Foul sputum of pulmonary origin

Specialty: Respiratory.

• expectoration of putrid odor
• sputum with an anaerobic odor

Why it occurs

• Primary lung abscess due to aspiration (polymicrobial infection where strict anaerobic microorganisms of the oral cavity such as Peptostreptococcus, Fusobacterium nucleatum and Prevotella predominate)
• Bronchiectasis superinfected by anaerobes or coliform organisms (with prolonged retention of purulent secretions that undergo putrefaction)
• Pleural empyema with active bronchopleural fistula (where pus from the pleural space, with a foul odor, drains directly into a bronchus and is expelled outside)
• Cavitated lung cancer with superinfected central tumor necrosis (the lack of vascularization of the tumor nucleus favors the growth of colonizing anaerobic bacteria)
• Retained intrabronchial foreign body of long evolution (causes lobar or segmental obstruction with distal fetid suppuration)

Initial workup

Computed tomography (CT) of the chest with contrast; Sputum culture obtained by methods that avoid contamination of oral flora (such as transtracheal aspirate, protected double-lumen catheter, or protected bronchial brushing during bronchoscopy); sputum cytology; Flexible bronchoscopy to evaluate mechanical or neoplastic endobronchial obstructions.

Standard management

• Clindamycin — 600 mg intravenously every 8 hours, or 300-450 mg orally every 6 hours for excellent anaerobic coverage of the oral cavity
• Ampicillin/Sulbactam — 3 g intravenously every 6 hours
• Moxifloxacin (400 mg orally or intravenously once a day in penicillin-allergic patients with aspiration pneumonia).