Lung abscess natural history, complications and prognosis

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.

Template:WikiDoc Sources

[pmid423274-1] 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.

[pmid10084487-2] 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.

[pmid8346503-3] 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.

[pmid27208219-4] 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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