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Vol. 15. Issue 2.
Pages 165-178 (March - April 2009)
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Vol. 15. Issue 2.
Pages 165-178 (March - April 2009)
Artigo Original/Original Article
Open Access
Abcessos pulmonares: Revisão de 60 casos
Lung abscesses: Review of 60 cases
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Luísa Magalhães1,*, Diana Valadares1, Júlio R. Oliveira2, Ernestina Reis2
1 Interna Complementar de Medicina Interna Hospital Geral de Santo António. Serviço de Medicina 1 (Director de Serviço: Dr. Nelson Rocha) – Unidade D (responsável de unidade: Dra. Ernestina Reis)/ Resident, Internal Medicine Work carried out at Hospital Geral de Santo António. Serviço de Medicina 1 (Department Head: Dr. Nelson Rocha) – Unidade D (Head: Dr. Ernestina Reis)
2 Assistente Hospitalar de Medicina Interna Hospital Geral de Santo António. Serviço de Medicina 1 (Director de Serviço: Dr. Nelson Rocha) – Unidade D (responsável de unidade: Dra. Ernestina Reis)/ Internal Medicine Consultant Work carried out at Hospital Geral de Santo António. Serviço de Medicina 1 (Department Head: Dr. Nelson Rocha) – Unidade D (Head: Dr. Ernestina Reis)
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Resumo

Abcessos pulmonares (AP) acarretam graves implicações clínicas e sociais. Os autores analisam retrospectivamente a casuística dum hospital terciário.

Identificaram-se 60 internamentos por AP ocorridos entre 2000 e 2005. Quarenta e cinco doentes eram homens; a idade média foi 56,2 (±15,1) anos. A duração média dos sintomas de pré-hospitalização foi de 23,0 (±50,2) dias, mas a infecção respiratória aguda foi o modo de apresentação em 36 doentes. Em 40 casos, com base em dados clínicos, a suspeita de AP seria elevada. O diagnóstico estabeleceu-se em 8,7 (±11,4) dias após a admissão. Identificouse agente microbiano em 26 casos. Em 27 doentes classificou-se o AP como primário. Mau estado dentário e imunodeficiência foram os principais factores de risco. Exis tiam comorbilidades em 34 casos. Após o diagnóstico, todos receberam antibioterapia (AB) intravenosa (IV) em média durante 16,5 (±10,9) dias. A média do tempo global de AB foi de 39,2 (±15,7) dias. Dez opções de AB foram usadas e a AB IV inicial alterada em 23 casos. Foi necessária cirurgia em 6 doentes. Conseguiu-se apirexia em média após 6,4 (±6,4) dias. Ocorreram complicações em 21 doentes; 7 faleceram. A duração média do internamento foi de 27,5 (±16,3) dias e 38 doentes foram convocados para consulta pós-alta.

Estes dados são, em geral, concordantes com a literatura. A elevada percentagem de doentes do sexo masculino coincide com maior prevalência do alcoolismo e do carcinoma pulmonar nos homens. Aspectos pertinentes no sentido de melhorar o prognóstico e tempo de internamento poderão ser a brevidade no diagnóstico e o consenso no tratamento antibiótico.

Rev Port Pneumol 2009; XV (2): 165-178

Palavras-chave:
Abcesso pulmonar
pneumonia necrotizante
infecções pulmonares
Abstract

Lung abscesses (LA) carry with them severe clinical and social implications. The authors retrospectively analyse case files from a tertiary hospital.

Admissions from 2000 to 2005 codified as LA were identified. Forty-five patients were males and the mean age was 56.2 (±15.1) years. The average duration of symptoms pre-hospitalisation was 23.0 (±50.2) days, with acute respiratory infection the initial syndrome in 36 patients. Clinical data show LA could have been suspected in 40 patients. Diagnosis was established 8.7 (±11.4) days after admission. A microbial pathogen was recovered in 26 cases. Primary LA was diagnosed in 27 patients. Dental disease and immunodeficiency were the main risk factors. Other co-morbidities were present in 34 patients. After LA diagnosis, intravenous (IV) antibiotic (AB) was prescribed for 16.5 (±10.9) days with mean total AB time 39.2 (±15.7) days. Ten options of AB were used and 23 patients had their initial IV AB changed to a second choice. Six patients needed surgery. Apyrexia was achieved after 6.4 (±6.4) days of treatment. 21 patients had complications and 7 died. The mean length of hospital admission was 27.5 (±16.3) days and 38 patients were called for a follow-up visit.

These data are generally in accordance with the literature. The high male percentage agrees with the similarly high prevalence of alcoholism and lung neoplasms in males. Key facts to ameliorate in order to improve prognosis and length of hospital admission could be a swifter diagnosis and consensus on the AB treatment.

Rev Port Pneumol 2009; XV (2): 165-178

Key-words:
Lung abscess
necrotising pneumonia
lung infections
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Copyright © 2009. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
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