Lung abscess literally means a collection of pus within a de-stroyed portion of the lung; thus there are numerous possible causes of such a lesion (Table 6). As uscd cliniclly, however, the term "lung abscess" refers to a pulmonary infection with parenchymal necrosis, generally caused by bacteria other than mycobacteria. Lung abscesses are usually solitary, but occasionally multiple dis-crete lesions are observed. Numerous small abscesses confined to a given region of the lung are sometimes referred to as "necrotizing pneumonia. "Because they share a common pathogenesis, there is considerable overlap among aspiration pneumonia, lung abscess, and necrotizing pneumonia, and each of these may lead to and coexist with an empyema(a collection of pus within the pleural space).
Etioloay As indicated in the following Table, many different underlying processes can lead to the formation of a lung abscess. By far the most important are necrotizing pulmonary infections, and of these, anaerobic bacteria are responsible for the majority. These or-ganisms account for essentially all "putrid" lung abscesses and nearly all that have been classified as "nonspecific" or "primary". Most of these infections involve multiple bacterial species, which may in-dude aerobic organisms , The dominant bacteria are Fusobacterium nucleatum, Bacteroides melaninogenicus, B. intermedius, pep-tostreptococcus, aerobic streptococci, and microaerophilic strepto-cocci.
Pneumonia, particularly cases caused by Staphylococcus aureus and Klebsiella pneumoniae, may also be complicated by abscess formation. Less frequent but well-documented agents of lung abscess include Streptococcus pyogenes(group A beta-hemolytic streptococci), Streptococcus pneumoniae (especially type 3), Streptococcus milleri, Haemophilus influenzae (type B),Pseudo-monas aeruginosa, Pseudomonas pseudomallei(me-lioidosis), Ac-tinomyces (actinomycosis), Legionella, Nocar-dia, Paragonimus Westermani (lung fluke), and Entamoeba histolytica (amebiasis), Enteric gram-negative bacilli other than K. pneumoniae may cause lung abscess, but this occurs almost exclusively in debilitated patients with severe associated medical-surgical conditions. Necrotizing alveolitis is a separate entity diagnosed by micro-scopic examination and usually caused by P. aeruginosa; sometimes these microabscesses coa-lesce to form radiographically detectable cavities.
Differentiation and Treatiment of Common Syndromes in Traditional Chinese Medicne
1. The Primary Stage:
Clinical manifestations: Chills, fever, cough, chest pain, small amount of mucous sputum, disturbance of breath, thin and yellowish coating of the tongue, floating and rapid pulse.
Therapeutic method : Clearing away and dispelling lungheat and removing toxic substances from the lung.
Recipe: Modified Powder of Lonicera and Forsythia.
Ingredients :
Flos Lonicerae 15g
Fructus Forsythiae 15g
Folium Isatidis 12g
Radix Scutellariae 30g
Herba Taraxaci 10g
Herba Menthae 30g
Herba Houttuyniae 10g
Bulbus Fritillariae Cirrhosae 10g
Radix Platycodi 30g
Administration: All the above drugs are to be decocted in water for oral administration.
Modification: In case of chest pain, add Fructus Tri-chosanthis 20g, Radix Curcumae 12g.
