Lung abscess natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Symptoms of lung abscess begin approximately 10 days after aspiration of infected material.Symptoms lasting less than 14 days is considered acute lung abscess, while longer lasting symptoms constitute chronic lung abscess.Acute symptoms include a prodrome accompanied by fever, productive cough, pleuritic chest pain and occasional episodes of hemoptysis.Patients with chronic lung abscess develop weight loss and malaise.The prognosis of lung abscess is good with appropriate antibiotic treatment with a high success rate.Complications include | Symptoms of lung abscess begin approximately 10 days after aspiration of infected material. Symptoms lasting less than 14 days is considered acute lung abscess, while longer lasting symptoms constitute chronic lung abscess. Acute symptoms include a prodrome accompanied by fever, productive cough, pleuritic chest pain and occasional episodes of hemoptysis. Patients with chronic lung abscess develop weight loss and malaise. The prognosis of lung abscess is good with appropriate antibiotic treatment with a high success rate. Complications include hemorrhage pyopneumothorax pleural empyema and sepsis. | ||
==Natural History== | ==Natural History== | ||
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== Prognosis == | == Prognosis == | ||
The prognosis of lung abscess is good with appropriate antibiotic treatment with a high success rate. The outcomes depend on the other associated conditions underlying lung abscess. The mortality rate of lung abscess is as high as 75% in patients with underlying immunocompromised state and bronchial obstruction favoring poor prognosis | The prognosis of lung abscess is good with appropriate antibiotic treatment with a high success rate. The outcomes depend on the other associated conditions underlying lung abscess. The mortality rate of lung abscess is as high as 75% in patients with underlying immunocompromised state and bronchial obstruction favoring poor prognosis. | ||
The following factors are considered to be associated with poor prognosis among patients.<ref name="pmid10084487">{{cite journal |vauthors=Hirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer MR |title=Factors predicting mortality of patients with lung abscess |journal=Chest |volume=115 |issue=3 |pages=746–50 |year=1999 |pmid=10084487 |doi= |url=}}</ref> | The following factors are considered to be associated with poor prognosis among patients.<ref name="pmid10084487">{{cite journal |vauthors=Hirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer MR |title=Factors predicting mortality of patients with lung abscess |journal=Chest |volume=115 |issue=3 |pages=746–50 |year=1999 |pmid=10084487 |doi= |url=}}</ref> | ||
* Large size cavities(>6cms) | * Large size cavities(>6cms) | ||
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*Abscess due to aerobic bacteria and hospital acquired | *Abscess due to aerobic bacteria and hospital acquired | ||
*Bronchial obstruction due to tumors or foreign body (secondary abscess) | *Bronchial obstruction due to tumors or foreign body (secondary abscess) | ||
* | *Immunocompromised individuals | ||
==Complications== | ==Complications== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Symptoms of lung abscess begin approximately 10 days after aspiration of infected material. Symptoms lasting less than 14 days is considered acute lung abscess, while longer lasting symptoms constitute chronic lung abscess. Acute symptoms include a prodrome accompanied by fever, productive cough, pleuritic chest pain and occasional episodes of hemoptysis. Patients with chronic lung abscess develop weight loss and malaise. The prognosis of lung abscess is good with appropriate antibiotic treatment with a high success rate. Complications include hemorrhage pyopneumothorax pleural empyema and sepsis.
Natural History
- Lung abscess can occur at any age but most frequently seen in the fifth decades, with risk factors or underlying other lung disorders.[1]
- Clinical manifestations include fever, productive cough, pleuritic chest pain and occasional episodes of hemoptysis, typically developing 8-14 days after aspiration.
- The progression of the abscess is dependent on two factors: immune status of the patient and antibiotic therapy.
- In immunocompetent patients with adequate treatment abscess resolves by forming a granulation tissue scar, without treatment the abscess progressively worsens and can result in septicemia, hemorrhage, and death.
Prognosis
The prognosis of lung abscess is good with appropriate antibiotic treatment with a high success rate. The outcomes depend on the other associated conditions underlying lung abscess. The mortality rate of lung abscess is as high as 75% in patients with underlying immunocompromised state and bronchial obstruction favoring poor prognosis. The following factors are considered to be associated with poor prognosis among patients.[2]
- Large size cavities(>6cms)
- Old age
- Necrotizing pneumonia
- Prolonged symptoms
- Abscess due to aerobic bacteria and hospital acquired
- Bronchial obstruction due to tumors or foreign body (secondary abscess)
- Immunocompromised individuals
Complications
Without treatment, lung abscess can result in the following complications:
- Hemorrhage [3]
- Pyopneumothorax
- Pleural empyema[4]
- Fibrosis and calcification of lung tissue
- Mediastinal, pleural and cutaneous fistulas
- Sepsis
Reference
- ↑ Adebonojo SA, Osinowo O, Adebo O (1979). "Lung abscess: a review of three years' experience at the University College Hospital, Ibadan". J Natl Med Assoc. 71 (1): 39–43. PMC 2537236. PMID 423274.
- ↑ Hirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer MR (1999). "Factors predicting mortality of patients with lung abscess". Chest. 115 (3): 746–50. PMID 10084487.
- ↑ Philpott NJ, Woodhead MA, Wilson AG, Millard FJ (1993). "Lung abscess: a neglected cause of life threatening haemoptysis". Thorax. 48 (6): 674–5. PMC 464615. PMID 8346503.
- ↑ Schattner A, Dubin I, Gelber M (2016). "Double jeopardy - concurrent lung abscess and pleural empyema". QJM. 109 (8): 545–6. doi:10.1093/qjmed/hcw078. PMID 27208219.