Lung Abscess: Causes – Symptoms and Treatment

What is a Lung Abscess?

Lung abscess is a condition when a bacterial infection attacks the lungs, causing pus to appear and is characterized by coughing up phlegm. ^[1,2,5,6,7]

Patients who produce phlegm when coughing, usually this phlegm will contain pus, blood and an unpleasant odor.Lung abscess is a condition when a bacterial infection attacks the lungs, causing pus to appear and is characterized by coughing up phlegmPatients who produce phlegm when coughing, usually this phlegm will contain pus, blood and an unpleasant odor.

When a bacterial infection occurs in lung tissue, it causes tissue death, which is then filled with pus.

If not treated promptly, death is the worst consequence of this disease.

Overview.
A lung abscess is a lung condition that is infected by bacteria and then pus arises and is usually characterized by coughing up bloody phlegm or coughing up purulent phlegm.

Facts About Lung Abscess

1. Lung abscess can occur in anyone and at any age, but the age of the child has a very low risk of developing this disease ^[6].
2. The mortality rate of lung abscess in the past hundreds of years was very high and reached a percentage of 75%. ^[1].
3. The procedure of administering antibiotics for the treatment of lung abscesses can then reduce the risk of death by 8.7% and surgical removal of abscesses reduces the risk of death by 20-35% ^[1].
4. In 90% of cases of lung abscess, the sufferer can recover using a prescription antibiotic from a doctor without experiencing any health complications ^[3].

Types of Lung Abscesses According to their Causes

Lung abscesses are classified into two types of conditions, according to the cause, namely primary lung abscess and secondary lung abscess ^[1,4,6].

This is because lung abscesses can develop from a number of different causative factors as well as different types of bacteria.

Primary Lung Abscess

The cause of primary lung abscess is an infection in the lung, such as aspiration pneumonia.

This type of pneumonia is an infectious condition whose development can occur after a foreign object enters the lung.

Food or other foreign objects that should enter the throat can be directly inhaled and then enter the lungs.

Because it persists in the lungs and cannot be expelled again, over time a bacterial infection is triggered to rise, causing inflammation of the lungs.

If you don’t get prompt and proper treatment, abscesses can occur and threaten the life of the sufferer.

Several types of bacteria that can cause lung abscess include: ^[6]:

• Peptostreptococcus spp
• Bacteroides spp
• Fusobacterium spp
• Mycoplasma pneumoniae (rare)
• Klebsiella pneumonia
• Staphylococcus aureus
• Streptococcus spp
• Pseudomonas aeruginosa
• Escherichia coli

Secondary Lung Abscess

In secondary lung abscess, the cause of this condition is not an infection in the lungs.

There are other conditions that then cause the lung to be affected and lead to a lung abscess.

In other words, lung abscess occurs as a complication of other medical conditions, such as:

• The airways in the lungs are blocked (enlarged glands in the lungs or the presence of a tumor can be a trigger).
• Endocarditis: The inner wall of the heart becomes infected.
• Bronchiectasis: The airways when breathing called bronchi are damaged in their tissues, thicken and widen.
• Cystic Fibrosis: Formation of mucus in the digestive system and/or lungs where this condition is a congenital abnormality that is also at risk of complications causing a lung abscess.
• Peritonitis: Inflammation of the peritoneum or the thin protective lining of the abdominal organs can cause an infection that has the potential to spread to the lungs if left untreated. This infection, then triggers an abscess and threatens the life of the sufferer.

Lung Abscess Risk Factors

Apart from several other medical conditions that can trigger a lung abscess, there are also several factors that also increase a person’s potential to develop a lung abscess ^[1,5].

• Alco**hol abuse or excessive alco**hol consumption in the long term, so that it has become an addict.
• Have a low immune system.
• People with HIV/AIDS and cancer.
• The use of drugs that can make the body’s immune system go down easily.
• Being under the influence of sedatives or anesthetics.
• Have a poor overall body health condition.
• Insufficient or poor nutritional intake.
• Have an autoimmune disease.
• After organ transplant.

Overview.
- According to the cause, there are two types of lung abscess conditions, namely primary lung abscesses and secondary lung abscesses. 
- Primary lung abscesses are caused by direct infection of the lungs, while secondary lung abscesses are lung abscesses that occur as complications from other medical conditions. 
- Weak immune system, poor nutrient intake, alcohol use, and use of certain medications have the potential to increase the risk of lung abscesses.

Lung Abscess Symptoms

The main and most visible symptom of a lung abscess is a persistent cough.

The type of cough experienced by sufferers is usually a cough with phlegm accompanied by blood or pus..

Sputum that comes out with pus or blood when coughing is usually accompanied by an unpleasant odor.

But in addition to persistent cough with phlegm, some other accompanying symptoms include: ^[1,2,5,6]:

Overview.
A persistent cough is the main sign of a lung abscess, but it can also be accompanied by coughing up bloody sputum, coughing up purulent sputum, shortness of breath, fever, chest pain, excessive night sweats, weight loss, and foul-smelling breath..

Lung Abscess Examination

Since the symptoms of a persistent cough or coughing up phlegm accompanied by blood, doctors cannot confirm that a person has a lung abscess.

For this reason, several methods other than physical examination need to be carried out, namely follow-up examinations to confirm lung abscess ^[1,2,5,6].

• Medical History Examination: The doctor will find out in advance whether the patient is using certain drugs, whether the patient has recently undergone surgery, and what medical conditions the patient has.
• Bronchoscopy: This examination is done by a doctor to be able to identify the condition of the inside of the lungs using a tube equipped with a camera at the end. Through this method, doctors can also take samples of lung tissue for examination in the laboratory.
• X-ray Examination: X-ray or examination using X-rays will help the doctor in finding out whether there is an abscess in the patient’s lung from the test results in the form of images.
• CT Scan: For a more detailed examination, the identification of an abscess in the patient’s lung can be done through a scanning test such as a CT scan.
• Ultrasound: The use of ultrasonic waves will help doctors in detecting abscesses in the patient’s lungs more clearly.

Overview.
The examination to detect lung abscesses and confirm them is through physical examination, medical history, bronchoscopy, X-ray examination, ultrasound, and/or CT scan.

Lung Abscess Treatment

There are two methods of treating lung abscesses, namely with antibiotics and surgical steps where the patient’s condition determines what treatment is given by the doctor.

1. Giving Antibiotics

Because bacterial infection is the main cause in most cases of lung abscess, the most appropriate treatment is through the administration of antibiotics to the patient ^[1,2,5,6,7].

The doctor will prescribe antibiotics that are tailored to the type of bacteria that causes the disease.

Antibiotics are usually initiated by injection rather than oral antibiotics.

The doctor gives this antibiotic to the patient for approximately 3-8 weeks.

After that, depending on the doctor’s decision and the patient’s condition, the doctor will prescribe oral antibiotics as a follow-up treatment.

The doctor prescribes oral antibiotics after the patient first takes another x-ray to see if the abscess in the lung is gone.

2. Surgery

Surgery is recommended by doctors if antibiotics are deemed insufficient, because the patient’s condition is quite serious.

The surgery also has different goals and the doctor will adjust it according to the patient’s lung abscess condition ^{[1,2,3,4,5,6,7]}.

• Abscess Removal Surgery: During the examination process, an abscess more than 6 cm in diameter was found. The doctor will first ask the patient to take a CT scan so that the abscess suction device can be inserted through the patient’s chest wall.
• Surgical Removal of Partial Lung Tissue: In addition to removing the abscess or pus, your doctor may recommend other surgical procedures. If necessary, the doctor will advise the patient to undergo surgery to remove the part of the lung that has been affected by the abscess. So in this operation, it is no longer the abscess that is removed, but the part of the lung that has been affected must be removed.
• Surgical Removal of Entire Lung Tissue: However, when the infection has affected all parts of the lung, the doctor will recommend the patient for surgical removal of the entire lung tissue.
• Surgical Removal of Foreign Body: If a foreign object is found in the patient’s lungs, there is a possibility that the doctor will also suggest that the patient undergo surgery to remove the object.

Overview.
The administration of antibiotic drugs is the main treatment in patients with lung abscesses. However, if antibiotics are not enough, abscess removal surgery, surgical removal of part of the lung or entire lung, or surgical removal of a foreign body are medical procedures that doctors recommend.

Complications of Lung Abscess

Lung abscess that is treated late or not treated properly can increase the risk of various health complications, including: ^[1,3,4,6] :

• Ruptured Abscess: A ruptured lung abscess is one of the worst and most serious complications although this is very rare.
• Spread of Infection: Infections that start from the lungs can spread to other organs of the body and produce abscesses, including the part of the brain which is also known as sepsis.
• Bleeding: Bleeding is one form of complications that can occur mildly or seriously because too much blood comes out. Bleeding generally occurs from the patient’s chest wall or lungs.
• Bronchopleural fistula: If the abscess completely ruptures within the lung, the subsequent leakage causes a bronchopleural fistula. This is a condition where air is released from the lungs to the outside of the lungs and can only be corrected by surgery.
• Empyema : The formation of a large amount of pus in the pleura (the space between the inside of the chest wall and the lungs) can occur especially if the lung tissue becomes infected.

Overview.
An abscess that is not treated properly is capable of causing several complications such as empirics, sepsis, bronchpleural fistulas, bleeding from the lungs, and rupture of abscesses.

Lung Abscess Prevention

Maintaining personal hygiene is the most effective way to prevent various types of bacterial infections, including infections that cause lung abscesses.

Prevention can also be done by overcoming infectious diseases in other organs as soon as possible so that they do not spread and cause lung abscesses.

Increasing endurance and eating a balanced nutritious diet is also a way to keep the body strong and healthy.