Chronic Destructive PneumoniaChronic destructive pneumonia is characterised by severe pulmonary infection with destruction of an associated area of lung parenchyma. Usually there is a productive cough with large volumes of foul sputum and halitosis. Frequently there is fever and general malaise. It is often associated with high ethanol intake or epilepsy but less commonly than in lung abscess.
Diagnosis is made clinically and on chest x-ray, which usually shows an area of lung destruction frequently associated with areas of pneumonic change due to spill of infected lung contents. There is a tendency for untreated destructive pneumonia to spread affecting other areas of lung tissue. The commonest organism is Klebsiella but super-infection with a multitude of organisms especially gram negative is common. Treatment is with a combination of intravenous penicillin with a 2nd generation cephalosporin and initially intravenous metronidazole (after 24hours oral or recta)l while sensitivities are awaited. Intravenous antibiotics are continued for at least 14 days, this is then followed by a further month of oral treatment. If there is incomplete resolution, if there is a later relapse, or the pneumonia is complicated by haemoptysis further intervention may be necessary, usually surgery.