Lung Abscess

Paul G. Auwaerter, M.D., John G. Bartlett, M.D.
Lung Abscess is a topic covered in the Johns Hopkins ABX Guide.

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PATHOGENS

Some pathogens that may routinely cause lung abscesses/cavities. Lung abscesses often polymicrobial and involve oral flora.

  • Bacteria:
    • S. aureus including MRSA and MSSA
    • Anaerobes: most common cause; putrid sputum is diagnostic of this class of pathogens
      • Fusobacterium nucleatum,Bacteroides melaninogenicus and Peptostreptococcus are leading anaerobic pathogens.
    • Aerobic and microaerophilic streptococci including S. anginosus complex and Gr. A streptococci.
    • Gram-negative bacteria, especially in Taiwan, an unexplained strong association with Klebsiella pneumoniae
      • Also, P. aeruginosa.
      • Meloidosis (Burkholderia pseudomallei) is a concern, especially in SE Asia.
    • Legionella 
    • Nocardia 
    • Actinomyces 
    • Group A streptococci
    • H. influenzae (type b)
    • Rhodococcus equi
  • Mycobacteria: M. tuberculosis, MAI, M. kansasii, M. abscessus
    • Also, almost any non-tubercular mycobacteria may produce an abscess/cavity.
  • Fungi: Aspergillus, Cryptococcus, Coccidioides, Histoplasma, Blastomyces, Fusarium, Mucor, Rhizopus
  • Parasitic: usually more cystic
    • Hydatid cysts (Echinococcus)
    • Paragonimiasis

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PATHOGENS

Some pathogens that may routinely cause lung abscesses/cavities. Lung abscesses often polymicrobial and involve oral flora.

  • Bacteria:
    • S. aureus including MRSA and MSSA
    • Anaerobes: most common cause; putrid sputum is diagnostic of this class of pathogens
      • Fusobacterium nucleatum,Bacteroides melaninogenicus and Peptostreptococcus are leading anaerobic pathogens.
    • Aerobic and microaerophilic streptococci including S. anginosus complex and Gr. A streptococci.
    • Gram-negative bacteria, especially in Taiwan, an unexplained strong association with Klebsiella pneumoniae
      • Also, P. aeruginosa.
      • Meloidosis (Burkholderia pseudomallei) is a concern, especially in SE Asia.
    • Legionella 
    • Nocardia 
    • Actinomyces 
    • Group A streptococci
    • H. influenzae (type b)
    • Rhodococcus equi
  • Mycobacteria: M. tuberculosis, MAI, M. kansasii, M. abscessus
    • Also, almost any non-tubercular mycobacteria may produce an abscess/cavity.
  • Fungi: Aspergillus, Cryptococcus, Coccidioides, Histoplasma, Blastomyces, Fusarium, Mucor, Rhizopus
  • Parasitic: usually more cystic
    • Hydatid cysts (Echinococcus)
    • Paragonimiasis

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