Pulmonary infections

Specific conditions:

• Lung abscess - separate topic
• Bronchiectasis - separate topic
• Histoplasmosis
• Organising pneumonia
  • If the shadow or mass persists for 6-8 weeks, resection can be performed to exclude carcinoma
• Mycobacterial infections
  • Tends to occur in apical and posterior segments of the upper lobes and superior segments of the lower lobes
• Fungal infections
  • Aspergillosis
    • Aspergilloma - colonisation of an existing lung cavity (commonly TB) - treat aggressively and resect when possible
    • Invasive aspergillosis - immunocompromised patients - primarily medical
    • Allergic aspergillosis - allergic reaction to chronic colonisation - usually treated medically
  • Histoplasmosis
    • Generally a serious systemic disease
  • Coccidiodomycosis
    • Usually self-limited
  • Cryptococcus
• Parasitic
  • Entamoeba histolytica can extend from liver to RLZ

Presentation

• Similar to pneumonia - fever, cough, leucocytosis, pleuritic pain, sputum production
• Ask about foreign body aspiration

Work-up

• CXR and CT of chest and upper abdomen
• Bronchoscopy indications:
  • Clear secretions
  • Rule out cancer/foreign body/bronchial stenosis/stricture
• Cultures to guide antibiotics

Management

• Optimise medical treatment
  • Cease smoking
  • Postural drainage
  • Bronchodilators
  • Antibiotics