Lung abscess history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Kiran Singh, M.D. [2] ;Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [3]

Overview

Patient history is important to establish a diagnosis of lung abscess. Common history findings include conditions associated with a risk of gastric content aspiration, a recent history of hospitalization or surgery. Common symptoms include high fever (>101°F [>38.5°C]), productive cough with purulent sputum, and pleuritic chest pain. The presence of a purulent sputum is pathognomic of acute lung abscess.

History

A detailed and thorough history from the patient is necessary. Following past medical history is evident in patients with lung abscess.

There may be a history of a condition associated with a risk of gastric content aspiration, such as dysphagia associated with neurologic disease (e.g., stroke, bulbar dysfunction) or esophageal disease (stricture, malignancy, and reflux), or poor dentition and gingivitis.
There may also be a recent history of pneumonia, general anesthesia, nasogastric or endotracheal tube insertion, tooth extraction , dental surgery or oropharyngeal surgery.
Risk factors for pulmonary embolism should be investigated in a patient suspected of this diagnosis.^[1]
Underlying chronic illness predisposing to lung abscess (e.g., COPD, bronchiectasis, diabetes mellitus, scleroderma, esophageal diverticulum, liver and kidney disease) or immunosuppression (e.g., chemotherapy, organ transplantation, corticosteroid therapy, HIV infection) should also be noted.

Symptoms

Presentation of lung abscess depends upon on the duration of symptoms, it can be acute or chronic
Acute presentation

High fever (>101°F [>38.5°C])
Productive cough with purulent sputum, and pleuritic chest pain ^[2]
Large amounts of purulent secretions are expectorated in the second or third week of the disease
Putrid sputum is present in about 50% of patients (foul-smelling sputum is highly suggestive of an anaerobic infection)^[3]

Chronic presenation

Profound weight loss, malaise^[4]
Low-grade fever, night sweats
Productive cough
These symptoms mimic those of malignancy (hematologic malignancies).
Massive hemoptysis can be present in chronic lung abscess.^[5]

Reference

↑ 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.
↑ Chan PC, Huang LM, Wu PS, Chang PY, Yang TT, Lu CY, Lee PI, Chen JM, Lee CY, Chang LY (2005). “Clinical management and outcome of childhood lung abscess: a 16-year experience”. J Microbiol Immunol Infect. 38 (3): 183–8. PMID 15986068.
↑ Grippi, Michael (2015). Fishman’s pulmonary diseases and disorders. New York: McGraw-Hill Education. ISBN 978-0071807289.
↑ Ferri, Fred (2015). Ferri’s clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
↑ 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.

Template:WikiDoc Sources

[pmid10084487-1] 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.

[pmid15986068-2] Chan PC, Huang LM, Wu PS, Chang PY, Yang TT, Lu CY, Lee PI, Chen JM, Lee CY, Chang LY (2005). “Clinical management and outcome of childhood lung abscess: a 16-year experience”. J Microbiol Immunol Infect. 38 (3): 183–8. PMID 15986068.

[3] Grippi, Michael (2015). Fishman’s pulmonary diseases and disorders. New York: McGraw-Hill Education. ISBN 978-0071807289.

[4] Ferri, Fred (2015). Ferri’s clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.

[pmid8346503-5] 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.

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