Lung abscess and its homoeopathic management

Dr Vishnuvardhan Reddy

ABSTRACT: Lung abscess is a type of suppurative pleuro- pulmonary disease.
Lung abscess is a common problem encountered in developing countries, the incidence of lung abscess was high in the pre antibiotic era which reduced after the antibiotics in mortality and morbidity, but with the emerging antibiotic resistance of bacteria causing the lung abscess it is need to consider the potential of alternative systems of medicine.

KEYWORDS: Pleuro Pulmonary, Suppurative, Lung Abscess, Bronchiectasis, Necrotising Pneumonia, Empyema, Homoeopathy

INTRODUCTION:  Lung abscess is a necrotizing lung infection characterized by a pus-filled cavity lesion following microbial infection.

Lung abscesses can be single or multiple but usually are marked by a single dominant cavity >2 cm in diameter.

DEFINITION
Lung abscess is a circumscribed collection of purulent and necrotic material (pus) within the lung parenchyma.

It is of two types

• Primary lung abscess develops in the absence of underlying pulmonary or systemic disease due to aspiration
• Secondary lung abscess develops with an underlying condition such as post obstructive or systemic condition (haematogenous spread to the lung).

EPIDEMIOLOGY

Age – common in old age and middle aged

Sex – male predominance

Risk factors for aspiration

• Altered mental status
• Alcoholism
• Drug overdose
• Seizures
• Bulbar dysfunction
• Prior cerebrovascular or cardiovascular events
• Neuromuscular disease
• Patients with esophageal dysmotility or esophageal lesion strictures or tumors and those with gastric distention and/or gastroesophageal reflux, especially those who spend substantial time in the recumbent position.

Immune suppression

Local

• Chronic lung disease

      Systemic (Impairment of cell mediated or humoral immunity)

• Primary
• Secondary
  • Diabetes mellitus
  • Malignancy
  • Chemotherapy
  • HIV infection

Mechanical bronchial obstruction

• Foreign body
• Tumour
• Lymphadenopathy

AETIOPATHOGENISIS

• The location of lung abscess is dependent segments – posterior upper lobes and superior lower lobes and right lung is more commonly affected
• In primary lung abscess Chiefly from anaerobic bacteria and microaerophilic streptococci from aspirated contents. Patients who have an overwhelming burden of aspirated material or are unable to clear the bacterial load develop pneumonitis initially then after a 7- 14 days, the anaerobic bacteria produce parenchymal necrosis and cavitation depending on the host pathogen reaction.
• In secondary lung abscess depends on the predisposing factors like
  • Failure to clear the oropharyngeal secretions in bronchial obstruction
  • Impaired host defense mechanisms in underlying systemic diseases like immunosuppression.
  • Septic emboli from tricuspid valve endocarditis or lemierre’s syndrome.
• A putrid (foul) odour of sputum is characteristic of anaerobic micro-organisms

CLINICAL MANIFESTATIONS

Initial symptoms

• Fever
• Cough
• Sputum production
• Chest pain

In chronic and indolent presentation

• Night sweats
• Fatigue
• Anemia
• Foul-tasting or foul-smelling sputum.

SIGNS

• Temperature ≥ 38◦C
• Crackles over affected area
• Egophony

DIFFERENTIAL DIAGNOSIS

• Lung infarction
• Malignancy
• Sequestration
• Vasculitides

DIAGNOSIS

• Chest x ray
• Computed tomography (CT)
• Bronchoalveolar lavage

COMPLICATIONS

• Bronchiectasis
• Empyema
• Hemoptysis

INDICATIONS OF HOMOEOPATHIC REMEDIES FOR LUNG ABSCESS

ARSENICUM ALBUM

• Gangrene of lungs, with green, ichorous sputa with chilliness, restlessness, prostration, anxiety and fear, a horrible odor black, foul expectoration with heat relives.
• Burning in chest and stomach with Hemoptysis. Acute, sharp, fixed or darting pain in apex and through upper third of right lung.

BACILLINUM

• Oppression of the chest with Catarrhal dyspnea. Bubbling rales and mucopurulent expectoration which is poly-bacillary.
• Often relieves congestion of the lungs. Should not be given below the thirtieth and not repeated frequently. One dose a week often sufficient to bring about reaction.

CALCAREA CARBONICUM

• Ulceration of the lungs. Cough, with expectoration of thick mucus; gray; bloody; purulent; tasting sour; or yellowish and fetid, generally at night, or in the morning
• On coughing, pressure in the stomach, shootings or shocks in the head, and pains in the chest.
• Obstructed breathing on stooping, walking against the wind, or on lying down. Sensation, as if respiration were obstructed between the shoulder-blades.

CROTALUS HORRIDUS

• Bruised pain from larynx to chest. Cough with stitch in left side and bloody expectoration. Dry cough on speaking, aggravated in dry or cold air. Excessive oppression of chest. Burning in chest with heat in forehead.
• Pneumonia with tendency to gangrene. Lungs seem passive. Stitches in right chest near sternum.

HEPAR SULPHURIS CALCAREUM

• Pulmonary abscess with Cough with spitting, of blood and abundant expectoration of mucus. Soreness in the chest. Attacks of suffocation, which force the patient to throw back the head. Shortness of breath. Spasmodic constriction of the chest. Frequent want to breathe deeply. Stitching type of pains and least exposure to cold air or uncovering causes cough.

HIPPOZAENINUM

• It diminishes expectoration, abates constantly recurring aggravations of inflammation, and checks liability to catarrhal affections.
• Papules and ulcerations in frontal sinuses, pharynx, larynx, and trachea.Patients cough severely and expectorate profusely, sputa. Tubercles, size of millet seed to a pea, of a grey, yellowish, or reddish color.

KALI CARBONICUM

• Cutting pain in chest worse lying on right side. Dry, hard cough about 3 am, with stitching pains and dryness of pharynx. Expectoration scanty and tenacious, but increasing in morning and after eating; aggravated right lower chest and lying on painful side. Leaning forward relieves chest symptoms. Expectoration must be swallowed; cheesy taste; copious, offensive, lump. Coldness of chest. Tendency to tuberculosis; constant cold taking; better in warm climate.

LACHESIS

• Extravasation of blood in lungs. Gangrene of lungs.
• Pressure on chest, as from a weight, or as if it were filled with wind, and principally at night. Contraction of the chest wakens him after midnight, with slow, heavy, wheezing breathing, compelling him to sit up with his chest bent forward.
• The cough is aggravated during the day; after sleeping; from changes in the temperature; from alcoholic drinks; from acids and sour drinks.
• Contraction and constriction of the larynx, with a sensation of swelling and of tension.

LEDUM PAL

• Phthisis, preceded by history of neuralgia and rheumatism in head and limbs, with inflammatory tendency.
• Cough, preceded by suffocating suspension of respiration. Cough, with purulent expectoration, esp. in morning or at night. Greenish expectoration of a fetid smell, during fit of coughing. Hollow shaking cough, with expectoration of bright red blood.

LYCOPODIUM

• Neglected pneumonia, with great dyspnoea, flaying of alae nasae and presence of mucous rales.
• Tensive, constrictive, burning pain in chest. Cough deep, hollow, worse going down hill. Expectorations gray, thick, bloody, purulent, salty, tastes like old cheese; large quantities of pus. Cough aggravated from 4 to 8 P. M., on alternate days, from exertion, from stretching arms out, stooping or lying down, lying on left side, from eating and drinking cold things, in warm room.

MANGANUM

• Hemoptysis with stitching pains through right lung and dry cough, always ceasing on lying down, with much anemia and palpitation of heart.
• Sputum greenish or yellow lumps difficult, of tough mucus, reddish phlegm, bloody.

MERCURIUS SOLUBILIS

• Suppuration of lungs after hemorrhages, or after pneumonia.
• Anxious oppression and heavy breathing, with desire to take deep breath.
• Cough two paroxysms in rapid succession at night, followed by a long interval of rest, vomiting, with epistaxis, blood at once coagulating, profuse sweat at night.
• Debilitating night and morning sweats. 

PHOSPHOROUS

• Tuberculosis in tall, slender, weak-chested persons growing rapidly with repeated haemoptysis and great debility. Feeling of fullness in chest up to throat, as if from eating too much. Lungs felt clogged, troublesome dyspnoea. Acute pain in lower part of left lung worse lying on left side.

PLUMBUM METALLICUM

• Phthisis with suppuration of lungs. Pressure upon chest, with difficulty in breathing and short, dry, nervous cough. Great emaciation and fever with evening exacerbation, night sweats
• Constant cough, day and night, with profuse greenish, purulent, lumpy, blood-streaked expectoration. dullness on percussion in apex of right lung, with rales. 

PSORINUM

• Suppuration of lungs from Phthisis pulmonalis. Pain in chest, as if raw, as from subcutaneous ulceration.
• Pain in chest comes by fits with great anxiety and chest inflates only with much exertion. Coughs a long time before beginning to expectorate.

PULSATILLA

• Tuberculosis of lung with suppurative stage. Acute suppuration of lungs. Expectoration of copious yellow mucus, bitter, greenish or of blood with pieces of dark, coagulated blood, after rising in morning which is salty and offensive.

SILICEA

• Abscess in the lung with no tendency to heal, it brings about repair, causes contraction of its walls
• Pulmonary affections in stone-cutters. Establishes a suppuration and throws off these particles of stone.
• Expectoration profuse, foetid, green, purulent; only during the day viscid, milky, acrid-mucus, at times pale, frothy blood. Inflammation of lungs resulting in suppuration. Chronic neglected pneumonia, passing over into suppuration.

STANNUM METALLICUM

• Chest so weak he cannot talk, empty feeling in chest. Great sore feeling in chest with bruised pain. Pains that come and go gradually. Stitches in left side of chest, when breathing or lying on that side.
• Cough is in fatiguing paroxysms with painful epigastric region, as if beaten. Hemoptysis with copious expectoration. Sputum is like white of an egg or yellow green pus which is sweetish or putrid, sour or saltish worse during day.

TUBERCULINUM

• Useful in symptoms are constantly changing or well-selected remedies fail to improve. Abscesses in the lungs. New ulcers have suddenly appeared, esp. in pleura, pericardium, and peritoneum. Hard, dry cough. Tubercular deposit begins in apex of lungs, usually the left which have a tendency to form perforating abscesses.

RUBRICS FOR LUNG ABSCESS:

SYNTHESIS REPERTORY

• • CHEST – ABSCESS – Lungs – accompanied by – Lungs; inflammation of
  • CHEST – INFLAMMATION – Lungs – chronic – accompanied by – Lungs; abscess of
  • CHEST – ABSCESS – Lungs – left
  • CHEST – ABSCESS – Lungs
  • CHEST – SUPPURATION of lungs

HOMOEOPATHIC MATERIA MEDICA AND REPERTORY DR. WILLIAM BOERICKE

• • RESPIRATORY SYSTEM – LUNGS, Abscess
  • RESPIRATORY SYSTEM – CHEST, Affection, after operation, for hydrothorax, empyema

MURPHY’S REPERTORY

• • CHEST – ABSCESS, sensation of, on left, between pectoralis major and minor, hard and sensitive to touch, drawing pains in every direction, worse on motion of arm
  • LUNGS – ABSCESS, lungs
  • LUNGS – ABSCESS, alcoholics, in
  • LUNGS – ABSCESS, left
  • LUNGS – ABSCESS, thirst, with

COMPLETE REPERTORY 

• • CHEST – ABSCESS – general – lungs
  • CHEST – ABSCESS – general – lungs, left
  • CHEST – ABSCESS – general – lungs, cancerous affections, in
  • CHEST – ABSCESS – general – lungs, drunkards, in
  • CHEST – ABSCESS – general – lungs, thirst, with
  • CHEST – ABSCESS – general – lungs

PHATAK’S REPERTORY

• • CHEST AND LUNGS – abscess of lung

ROBERTS H. REPERTORY

• • INTERNAL CHEST – Suppurating behind sternum

CONCLUSION:
Lung abscess is a necrotizing lung infection characterised by a pus-filled cavitary lesion, and is commonly caused by aspiration of oral secretions by patients who have impaired consciousness or due to systemic or local immune suppression, with a male predominance. Diagnosis is based primarily on chest x-ray.

Although many drugs have affinity on lungs, success in homoeopathic prescription lies in the ability to individualise the patient and differentiate from the group of similar remedies, there by arriving at the similimum.

REFERENCES

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Dr Vishnuvardhan Reddy
PG Scholar,Department of Practice of medicine
U/G/O Dr Praveen Kumar P. D (HOD of Dept of Medicine)
Government Homoeopathic Medical College and Hospital,
Dr. Siddhaiah Puranik Road, Basaveshwar Nagar, Bengaluru,560079