease entity. In the past, prolonged courses of intravenous (IV) antibiotics have been successfully used; however, with the advent of interventional radiology, the main therapeutic approach is through percutaneous placement of pigtail catheters with ultrasound and computed tomography (CT) direction, where available. The pathogen yield identified from fluid samples of the abscess has dramatically increased owing to the greater invasive measures, such as aspiration and drainage, as well as enhanced microbiological diagnostic methods, which also include polymerase chain reaction testing. In our case report, in 2012 when the patient was two years old, she was diagnosed with pulmonary Koch's and underwent anti-Koch's therapy, category 2. High-resolution CT of the chest revealed a large lobulated cavitary lesion with an air-fluid level suggestive of a right lung abscess. After initial therapy with IV antibiotics for three weeks and a negative tuberculosis work-up, she underwent right limited lateral thoracotomy and drainage with decortication of the right lung abscess (LA) in 2019 via a left endobronchial tube with a bronchial blocker (general endobronchial anesthesia). All samples sent for histopathologic examination after surgery yielded negative results, and she was discharged after a course of injectable antibiotics for 21 days. She remained almost symptom-free for the next four years. Thereafter, she presented with a right LA recurrence due to a thick-walled cavitary lesion, with a severely damaged right lower lung lobe resulting in right lower lobectomy under single-lung ventilation (double-lumen endotracheal tube No. 26 Fr.). Culture results should guide management, particularly for immunocompromised patients, as the LA may be attributed to complications arising from underlying conditions. Primary lung abscesses (PLA) in children are typically caused by Staphylococcus aureus, Streptococcal species, and Klebsiella pneumoniae . Compared to adults, children with PLA and secondary lung abscesses have a meaningfully greater rate of recovery. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee (IEC), H. M. Patel Centre for Medical Care and Education issued approval IEC/BU/2023/Cr.21/135/2023. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Bhende et al.) |
| Databáze: | MEDLINE |
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