Pediatric lung abscess

　　1, Etiology

　　The etiology of this disease is most commonly caused by Staphylococcus aureus and anaerobic bacteria, followed by Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and others. The latter often occur in mixed infections with anaerobic bacteria.

　　2, Pathogenesis

　　Lung abscess is often secondary to pneumonia, followed by sepsis, and a few cases may be caused by suppurative foci of adjacent tissues, such as liver abscess, subdiaphragmatic abscess, or empyema spreading to the lungs. Airway foreign bodies secondary to infection, bacterial contamination of secretions, vomit, which is sometimes aspirated into the lower respiratory tract under certain conditions, and infections caused by lung flukes, ascaris, and amebae in the pleural cavity. Inhalation lung abscess is more common in older children, while blood源性 lung abscess and secondary lung abscess are more common in infants and young children.

　　Empyema and bronchopleural fistula.

　　1, Empyema

　　It refers to the pleural cavity being invaded by pathogenic bacteria, causing infection and pus. From neonates to the elderly, it can occur at any age. Empyema is often caused by pyogenic bacteria. Most empyemas are secondary to pulmonary infection.

　　2, Bronchus and pleura

　　Abnormal channels formed. It can be caused by various reasons, such as tuberculous empyema, lobar pneumonia, lung abscess, and postoperative infection, etc. Its formation is due to the pus of chronic empyema corroding the adjacent lung tissue and piercing the bronchus, or due to the direct invasion of the pleural cavity by the focus inside the lung or the rupture into the pleural cavity to form a fistula. There is also the infection caused by pleural puncture or surgical resection of the abscess cavity.

　　The onset is acute, with fever without a fixed pattern, persistent or remitting high fever, which may be accompanied by chills, coughing can be paroxysmal, sometimes there is an increase in respiratory rate or dyspnea, chest pain or abdominal pain, common night sweats, fatigue, weight loss. Infants and young children often have vomiting and diarrhea. If the abscess communicates with the respiratory tract, coughing up foul-smelling sputum, it is related to anaerobic bacterial infection, and it may cough up blood-stained sputum, even massive hemoptysis. If the abscess ruptures and communicates with the pleural cavity, it becomes empyema and bronchopleural fistula. Symptoms may be relieved with the excretion of a large amount of sputum. Generally, the ipsilateral chest wall movement is weakened, percussion sounds are dull, respiratory sounds are reduced. If the abscess cavity is large and communicates with the bronchus, local percussion may sound like a resonant jar, and tubular respiratory sounds or moist rales may be heard. The voice conduction is enhanced. Severe cases may have dyspnea and cyanosis. Chronic cases may have clubbing (of fingers or toes).

　　Acute pneumonia and sepsis should be treated promptly and thoroughly. Actively control infection, maintain unobstructed airways, correct hypoxia, prevent complications, enhance the body's resistance to promote recovery. If there is a foreign body in the respiratory tract, it must be removed quickly. During the process of tonsillectomy and other oral surgeries, it should be avoided to allow tissue to be aspirated into the lungs. To maintain unobstructed airways, it is necessary to promptly remove nasal crusts, nasal secretions, and respiratory tract sputum. Improve ventilation function, increase alveolar ventilation volume, correct hypoxia, and reduce CO2 retention.

　　1. Acute stage

　　The total white blood cell count is as high as (20～30)×10^9/L or higher, with an increase in neutrophils and left shift of the nucleus; in the chronic stage, the white blood cell count is close to normal, and anemia can be seen.

　　2. Pathogenic examination

　　Culturing the pathogen can be obtained from sputum or tracheal aspirate secretions, and Gram staining of sputum smears can find pathogenic bacteria. Routine culture of sputum can find pathogenic bacteria. Since this disease is mostly mixed infection with anaerobic bacteria as the main pathogen, if it is suspected to be the disease, anaerobic bacterial culture should be done at the same time.

　　3. Sputum microscopic examination

　　Sputum can be as much as several hundred milliliters, and under microscopic examination, elastic fibers can be seen, proving the destruction of lung tissue.

　　4. X-ray examination

　　In the early stage, only inflammatory infiltration shadows can be seen, and the formation of abscesses shows dense shadow masses. If it communicates with the bronchus, a liquid level can be seen inside, surrounded by inflammatory infiltration shadows. The wall of chronic lung abscesses becomes thick, surrounded by dense fibrous strands, which may be accompanied by bronchial dilation, pleural thickening, and multiple mass-like dense shadows in both lungs for hemogenic lung abscess.

　　5. Ultrasound and CT examination

　　Can assist in distinguishing between lung abscess and empyema.

　　1. 100 grams of fresh reed root, 90 grams of winter melon seeds, decocted to make a decoction, drink as tea, once a day. This recipe has the effects of clearing the lung and resolving phlegm, and promoting diuresis and expelling pus.

　　2. 250 grams of frog, 500 grams of pumpkin, 60 grams of garlic, and 15 grams of scallions. After the frog is peeled and the internal organs are removed, wash and cut into pieces. Clean and peel the garlic, wash and cut the pumpkin into pieces, and put them all into a pot of boiling water. Boil over high heat and then simmer over low heat for 30 minutes, add scallion pieces for seasoning, and it is ready. This recipe has the effects of expelling pus, resolving phlegm, clearing heat, and detoxifying.

　　3. 250 grams of lean beef cut into pieces, 25 grams of ginger, 600 milliliters of water, stewed until 80% done. Add 500 grams of pumpkin peeled and cut into pieces to the beef soup and stew together. Season with salt, monosodium glutamate, and take in several doses.

　　4. 6 grams of nori, ground into powder, soaked in boiling water, and mixed with an appropriate amount of honey for drinking, twice a day. Suitable for lung abscess, cough, and expectoration of foul sputum.

　　5. 50 grams of fragrant melon seeds, crushed and finely ground, mixed with an appropriate amount of sugar, and taken with warm water. Suitable for lung abscess and intestinal abscess.

　　Dietary taboos for pediatric lung abscess:

　　1. It is recommended to have light and plain food, eat more fresh vegetables, beans, and fruits, such as spinach, green vegetables, chive, radish, soybeans, tofu, oranges, loquat, pear, and walnuts.

　　2. It is recommended to frequently consume pork lung soup, Job's tears porridge, reed root or mugwort root tea, which have the effects of nourishing the body with the form, expelling pus, and clearing heat.

　　3. Avoid all spicy and stimulating foods such as scallions, garlic, chives, peppers, and ginger.

　　4. Avoid smoking and drinking.

　　5. Avoid seafood and other stimulants such as sea fish, shrimps, crabs, etc.

　　6. Avoid greasy and hot foods to prevent phlegm and fire.

　　7. Avoid overly salty foods.

　　1. Treatment

　　1. General Therapy

　　Pay attention to rest and nutrition, and strengthen supportive therapy. Symptomatic therapy includes oxygen supply, expectoration, and positional drainage.

　　2. Antibiotic Therapy

　　It mainly relies on antibiotic treatment, and penicillin 100,000U/(kg·d) can be used in the early stage, with a course of 4 to 6 weeks. For those allergic to penicillin or ineffective, sensitive antibiotics can be selected according to sputum bacterial culture and sensitivity test, such as cephalosporins, vancomycin, and imipenem/cilastatin sodium (Tieneng) for treatment. In addition to systemic medication, antibiotics can also be used for nebulization inhalation or instillation into the trachea to achieve a higher drug concentration in the pus cavity. The course of treatment is determined by the speed of abscess absorption, the degree of abscess, and the severity of clinical manifestations, usually 3 to 4 weeks.

　　3. Traditional Chinese Medicine Therapy

　　Traditional Chinese medicine refers to this disease as lung abscess, which is mostly heat and fullness in the early stage. In various parts of the country, it is common to use traditional herbal formulas such as Qianjin Wei Jin Decoction and Jiegeng Decoction, supplemented with heat-clearing and detoxifying herbs like Huxingcao, Dazhengye, Yinhua, Lianqiao, and Huangqin, as well as herbs for promoting blood circulation and removing blood stasis such as Danggui and Chishao, with certain efficacy. From 1969 to 1979, Lu Shuliang and others from the Department of Traditional Chinese Medicine at Beijing Children's Hospital conducted a treatment on 61 children with lung abscess using only oral herbal formulas for heat-clearing, detoxifying, promoting blood circulation, removing blood stasis, and draining pus and reducing swelling, such as the脓疡散 (Pus Ulcer Powder) (of whom 54 had previously been treated with antibiotics). The duration of the disease at admission was mostly between 6 to 30 days, with ages ranging from 5 months to 14 years. Of the 43 cases with body temperature above 38℃, accounting for 70.5%, 22 cases had temperatures above 39.5℃, showing remittent fever, with some patients also showing other symptoms of infection and poisoning. X-ray examination showed typical changes of lung abscess, with 9 cases being multiple lung abscesses, 8 cases with a pus cavity diameter of more than 3cm, and the largest pus cavity with a diameter of 14cm. More than half of the cases recovered from fever within 10 days after taking the medicine, and 80% of the cases showed the beginning of absorption of pulmonary lesions within 20 days. At the time of discharge, 23 cases were cured, with a cure rate of 37.7%. The standard for cure was the complete disappearance of all clinical symptoms, complete absorption of X-ray pulmonary lesions, and only fibrous cord shadows remaining. The remaining 38 cases, except for a few with low fever, had no clinical symptoms; the pulmonary inflammatory lesions on X-ray films showed significant absorption, only with hollow spaces not closed. The average hospitalization days for the 61 cases were 23.8 days. Among the 41 cases followed up for half a year to 9 years after discharge, none had recurrence and no chronic pulmonary diseases were left behind. Pharmacological and pharmacological chemical studies also prove that Pus Ulcer Powder has anti-inflammatory, expectorant, and enhancing phagocytic function, as well as dilating microvessels. The Pus Ulcer Powder prescription: Qingdai 3g, Zicao 9g, Ru Xiang 6g, Ya Zao 6g, Han Shui Shi 9g. This formula can be decocted into a decoction, with a dose of 30ml per time for children under 1 year old, 3 times a day; 40ml per time for children aged 1 to 3 years, 3 times a day; 60ml per time for children aged 3 to 7 years, 3 times a day; 100ml per time for children aged 7 to 14 years, 2 times a day; or directly taken as a powder, with an oral dose of 3g per time for children aged 1 to 3 years, 2 times a day; 3g per time for children aged 3 to 7 years, 3 times a day; 4.5g per time for children aged 7 to 14 years, 3 times a day. The course of treatment is 1 month, and the efficacy of both is similar. During the process of traditional Chinese medicine treatment, it should be avoided to puncture the pus cavity to prevent the spread of infection caused by puncture.

　　4. Surgical Treatment

　　Most cases do not require surgery. For chronic lung abscesses, there is a large amount of fibrous tissue proliferation, and there are complications such as bronchiectasis; or there are recurrent infections and massive hemoptysis, surgery should be considered. Generally, surgery is recommended within 4 to 12 months after onset.

　　II. Prognosis

　　Generally, the prognosis is good. Those caused by aspiration of foreign bodies recover quickly after the foreign body is removed. Sometimes abscesses drain pus through the bronchus and can occasionally heal spontaneously. The prognosis is poor when complications such as bronchiectasis, migratory abscesses, or empyema occur.