Аcute purulent-necrotic destruction of the lungs: classification, etiology, pathogenesis

Abstract

Objective. Identification of the etiology and pathogenesis of acute purulent-necrotic destruction of the lungs (APDL).

Materials and methods. The results of examination and treatment of 780 patients with OGDL who were in two pulmonary surgery departments over 12 years were studied. Clinical forms and course options were determined by clinical and radiological studies. In 34 patients, the test material was taken during puncture of abscesses through the chest wall in the phase of their formation, and the pathogen was identified by a quantitative method and by cultivating bacteria in an Oxoid anaerostat.

Results. Among the patients observed with APDL, limited purulent destruction was diagnosed in 69.2 %, widespread purulent destruction — in 18.1 %, limited gangrene — in 10.6 %, widespread gangrene — in 2.1 %. With bacteriological examination of sputum, it is impossible to obtain reliable information about the pathogen. In all 34 patients, non-spore-forming anaerobes were found in the purulent contents taken directly from the abscess in the phase of its formation in quantities of 2×107—7×109 per 1 ml. Aerobic bacteria (pneumococci) were detected in 8 out of 34 patients in unreliably small diagnostic quantities. The information obtained about anaerobic etiology provided the basis for clarifying the pathogenesis of APDL.

Conclusion. The ratio of different clinical forms of APDL was determined. Pathogenetic factors have been identified, according to which variants of the clinical course for each clinical form have been identified. It has been established that APDLs arise under the influence of non-spore-forming anaerobes. The mechanism of interdependence of etiological and pathogenetic factors in the development of acute nonspecific inflammatory processes in the lungs has been clarified.