Fetid Sputum Research Articles

Surgical treatment of bronchiectasis: a retrospective observational study of 138 patients.

We analyzed cases of bronchiectasis; its presentation, etiology, diagnosis, indications for surgery, surgical approach, and the outcome. A retrospective analysis of 138 patients who underwent surgery for bronchiectasis. The mean age was 30.2±15.7 years. 55.8% patients were males. Symptoms were recurrent infection with cough in all patients, fetid sputum (79.7%), and hemoptysis (22.5%). The etiology was recurrent childhood infection (38.4%), pneumonia (29%), TB (9.4%), sequestration (4.3%), foreign body obstruction (4.3%), and unknown etiology (14.5%). CXR, CT scan, and bronchoscope were done for all patients. Bronchiectasis was left-sided in (55.1%) of patients. It was mainly confined to the lower lobes either alone (50.7%) or in conjunction with middle lobe or lingual (7.2%). Indications for resection were failure of conservative therapy (71.7%), hemoptysis (15.9%), destroyed lung (8%), and sequestration (4.3%). Surgery was lobectomy (81.2%), bilobectomy (8.7%), and pneumonectomy (8%). Complications occurred in 13% with no operative mortality. 84% of patients had relief of their preoperative symptoms. Surgery for bronchiectasis can be performed with acceptable morbidity and mortality at any age for localized disease. Proper selection and preparation of the patients and complete resection of the involved sites are required for the optimum control of symptoms and better outcomes.

Invited Commentary

Defining “bronchiectasis” can be a challenge because it can be described by radiologic, pathologic, or clinical terms. Pathologically it refers to the permanent dilatation of bronchi. This can be clinically asymptomatic or can result in poor airway clearance, pooling of secretions, and recurrent infections. In severe cases it can result in copious fetid sputum production, progressive lung damage, metastatic abscess formation, hemoptysis, and potential death. Acquired causes are varied and may consist of severe childhood pulmonary infection or foreign bodies.

Surgical management of bronchiectasis: analysis and short-term results in 238 patients.

Bronchiectasis is defined permanent dilatations of bronchi with destruction of the bronchial wall. It is still a major cause of morbidity and mortality in developing countries. The aim of this retrospective study is to present our surgical experiences, the early and long-term results of 238 patients with bronchiectasis during a 10-year period. We reviewed the medical records of 238 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2001, at Gülhane Military Medical Academy (GMMA) Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and type of operation, mortality, morbidity and the result of surgical therapy were analyzed. There were 205 (86.13%) male and 33 (13.87%) female patients with an average age of 23.7 and a range of 15-48 years. The presenting symptoms were productive cough in 133 (55.88%), fetid sputum in 116 (48.73%), recurrent infections in 84 (35.29%), and hemoptysis in 39 (12.18%) patients. The disease was bilateral in 31 patients (13.02%) and mainly confined to the lower lobes in 162 (68.06%). The surgical treatment was as follows: pneumonectomy in 13 patients (5.46%), lobectomy in 189 (79.40%), lobectomy+segmentectomy in 31 (13.02%), and wedge resection or segmentectomy in five (2.1%). Staged bilateral thoracotomy was used in 14 patients. There was no operative mortality. Complications occurred in 21 patients and the morbidity rate was 8.82%. Complete resection was achieved in 154 (64.7%) patients. Follow-up data were obtained for 229 (96.21%) of the patients. Nine patients were lost to follow-up. The mean follow-up of these patients was 9 months (range, 3 months to 4 years). The symptoms disappeared in 189 patients (79.41%) and 29 patients (12.18%) had improved, whereas 11 patients (4.62%) had no improvement. Significantly better results were obtained in patients who had undergone a complete resection. Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.

Clinical spectrum of bronchiectasis in children.

The prevalence of bronchiectasis decreased due to the effective use of vaccines and advances of antibiotic therapy after 1970. However, it remains an important long-term morbidity of lower respiratory tract infection in developing country. To evaluate the clinical features of bronchiectasis in a tertiary hospital, we collected 21 patients with a diagnosis of bronchiectasis in Taipei Veterans General Hospital from May, 1984 to Dec, 2001 in pediatric outpatient with the admission of age below 18 years old. The diagnosis was based on the history of recurrent cough with fetid sputum, hemoptysis, or recurrent lobar pneumonia for months at least and radiological findings of lobar infiltration, tram-track like patterns, bronchiolar dilatation or honeycomb patterns. The diagnostic examinations included chest plain radiography, bronchography and chest computed tomography (CT) scans. Respiratory tract infections were the commonest cause predisposing to bronchiectasis in our study. Tuberculosis is not rare in this study. In recent years, immunodeficiency disorders have been recognized. Most patients suffered from recurrent cough and fetid sputum for years before diagnosis was established. Hemoptysis was the second common symptom in our study. The plain chest radiograph of bronchiectasis revealed dilatation of bronchial trees with honeycomb pattern or infiltration only. In recent years, chest CT became the most accurate and being noninvasive diagnostic tool. The initial treatment was primarily medical conservative therapy. Only five patients in our cases underwent pulmonary resection due to persistent hemoptysis, recurrent bacterial pneumonia or pulmonary parenchyma destruction. Most patients still suffered from recurrent pneumonia or occasional exacerbation in the long-term follow-up. In conclusion, bronchiectasis is not uncommon in pediatric population in northern Taiwan. The history of recurrent cough with fetid sputum, hemoptysis, or recurrent pneumonia were the most important clues to early diagnosis of this disease. Early diagnosis and appropriate treatment are effective in order to prevent lung abscess, empyema and pneumothorax, bronchopleural fistula, hemoptysis or cor pulmonale.

Surgical management of bronchiectasis

The prevalence of bronchiectasis has decreased significantly over recent decades. We reviewed the morbidity, mortality, and outcome of surgical treatment for pulmonary bronchiectasis in the modern era of antibiotic therapy. From January 1976 through January 1993, 134 patients (55 male and 79 female patients) underwent pulmonary resection for bronchiectasis. The mean age was 48.4 years (range, 4 to 89 years). The indication for operation was failure of medical therapy in 85 patients (63.4%), hemoptysis in 26 (19.4%), lung abscess in 12 (9.0%), and a nondiagnostic mass in 11 (8.2%). Mean duration of symptoms was 6 years (range, 1 to 60 years) and included a productive cough in 104 patients, fetid sputum in 91, recurrent infections in 81, and hemoptysis in 56. Thirteen patients (9.7%) had no prior symptoms and presented with either hemoptysis, lung abscess, or unresolved pneumonia. The disease was bilateral in 26 patients (19.4%) and mainly confined to the lower lobe in 75 (56.0%). The mean number of segments involved was 4.4 (range, one to 14 segments). Surgical treatment included lobectomy in 86 patients (64.2%), pneumonectomy in 21 (15.7%), wedge resection or segmentectomy in 18 (13.4%), and a combination of these approaches in 9 (6.7%). Disease was considered completely resected in 108 patients (80.6%). The operative mortality rate was 2.2% and the morbidity rate was 24.6%. The mean follow-up in 103 patients was 6 years (range, 1 to 16 years). Overall, 61 patients (59.2%) were asymptomatic after operation. Symptoms were improved in 30 patients (29.1%) and unchanged in 12 (11.7%). Complete resection resulted in a significantly better result than incomplete resection (p < 0.05). Pulmonary resection for bronchiectasis can be done with low mortality and morbidity. When possible, complete resection should be performed.

Multiple Pulmonary Nodules with Cavitation and Fever in a 48-Year-Old Man

count was 12.0 x 10�/cu mm, and the erythrocyte sedimentation rate was 2 mm/h. The electrocardiogram (ECG) was normal. A chest x-ray film revealed three nodules in the right hemithorax and two in the left hemithorax, with diameters of 1 .5 to 3 cm (Fig 1). Linear tomography showed cavitation in two of them. An otolaryngologic examination and a paranasal sinus x-ray study were normal. Bacterial and mycobactenal cultures were negative, as were serologic and immunologic study. The echocardiogram showed no signs of endocarditis. Fiberoptic bronchoscopy was carried out, and no endobronchial lesions were found. The findings from BAS cytologic and bacteriological studies were normal. Abdominal ultrasound examination and computed tomography (CT), barium examination of the upper gastrointestinal tract, barium enema, and bone scintigraphy were also carried out, with no abnormal findings. The patient was questioned again, and he remembered that one month before admission he had fallen down the stairs and had chest pain for two days. He did not consult a physician for this. Fifteen days after admission the patient was still feverish, and a purulent fetid sputum appeared. Consecutive blood tests revealed a white blood cell count of 24.0 x 10�/cu mm with one metamyelocyte, seven band cells, 80 polymorphonuclear leukocytes, ten lymphocytes, and two monocytes; the hemoglobin level was 10.5 g/dl, and the erythrocyte sedimentation rate was 108 mm/h. A chest x-ray film demonstrated that the nodules were increasing in size, with cavitation and air-fluid levels in all of them (Fig 2). A diagnostic procedure was performed.

Anaerobic pleuropulmonary infections

Anaerobic pleuropulmonary infections usually arise from aspiration of oral bacteria. The degree of virulence depends on host factors, especially state of tissue oxygenation, and on size of inoculum. Fetid sputum, if present, frequently is diagnostic. Use of penicillin G is preferred therapy for all forms of anaerobic pleuropulmonary infection.

Evaluation of clindamycin and other antibiotics in the treatment of anaerobic bacterial infections of the lung.

Fifty patients who had pneumonia, lung abscess, or empyema, and whose specimens had a fetid odor, were presumed to be suffering from anerobic lung infection and were treated with clindamycin either orally (33 patients) or parenterally (17). Forty-six patients showed marked improvement or recovered; two also underwent lung resection, and thoracotomy was performed in 10. There were three outright treatment failures, and superinfection occurred in one patient. A review of the literature suggests that clindamycin and penicillin (in substantial dosage) are equally effective in treatment of anaerobic lung infection. Transtracheal aspiration is not deemed necessary if the patient is expectorating fetid sputum.

Clindamycin in the Oral Treatment of Putative Anaerobic Pneumonias

Thirty patients with presumed anaerobic pleuropulmonary infection were treated with clindamycin hydrochloride. Diagnoses of anaerobic infections were made primarily on clinical evidence, including history of aspiration, fetid sputum, and x-ray findings of pulmonary infiltrates, frequently with cavity formation. All patients were treated with clindamycin hydrochloride by mouth for 10 to 28 days in a dosage of 150 to 300 mg four times a day. Twenty-six patients showed a favorable response, although 6 also required closed thoracotomy with tube drainage of the pleural space. No serious side effects were encountered, although one patient developed transient neutropenia, and another showed elevation of hepatic enzyme levels. There were no cases of clinical superinfection, and only four patients acquired Gram-negative enteric pathogens in the sputum in low titers. Clindamycin given orally thus appears to be an effective initial antibiotic in the treatment of anaerobic pneumonias.

Bronchiectasis: Experience of Surgical Management at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Bronchiectasis is one of the major health problems in Ethiopia. We analyzed the outcome of surgery done for bronchiectasis in a resource-limited setup. A retrospective cross-sectional analysis of 22 patients who underwent surgery for bronchiectasis in Tikur Anbessa specialized hospital (TASH) during the period 2012 - 2017 were done. There were 13(59%) female and 9(41%) male patients with a mean age of 34.1 +/-16.9 years. The mean duration of symptoms was 2.2 years. Blood streak sputum, 13(59%), dyspnea, 9(49.9%), fetid sputum, 8(36.4%), dry cough, 6(27.3%), chest pain, 6(27.3%) and massive hemoptysis 3(13.6%) were the main presenting symptoms. In 20(91%) of the patients, previous history of TB treatment was identified. Recurrent childhood infection, 1(4.5%), and tumor obstruction, 1(4.5%), were also seen. Bronchiectasis was left sided in 12(54.5%), right-sided in 7(31.8%) and bilateral in 3(13.6%) patients. The disease affected multiple lung lobes in 9(40.9%), left lower lobe in 6(27.3%) and left upper lobe in 3(13.6%) cases. Indications for surgery were the failure of medical management in 10(45.5%), destroyed lung in 9(40.9%), and massive hemoptysis in 3(13.6%) cases. The procedures performed were lobectomy in 14(63.6%) and pneumonectomy in 8(36.4%) cases. Postoperative complications occurred in 5(22.7%) patients with one (4.5%) death. On the other hand, 77.3% of operated patients had significant improvement compared to their preoperative symptoms. In a resource-limited setup like TASH, localized bronchiectasis can be treated surgically with an acceptable result. Proper selection and preparation with complete resection of the involved segments are needed for maximum control of symptoms and better outcomes.