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==Overview==


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==Overview==
==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.<ref name="pmid423274">{{cite journal |vauthors=Adebonojo SA, Osinowo O, Adebo O |title=Lung abscess: a review of three years' experience at the University College Hospital, Ibadan |journal=J Natl Med Assoc |volume=71 |issue=1 |pages=39–43 |year=1979 |pmid=423274 |pmc=2537236 |doi= |url=}}</ref>
* 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.


==Natural History==
== 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>
* 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)
*Immuncompromised individuals


==Complications==
==Complications==
Rare now a days but include spread of infection to other lung segments, [[bronchiectasis]], [[empyema]], and bacteraemia with [[metastasis|metastatic]] infection such as [[brain abscess]].
Without treatment, lung abscess can result in the following complications:
 
*Hemorrhage <ref name="pmid8346503">{{cite journal |vauthors=Philpott NJ, Woodhead MA, Wilson AG, Millard FJ |title=Lung abscess: a neglected cause of life threatening haemoptysis |journal=Thorax |volume=48 |issue=6 |pages=674–5 |year=1993 |pmid=8346503 |pmc=464615 |doi= |url=}}</ref>
== Prognosis ==
*Pyopneumothorax
Most cases respond to antibiotic and prognosis is usually excellent unless there is a debilitating underlying condition. Mortality from lung abscess alone is around 5% and is improving.
*Pleural empyema<ref name="pmid27208219">{{cite journal |vauthors=Schattner A, Dubin I, Gelber M |title=Double jeopardy - concurrent lung abscess and pleural empyema |journal=QJM |volume=109 |issue=8 |pages=545–6 |year=2016 |pmid=27208219 |doi=10.1093/qjmed/hcw078 |url=}}</ref>
*Fibrosis and calcification of lung tissue
*Mediastinal, pleural and cutaneous fistulas
*Sepsis


== Reference ==
== Reference ==

Revision as of 13:01, 6 February 2017

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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

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)
  • Immuncompromised 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

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.

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