PNEUMONIA

Pneumonia is an inflammatory condition of the lung. It is often characterized as

including inflammation of the parenchyma of the lung (that is, the alveoli) and abnormal
alveolar filling with fluid (consolidation and exudation).

The alveoli are microscopic air filled sacs in the lungs responsible for gas exchange.
Pneumonia can result from a variety of causes,
including infection with bacteria, viruses, fungi, or parasites, and chemical or physical
injury to the lungs. Its cause may also be officially described as unknown when infectious
causes have been excluded.

Typical symptoms associated with pneumonia include cough, chest pain, fever,
and difficulty in breathing. Diagnostic tools include x-rays and examination of
the sputum. Treatment depends on the cause of pneumonia; bacterial pneumonia is
treated with antibiotics.

Pneumonia is common, occurring in all age groups, and is a leading cause of death
among the young, the old, and the chronically ill. Vaccines to prevent certain types of
pneumonia are available. The prognosis depends on the type of pneumonia, the
treatment, any complications, and the person's underlying health.

Pneumonias can be classified in several ways. The primary system of classification

is the combined clinical classification, which combines factors such as age, risk factors
for certain microorganisms, the presence of underlying lung disease or systemic disease,
and whether the person has recently been hospitalized.

Other classifications include according to the anatomic changes that can be found in the
lungs duringautopsies, based on the microbial cause, and a radiological classification.

Community-acquired

Community-acquired pneumonia (CAP) is infectious pneumonia in a person who has not

recently been hospitalized. CAP is the most common type of pneumonia. The most
common causes of CAP vary depending on a person's age, but they
include Streptococcus pneumoniae, viruses, the atypical bacteria, and Haemophilus
influenzae. Overall, Streptococcus pneumoniae is the most common cause of
community-acquired pneumonia worldwide. Gram-negative bacteria cause CAP in certain
at-risk populations. CAP is the fourth most common cause of death in the United
Kingdom and the sixth in the United States. The term "walking pneumonia" has been
used to describe a type of community-acquired pneumonia of less severity (because the
sufferer can continue to "walk" rather than require hospitalization). Walking pneumonia
is usually caused by the atypical bacterium, Mycoplasma pneumoniae.

Hospital-acquired

Hospital-acquired pneumonia, also called nosocomial pneumonia, is pneumonia acquired

during or after hospitalization for another illness or procedure with onset at least 72 hrs
after admission. The causes, microbiology, treatment and prognosis are different from
those of community-acquired pneumonia. Up to 5% of patients admitted to a hospital for
other causes subsequently develop pneumonia. Hospitalized patients may have many
risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition,
underlying heart and lungdiseases, decreased amounts of stomach acid, and immune
disturbances. Additionally, the microorganisms a person is exposed to in a hospital are
often different from those at home. Hospital-acquired microorganisms may include
resistant bacteria such as MRSA,Pseudomonas, Enterobacter, and Serratia. Because
individuals with hospital-acquired pneumonia usually have underlying illnesses and are
exposed to more dangerous bacteria, it tends to be more deadly than community-
acquired pneumonia. Ventilator-associated pneumonia(VAP) is a subset of hospital-
acquired pneumonia. VAP is pneumonia which occurs after at least 48 hours
of intubation and mechanical ventilation.

Other types

 Bronchiolitis obliterans organizing pneumonia (BOOP)

BOOP is caused by inflammation of the small airways of the lungs. It is also known as
cryptogenic organizing pneumonitis (COP).

 Eosinophilic pneumonia

Eosinophilic pneumonia is invasion of the lung by eosinophils, a particular kind of white

blood cell. Eosinophilic pneumonia often occurs in response to infection with
a parasite or after exposure to certain types of environmental factors.

 Chemical pneumonia

Chemical pneumonia (usually called chemical pneumonitis) is caused by

chemical toxicants such as pesticides, which may enter the body by inhalation or by skin
contact. When the toxic substance is an oil, the pneumonia may be called lipoid
pneumonia.

 Aspiration pneumonia

Aspiration pneumonia (or aspiration pneumonitis) is caused by aspirating foreign objects

which are usually oral or gastric contents, either while eating, or after reflux or vomiting
which results in bronchopneumonia. The resulting lung inflammation is not an infection
but can contribute to one, since the material aspirated may contain anaerobic bacteria
or other unusual causes of pneumonia. Aspiration is a leading cause of death among
hospital and nursing home patients, since they often cannot adequately protect their
airways and may have otherwise impaired defenses.

 Dust pneumonia

Dust pneumonia describes disorders caused by excessive exposure to dust storms,

particularly during the Dust Bowl in the United States. With dust pneumonia, dust settles
all the way into the alveoli of the lungs, stopping the cilia from moving and preventing
the lungs from ever clearing themselves.

 Necrotizing pneumonia, although overlapping with many other classifications,

includes pneumonias that cause substantial necrosis of lung cells, and sometimes
even lung abscess. Implicated bacteria are extremely commonly anaerobic
bacteria, with or without additional facultatively anaerobic ones
like Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pyogenes.
[4]
Type 3 pneumococcusis uncommonly implicated.[4]

 Opportunistic pneumonia includes those that frequently

strike immunocompromised victims. Main pathogens
are cytomegalovirus,Pneumocystis jiroveci, Mycobacterium avium-intracellulare,
invasive aspergillosis, invasive candidiasis, as well as the "usual bacteria" that
strike immunocompetent people as well.[4]

 Double pneumonia is a historical term for acute lung injury (ALI) or acute
respiratory distress syndrome (ARDS).[7] However, the term was, and is used still,
especially by lay people, to denote pneumonia affecting both lungs. Accordingly,
the term 'double pneumonia' is more likely to be used to describe bilateral
pneumonia than it is ALI or ARDS.

 Severe acute respiratory syndrome (SARS): is a highly contagious and deadly type
of pneumonia which first occurred in 2002 after initial outbreaks in China. SARS is
caused by the SARS coronavirus, a previously unknown pathogen. Last recorded
occurrence was in 2003.

Other

Initial descriptions of pneumonia focused on the anatomic or pathologic appearance of

the lung, either by direct inspection at autopsy or by its appearance under a microscope.

 A lobar pneumonia is an infection that only involves a single lobe, or section, of

a lung. Lobar pneumonia is often due to Streptococcus
pneumoniae (though Klebsiella pneumoniae is also possible.)[8]

 Multilobar pneumonia involves more than one lobe, and it often causes a more
severe illness.

 Bronchial pneumonia affects the lungs in patches around the tubes (bronchi or
bronchioles).
  Interstitial pneumonia involves the areas in between the alveoli, and it may be
called "interstitial pneumonitis." It is more likely to be caused by viruses or by
atypical bacteria.

The discovery of x-rays made it possible to determine the anatomic type of pneumonia
without direct examination of the lungs at autopsy and led to the development of
a radiological classification. Early investigators distinguished between typical lobar
pneumonia and atypical (e.g. Chlamydophila) or viral pneumonia using the location,
distribution, and appearance of the opacities they saw on chest x-rays. Certain x-ray
findings can be used to help predict the course of illness, although it is not possible to
clearly determine the microbiologic cause of a pneumonia with x-rays alone.

With the advent of modern microbiology, classification based upon the causative
microorganism became possible. Determining which microorganism is causing an
individual's pneumonia is an important step in deciding treatment type and length.
Sputum cultures, blood cultures, tests on respiratory secretions, and specific blood tests
are used to determine the microbiologic classification. Because such laboratory testing
typically takes several days, microbiologic classification is usually not possible at the
time of initial diagnosis.

Signs and symptoms

Main symptoms of infectious pneumonia

People with infectious pneumonia often have a cough producing greenish or

yellow sputum, orphlegm and a high fever that may be accompanied by shaking
chills. Shortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing
pain, either experienced during deep breaths or coughs or worsened by them. People
with pneumonia may cough up blood, experienceheadaches, or develop sweaty and
clammy skin. Other possible symptoms are loss of appetite, fatigue, blueness of the
skin, nausea, vomiting, mood swings, and joint pains or muscle aches. Less common
forms of pneumonia can cause other symptoms; for instance, pneumonia caused
by Legionella may cause abdominal pain and diarrhea, while pneumonia caused
by tuberculosis orPneumocystis may cause only weight loss and night sweats. In elderly
people, manifestations of pneumonia are seldom typical. They may develop a new or
worsening confusion (delirium) or may experience unsteadiness, leading to falls. Infants
with pneumonia may have many of the symptoms above, but in many cases they are
simply sleepy or have a decreased appetite.[9]

Symptoms of pneumonia need immediate medical evaluation. Physical examination by a

health care provider may reveal fever or sometimes low body temperature, an increased
respiratory rate,low blood pressure, a high heart rate, or a low oxygen saturation, which
is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas
analysis. People who are struggling to breathe, who are confused, or who
have cyanosis (blue-tinged skin) require immediate attention.

Findings from physical examination of the lungs may be normal, but often show
decreased expansion of the chest on the affected side, bronchial breathing on
auscultation with a stethoscope (harsher sounds from the larger airways transmitted
through the inflamed and consolidated lung), and rales(or crackles) heard over the
affected area during inspiration. Percussion may be dulled over the affected lung, but
increased rather than decreased vocal resonance (which distinguishes it from a pleural
effusion).[9] While these signs are relevant, they are insufficient to diagnose or rule out a
pneumonia; moreover, in studies it has been shown that two doctors can arrive at
different findings on the same patient.[10][11]

Cause

Pneumonia can be due to microorganisms, irritants or an unknown causes. When

pneumonias are grouped this way, infectious causes are the most common.

The symptoms of infectious pneumonia are caused by the invasion of the lungs
by microorganisms and by the immune system's response to the infection. Although
more than one hundred strains of microorganism can cause pneumonia, only a few are
responsible for most cases. The most common causes of pneumonia
are viruses and bacteria. Less common causes of infectious pneumonia
are fungi and parasites.

Viruses

Viruses have been found to account for between 18—28% of pneumonia in a few limited
studies.[12] Viruses invade cells in order to reproduce. Typically, a virus reaches the lungs
when airborne droplets are inhaled through the mouth and nose. Once in the lungs, the
virus invades the cells lining the airways and alveoli. This invasion often leads to cell
death, either when the virus directly kills the cells, or through a type of cell controlled
self-destruction called apoptosis. When the immune system responds to the viral
infection, even more lung damage occurs. White blood cells, mainly lymphocytes,
activate certain chemical cytokines which allow fluid to leak into the alveoli. This
combination of cell destruction and fluid-filled alveoli interrupts the normal
transportation of oxygen into the bloodstream.
As well as damaging the lungs, many viruses affect other organs and thus disrupt many
body functions. Viruses can also make the body more susceptible to bacterial infections;
for which reason bacterial pneumonia may complicate viral pneumonia.[12]

Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory

syncytial virus (RSV), adenovirus, and parainfluenza.[12]Herpes simplex virus is a rare
cause of pneumonia except in newborns. People with weakened immune systems are
also at risk of pneumonia caused by cytomegalovirus (CMV).

Bacteria

Bacteria are the most common cause of community acquired pneumonia

with Streptococcus pneumoniae the most commonly isolated bacteria.[13] Another
important Gram-positive cause of pneumonia is Staphylococcus aureus,
with Streptococcus agalactiae being an important cause of pneumonia in newborn
babies. Gram-negative bacteria cause pneumonia less frequently than gram-positive
bacteria. Some of the gram-negative bacteria that cause pneumonia
include Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli,Pseudomonas
aeruginosa and Moraxella catarrhalis. These bacteria often live in the stomach or
intestines and may enter the lungs if vomit is inhaled. "Atypical" bacteria which cause
pneumonia include Chlamydophila pneumoniae, Mycoplasma pneumoniae,
and Legionella pneumophila.

Bacteria typically enter the lung when airborne droplets are inhaled, but can also reach
the lung through the bloodstream when there is an infection in another part of the body.
Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth and
sinuses, and can easily be inhaled into the alveoli. Once inside, bacteria may invade the
spaces between cells and between alveoli through connecting pores. This invasion
triggers the immune system to send neutrophils, a type of defensive white blood cell, to
the lungs. The neutrophils engulf and kill the offending organisms, and also
release cytokines, causing a general activation of the immune system. This leads to the
fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils,
bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal
oxygen transportation.

Fungi

Fungal pneumonia is uncommon, but it may occur in individuals with immune system
problems due to AIDS, immunosuppresive drugs, or other medical problems. The
pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia.
Fungal pneumonia is most often caused by Histoplasma capsulatum,
blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides
immitis.Histoplasmosis is most common in the Mississippi River basin,
and coccidioidomycosis in the southwestern United States.

Parasites
A variety of parasites can affect the lungs. These parasites typically enter the body
through the skin or by being swallowed. Once inside, they travel to the lungs, usually
through the blood. There, as in other cases of pneumonia, a combination of cellular
destruction and immune response causes disruption of oxygen transportation. One type
of white blood cell, the eosinophil, responds vigorously to parasite infection. Eosinophils
in the lungs can lead to eosinophilic pneumonia, thus complicating the underlying
parasitic pneumonia. The most common parasites causing pneumonia are Toxoplasma
gondii, Strongyloides stercoralis, and Ascariasis.

Idiopathic

Idiopathic interstitial pneumonias (IIP) are a class of diffuse lung diseases. In some types
of IIP, e.g. some types of usual interstitial pneumonia, the cause, indeed, is unknown or
idiopathic. In some types of IIP the cause of the pneumonia is known, e.g. desquamative
interstitial pneumonia is caused by smoking, and the name is a misnomer.

Diagnosis

Pneumonia as seen on chest x-ray.A: Normal chest x-ray. B: Abnormal chest x-ray
with shadowing from pneumonia in the right lung (white area, left side of image).
CT of the chest demonstrating right sided pneumonia (left side of the image).

If pneumonia is suspected on the basis of a patient's symptoms and findings

from physical examination, further investigations are needed to confirm the diagnosis.
Information from a chest X-ray and blood tests are helpful, and sputum cultures in some
cases. The chest X-ray is typically used for diagnosis in hospitals and some clinics with X-
ray facilities. However, in a community setting (general practice), pneumonia is usually
diagnosed based on symptoms and physical examination alone.[citation needed] Diagnosing
pneumonia can be difficult in some people, especially those who have other illnesses.
Occasionally a chest CT scan or other tests may be needed to distinguish pneumonia
from other illnesses.

Investigations

An important test for pneumonia in unclear situations is a chest x-ray. Chest x-rays can
reveal areas of opacity (seen as white) which represent consolidation. Pneumonia is not
always seen on x-rays, either because the disease is only in its initial stages, or because
it involves a part of the lung not easily seen by x-ray. In some cases, chest CT (computed
tomography) can reveal pneumonia that is not seen on chest x-ray. X-rays can be
misleading, because other problems, like lung scarring and congestive heart failure, can
mimic pneumonia on x-ray.[14] Chest x-rays are also used to evaluate for complications of
pneumonia (see below.)

If antibiotics fail to improve the patient's health, or if the health care provider has
concerns about the diagnosis, a culture of the person's sputum may be requested.
Sputum cultures generally take at least two to three days, so they are mainly used to
confirm that the infection is sensitive to an antibiotic that has already been started. A
blood sample may similarly be cultured to look for bacteria in the blood. Any bacteria
identified are then tested to see which antibiotics will be most effective.

A complete blood count may show a high white blood cell count, indicating the presence
of an infection or inflammation. In some people with immune system problems, the white
blood cell count may appear deceptively normal. Blood tests may be used to
evaluate kidney function (important when prescribing certain antibiotics) or to look
for low blood sodium. Low blood sodium in pneumonia is thought to be due to extra anti-
diuretic hormone produced when the lungs are diseased (SIADH). Specific
blood serology tests for other bacteria (Mycoplasma, Legionella andChlamydophila) and
a urine test for Legionella antigen are available. Respiratory secretions can also be
tested for the presence of viruses such as influenza, respiratory syncytial virus,
andadenovirus. Liver function tests should be carried out to test for damage caused by
sepsis.[9]

Combining findings

One study created a prediction rule that found the five following signs best
predicted infiltrates on the chest radiograph of 1134 patients presenting to an
emergency room:[15]

 Fever > 37.8 °C (100.0 °F)

 Pulse > 100 beats/min

 Rales/crackles

 Decreased breath sounds

 Absence of asthma

The probability of an infiltrate in two separate validations was based on the number of
findings:

 5 findings – 84% to 91% probability

 4 findings – 58% to 85%

 3 findings – 35% to 51%

 2 findings – 14% to 24%

 1 findings – 5% to 9%

 0 findings – 2% to 3%

A subsequent study comparing four prediction rules to physician judgment found that
two rules, the one above and also were more accurate than physician judgment because
of the increased specificity of the prediction rules.

Differential diagnosis

Several diseases and/or conditions can present with similar clinical features to
pneumonia. Chronic obstructive pulmonary disease (COPD) orasthma can present with
a polyphonic wheeze, similar to that of pneumonia. Pulmonary edema can be mistaken
for pneumonia (and vice versa), especially in the elderly, due to its similar symptoms
and signs. Other diseases to be taken into consideration includebronchiectasis, lung
cancer and pulmonary emboli.
 AP CXR showing AP CXR showing
left lower lobe right lower lobe
Normal AP CXR Normal lateral
pneumonia pneumonia
CXR
associated with a
small left sided
pleural effusion

Right upper lobe

AP CXR showing pneumonia as Left upper lobe
A lateral CXR
pneumonia of marked by the pneumonia with
showing right
the lingula of circle. a small pleural
lower lobe
the left lung effusion.
pneumonia

Prevention

There are several ways to prevent infectious pneumonia. Appropriately treating

underlying illnesses (such as AIDS) can decrease a person's risk of pneumonia. Smoking
cessation is important not only because it helps to limit lung damage, but also because
cigarette smoke interferes with many of the body's natural defenses against pneumonia.

Research shows that there are several ways to prevent pneumonia in newborn infants.
Testing pregnant women for Group B Streptococcusand Chlamydia trachomatis, and then
giving antibiotic treatment if needed, reduces pneumonia in infants. Suctioning the
mouth and throat of infants with meconium-stained amniotic fluid decreases the rate
of aspiration pneumonia.

Vaccination is important for preventing pneumonia in both children and adults.

Vaccinations against Haemophilus influenzae andStreptococcus pneumoniae in the first
year of life have greatly reduced the role these bacteria play in causing pneumonia in
children. Vaccinating children against Streptococcus pneumoniae has also led to a
decreased incidence of these infections in adults because many adults acquire infections
from children. Hib vaccine is now widely used around the globe. The childhood
pneumococcal vaccine is still as of 2009 predominantly used in high-income countries,
though this is changing. In 2009, Rwanda became the first low-income country to
introduce pneumococcal conjugate vaccine into their national immunization program.[18]
A vaccine against Streptococcus pneumoniae is also available for adults. In the U.S., it is
currently recommended for all healthy individuals older than 65 and any adults
with emphysema, congestive heart failure, diabetes mellitus, cirrhosis of
the liver, alcoholism, cerebrospinal fluidleaks, or those who do not have a spleen. A
repeat vaccination may also be required after five or ten years.[19]

Influenza vaccines should be given yearly to the same individuals who receive
vaccination against Streptococcus pneumoniae. In addition, health care workers, nursing
home residents, and pregnant women should receive the vaccine.[20] When an influenza
outbreak is occurring, medications such as amantadine, rimantadine, zanamivir,
and oseltamivir can help prevent influenza.[21][22]

Treatment

In the United States more than 80% of cases of community acquired pneumonia are
treated without hospitalization.[13] Typically, oral antibiotics, rest, fluids, and home
care are sufficient for complete resolution. However, people who are having trouble
breathing, with other medical problems, and the elderly may need greater care. If the
symptoms get worse, the pneumonia does not improve with home treatment, or
complications occur, then hospitalization may be recommended. Over the counter cough
medicine has not been found to be helpful in pneumonia.[23]

Bacterial

Antibiotics improve outcomes in those with bacterial pneumonia.[24] Initially antibiotic

choice depends on the characteristics of the person affected such as age, underlying
health, and location the infection was acquired.

In the UK empiric treatment is usually with amoxicillin, erythromycin, or azithromycin for

community-acquired pneumonia.[25] In North America, where the "atypical" forms of
community-acquired pneumonia are becoming more common, macrolides (such
as azithromycin), anddoxycycline have displaced amoxicillin as first-line outpatient
treatment for community-acquired pneumonia.[13][26] The use offluoroquinolones in
uncomplicated cases is discouraged due to concerns of side effects and resistance.
[13]
The duration of treatment has traditionally been seven to ten days, but there is
increasing evidence that short courses (three to five days) are equivalent.[27] Antibiotics
recommended for hospital-acquired pneumonia include third- and fourth-
generation cephalosporins, carbapenems, fluoroquinolones,aminoglycosides,
and vancomycin.[28] These antibiotics are often given intravenously and may be used in
combination.

Viral

No specific treatments exist for most types of viral pneumonia including SARS
coronavirus, adenovirus, hantavirus, and parainfluenza virus with the exception
of influenza A and influenza B. Influenza A may be treated
with rimantadine or amantadine while influenza A or B may be treated
with oseltamivir or zanamivir. These are beneficial only if they are started within 48
hours of the onset of symptoms. Many strains ofH5N1 influenza A, also known as avian
influenza or "bird flu," have shown resistance to rimantadine and amantadine.

Aspiration

There is no evidence to support the use of antibiotics in chemical pneumonitis without

bacterial superinfection. If infection is present inaspiration pneumonia, the choice of
antibiotic will depend on several factors, including the suspected causative organism and
whether pneumonia was acquired in the community or developed in a hospital setting.
Common options include clindamycin, a combination of a beta-lactam
antibiotic and metronidazole, or an aminoglycoside.[29] Corticosteroids are commonly
used in aspiration pneumonia, but there is no evidence to support their use either.[29]

Complications

Sometimes pneumonia can lead to additional complications. Complications are more

frequently associated with bacterial pneumonia than with viral pneumonia. The most
important complications include:

Respiratory and circulatory failure

Because pneumonia affects the lungs, often people with pneumonia have difficulty
breathing, and it may not be possible for them to breathe well enough to stay alive
without support. Non-invasive breathing assistance may be helpful, such as with a bi-
level positive airway pressuremachine. In other cases, placement of an endotracheal
tube (breathing tube) may be necessary, and a ventilator may be used to help the
person breathe.

Pneumonia can also cause respiratory failure by triggering acute respiratory distress
syndrome (ARDS), which results from a combination of infection and inflammatory
response. The lungs quickly fill with fluid and become very stiff. This stiffness, combined
with severe difficulties extracting oxygen due to the alveolar fluid, create a need for
mechanical ventilation.

Pleural effusion. Chest x-ray showing a pleural effusion. The A arrow indicates "fluid
layering" in the right chest. The B arrow indicates the width of the right lung. The volume
of useful lung is reduced because of the collection of fluid around the lung.

Sepsis and septic shock are potential complications of pneumonia. Sepsis occurs when
microorganisms enter the bloodstream and the immune system responds by
secreting cytokines. Sepsis most often occurs with bacterial pneumonia; Streptococcus
pneumoniae is the most common cause. Individuals with sepsis or septic shock need
hospitalization in an intensive care unit. They often require intravenous fluids and
medications to help keep their blood pressure from dropping too low. Sepsis can cause
liver, kidney, and heart damage, among other problems, and it often causes death.
Pleural effusion, empyema, and abscess

Occasionally, microorganisms infecting the lung will cause fluid (a pleural effusion) to
build up in the space that surrounds the lung (the pleural cavity). If the microorganisms
themselves are present in the pleural cavity, the fluid collection is called an empyema.
When pleural fluid is present in a person with pneumonia, the fluid can often be collected
with a needle (thoracentesis) and examined. Depending on the results of this
examination, complete drainage of the fluid may be necessary, often requiring a chest
tube. In severe cases of empyema, surgery may be needed. If the fluid is not drained,
the infection may persist, because antibiotics do not penetrate well into the pleural
cavity.

Rarely, bacteria in the lung will form a pocket of infected fluid called an abscess. Lung
abscesses can usually be seen with a chest x-ray or chest CT scan. Abscesses typically
occur in aspiration pneumonia and often contain several types of bacteria. Antibiotics are
usually adequate to treat a lung abscess, but sometimes the abscess must be drained by
a surgeon or radiologist.