Lung Abscess
A lung abscess is the formation of a cavity (hole) in the lung tissue that is larger than 2 centimeters. This hole contains a collection of dead lung tissue (necrosis) due to bacterial infection. This condition is part of a lung infection.
According to the time of occurrence, lung abscesses can be divided into two types, namely acute and chronic lung abscesses. Acute lung abscesses occur less than 6 weeks and lung abscesses are said to be chronic if they occur more than 6 weeks.
Symptoms of Lung Abscess
The early signs and symptoms of this condition are usually not too different from a common lung infection. Some symptoms of a lung abscess include:
- Fever.
- Shivering.
- Cough.
- Sweating especially at night.
- Hard to breathe.
- Weight loss and fainting.
- Chest pain.
- Anemia.
Cough that occurs in lung abscess is usually not phlegmy at first. But then it becomes phlegmy and sometimes accompanied by coughing up blood.
Risk Factors for Lung Abscess
People with alcohol use disorders or who have recently been sick (especially with pneumonia) are at higher risk of developing the disease. Others at risk include those with weakened immune systems.
Several factors can increase the risk of lung abscess, including:
- Inability to cough. This often occurs due to anesthesia, alcohol or drug use, nervous system disease, and sedation.
- Poor oral health. People with gum disease are more likely to develop a lung abscess.
- Immune system that does not work properly. This condition can allow germs to enter the mouth or throat. These germs include fungi or bacteria that cause tuberculosis, strep throat, and Methicillin-Resistant Staphylococcus aureus (MRSA). This risk can also be experienced by people with weak immune systems, such as people with HIV, cancer, or people who have had organ transplants.
- Blockage of the airway. Mucus can build up behind a tumor or foreign object in the throat, which can lead to an abscess. If bacteria get into the mucus, it can cause a blockage that can prevent you from coughing.
- Bloodborne causes. Although rare, bacteria or infected blood clots from other parts of the body can spread through the bloodstream and enter the lungs. This can cause a lung abscess.
The risk is high for people who have recently been anesthetized and those who are unconscious due to injury or illness. Inhaling a foreign object that blocks a large airway is also a risk factor.
Causes of Lung Abscess
Based on the cause, lung abscesses are divided into two, namely:
1. Primary lung abscess
This condition occurs due to a process in the lungs themselves and occurs in almost 60 percent of all cases. Causes of primary lung abscesses include aspiration (entry of objects other than air into the respiratory tract), for example due to dental infections, nose, impaired consciousness, swallowing disorders, gastric reflux disease, frequent vomiting, lung infections (pneumonia), or in conditions of very low immune system ( immunocompromised )
2. Secondary lung abscess
This condition occurs as a result of a process elsewhere. Some causes that can cause this condition are airway obstruction, for example by tumors, foreign objects, or enlarged lymph nodes, accompanied by lung disease (such as bronchiectasis, bullous emphysema, cystic fibrosis, pulmonary infarction, or pulmonary contusion).
In addition, the secondary type can be the result of blood-borne spread from another place, such as in sepsis, infective endocarditis, infection in the central venous catheter, and so on. Another cause of the secondary type is the result of direct spread. This can occur if there is a hole connecting the bronchus and esophagus and in subphrenic abscess.
Lung Abscess Diagnosis
Doctors usually identify lung abscesses by analyzing symptoms, risk factors and physical symptoms. On physical examination, doctors can usually find symptoms of fever. The doctor may also hear bronchial breath sounds and the overlying area may sound dull when the chest is tapped.
After a physical examination, your doctor may also need to perform one or more of the following types of tests:
1. Imaging tests
Computerized tomography (CT) of the chest is one of the effective tests. In addition, a lung ultrasound test can also help evaluate abscesses, especially those experienced by children. CT scans can also help distinguish between lung abscesses and empyema.
2. Bacterial culture analysis
Sometimes a sample of coughed-up sputum needs to be taken for laboratory analysis. However, this form of testing tends to be inaccurate.
Lung Abscess Treatment
The use of standard therapy that is usually used to treat lung abscess is antibiotics. Some types of antibiotics to treat lung abscess, namely:
- Clindamycin.
- Metronidazole.
- Combination of beta-lactam groups.
- Macrolides.
- Aminoglycosides.
The doctor will perform a complete examination to determine what type of antibiotic is right. Improvement in the condition usually occurs within 4-7 days, but healing and improvement in imaging results can be seen after about 2 months.
For abscesses that are larger than 6 centimeters or symptoms that have been felt for more than 12 weeks after taking antibiotics, a surgical procedure may be required.
The most common surgical procedures are lumpectomy or segmentectomy. Performing these procedures the doctor will remove the abscess and some of the surrounding tissue. This procedure can be done with minimally invasive surgery, namely thoracoscopic surgery assisted by video images.
However, surgical procedures are generally performed if there are indications such as the following:
- Large abscess (more than 6 centimeters in diameter).
- Coughing up blood.
- Sepsis.
- Prolonged fever or increased white blood cell count.
- Formation of bronchopleural fistula.
- Empiema.
- Treatment of the abscess with antibiotics or drainage is unsuccessful.
- If there is any suspicion of accompanying cancer.
The side effects that can occur in antibiotic therapy depend on the type of antibiotic used. While for surgical therapy, the side effects that can occur are bleeding, infection, or can be fatal if not done by an expert, or in general conditions that are at risk, such as in elderly sufferers, malnutrition, or alcoholics.
Prevention of Lung Abscess
Some efforts to prevent lung abscesses, namely:
- Eat nutritious food.
- Implement a healthy lifestyle.
- Stop drinking alcohol.
- Visit a doctor if you have medical problems related to breathing.
Complications of Lung Abscess
In rare cases, a lung abscess can rupture. If this occurs, it is a serious medical problem. Surgical treatment can also cause complications. Potential complications after rupture or surgical treatment of an abscess include:
- Empyema. In empyema, a large collection of infected fluid accumulates around the lung near an abscess. This condition can be life-threatening. Immediate medical care is needed to drain the fluid.
- Bronchopleural Fistula. A bronchopleural fistula is an abnormal connection that develops between a large airway inside the lung and a space in the lining around the outside of the lung. Surgery or bronchoscopy can repair it. In a bronchoscopy, a bronchoscope and sealant can close the fistula.
- Bleeding from the Lungs or Chest Wall. This can be a small amount of blood or a large amount of blood, which is life-threatening.
- Infection Spreads to Other Parts of the Body. If the infection leaves the lungs, it can produce abscesses in other parts of the body, including the brain.