Lung abscess natural history, complications and prognosis
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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
- ↑ 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.