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 (medicine)|acute]] lung [[abscess]], while longer lasting symptoms constitute [[Chronic (medical)|chronic]] lung [[abscess]]. Acute symptoms include a prodrome accompanied by [[Fever|fever,]] [[productive cough]], pleuritic [[chest pain]] and occasional episodes of [[hemoptysis]]. Patients with chronic lung abscess develop [[weight loss]] and [[Malaise|malaise.]] The prognosis of lung abscess is good with appropriate antibiotic treatment with a high success rate. Complications include [[hemorrhage]], | Symptoms of lung abscess begin approximately 10 days after [[aspiration]] of [[infected]] material. Symptoms lasting less than 14 days is considered [[Acute (medicine)|acute]] [[lung]] [[abscess]], while longer lasting symptoms constitute [[Chronic (medical)|chronic]] lung [[abscess]]. Acute symptoms include a prodrome accompanied by [[Fever|fever,]] [[productive cough]], [[pleuritic]] [[chest pain]] and occasional episodes of [[hemoptysis]]. Patients with chronic lung abscess develop [[weight loss]] and [[Malaise|malaise.]] The prognosis of lung abscess is good with appropriate [[Antibiotics|antibiotic treatment]] with a high success rate. Complications include [[hemorrhage]], pyopneumothorax, [[pleural empyema]] and [[Sepsis|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 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 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 (> 6 cm) | * Large size cavities (> 6 cm) | ||
*[[Old age]] | *[[Old age]] | ||
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*Pyo[[pneumothorax]] | *Pyo[[pneumothorax]] | ||
*[[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> | *[[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 | *[[Fibrosis]] and [[calcification]] of lung [[tissue]] | ||
*[[Mediastinum|Mediastinal]], [[pleural]] and [[Fistulas|cutaneous fistulas]] | *[[Mediastinum|Mediastinal]], [[pleural]] and [[Fistulas|cutaneous fistulas]] | ||
*[[Sepsis]] | *[[Sepsis]] | ||
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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
- The symptoms of lung abscess usually develop during the fifth decade of life with risk factors, and start with symptoms such as fever, productive cough, pleuritic chest pain and occasional episodes of hemoptysis, typically developing 8-14 days after aspiration [1]
- Without treatment based on the immune status of the patient, lung abscess can either resolve by forming a granulation tissue scar, or 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 (> 6 cm)
- 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.