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Lung Abscess


A lung abscess is a condition where a pocket or cavity filled with pus forms in the lungs. This condition causes the main symptom of coughing up phlegm, which often contains blood or pus. 

Lung abscesses are most often the result of a bacterial infection. This condition can last less than 6 weeks (acute) or last more than 6 weeks (chronic). 

Lung Abscess

If handled properly, a lung abscess has a high chance of healing. Conversely, untreated lung abscesses can cause serious complications and be fatal. 

Causes of Lung Abscess

Based on the cause, lung abscess is divided into two types, namely:

Primary lung abscess

A primary lung abscess results from infection within the lung itself. The emergence of infection in the lung tissue is generally caused by the entry of liquid or food containing bacteria directly into the lungs (pulmonary aspiration). This condition can occur when a person is unconscious due to the influence of alcohol or drugs, especially sedatives. 

Apart from pulmonary aspiration, primary lung abscesses can also occur due to the following conditions:

  • Pneumonia, especially aspiration pneumonia
  • Blockage of the airways in the lungs, either due to tumors, foreign bodies, or enlarged glands in the lungs
  • Bronchiectasis, namely widening, thickening, and damage to the airways (bronchi),
  • Cystic fibrosis, which is a disease of the respiratory tract that causes mucus or phlegm in the respiratory tract to become thicker so that the airway from or to the lungs is blocked

Secondary lung abscess

A secondary lung abscess occurs when the infection spreads to other parts of the body and infects the lungs. This infection can spread in various ways, namely:

  • Entry of bacteria that cause infection in the mouth or upper respiratory tract into the lungs
  • Blood flow, which comes from an infection in the heart,
  • Esophagus

Risk factors for lung abscess

There are a number of factors that can increase a person's risk of developing a lung abscess, namely:

  • Experiencing alcohol addiction or drug abuse
  • Are you under the influence of sedatives?
  • Suffering from diabetes mellitus
  • Suffering from severe tooth and gum disease
  • Been in a coma for a long time.
  • Suffering from congenital heart disease
  • Have a weak immune system, for example due to cancer or HIV/AIDS

Lung Abscess Symptoms

The main symptom of a lung abscess is a persistent cough. A cough may be accompanied by phlegm containing blood or pus that smells bad. 

Other symptoms that can appear due to a lung abscess are:

  • Chest pain
  • hard to breathe
  • Weight loss
  • Easily tired
  • high fever, which is over 380 °C.
  • Loss of appetite
  • Bad breath (halitosis)
  • Excessive sweating, especially at night

When to see a doctor

Immediately check with your doctor if you experience the symptoms mentioned above, especially if the symptoms persist or even get worse. Through early examination and treatment, the risk of developing lung abscess complications can be prevented. 

Diagnosis of pulmonary abscess

To diagnose a lung abscess, the doctor will conduct a question-and-answer session regarding the patient's symptoms and medical history, followed by a physical examination. Furthermore, the doctor will carry out several supporting examinations to confirm the diagnosis, namely:

  • Sputum test to detect infection and find out the type of bacteria causing the infection
  • Chest X-rays to see the condition of the inside of the lungs using X-rays
  • Ultrasound (USG) of the lungs to check for the presence of a lung abscess through the use of ultrasound waves
  • CT scan to get a clearer picture compared to X-rays so that lung abscesses are more easily detected.
  • Bronchoscopy: to examine the inside of the lungs and take samples of lung tissue (biopsy) to be examined in the laboratory.

Lung Abscess Treatment

Treatment of a lung abscess depends on the cause and severity. There are several treatment methods that can be used, namely:

Drugs

The doctor will prescribe antibiotics according to the results of the bacterial sensitivity test. This is so that the drug given is in accordance with the type of bacteria that infects it and can work effectively. Some types of antibiotics that can be given are:

  • Penicillin
  • Clindamycin
  • Piperacillin
  • Amoxicillin-clavulanate
  • Metronidazole
  • Ciprofloxacin
  • Vancomycin
  • Amikacin
  • Meropenem
  • Levofloxacin
The duration of using antibiotics can vary for each patient, depending on the severity of the abscess. However, the treatment for a lung abscess is generally quite long, ranging from 3 weeks to 6 months. 

In patients with secondary lung abscesses, the doctor will recommend treatment at the hospital to help treat the disease that triggers the abscess. 

Drainage

If the administration of antibiotics does not make the patient better within 10–14 days, the doctor will perform drainage to remove the abscess. Drainage is done by inserting a tube into the lung, and then the pus in the abscess will be sucked out. 

Operation

Although it rarely happens, doctors can also perform surgery on patients who have experienced complications, such as an accumulation of pus in the lining of the lungs (empyema) or the formation of abnormal passages (fistula). 

The type of surgery that can be performed is the removal of the damaged part of the lung (lobectomy) or the removal of the entire damaged lung (pneumonectomy). 

To help the healing process, patients will be asked to stop smoking and not consume alcoholic beverages. The patient will also be advised to drink more water. 

Lung abscess complications

If not treated properly, a lung abscess can cause the following complications:

  • Empyema, which is a condition when a collection of pus accumulates and spreads into the cavity of the lung lining,
  • Bronchopleural fistula, which is a condition when there is an abnormal hole in the lung that can cause air from inside the lung to leak out,
  • Pulmonary hemorrhage, which is a condition when an abscess damages the blood vessels in the lungs, causes bleeding that can be life-threatening.
  • Death of lung tissue (pulmonary gangrene)
  • Spread of infection to other organs of the body, such as the brain (brain abscess or meningitis).

Lung Abscess Prevention

Considering that a common cause of lung abscess is lung aspiration, efforts can be made to prevent this condition from occurring. Some efforts that can be made are:

  • Avoid eating and drinking excessively quickly. 
  • Get used to eating and drinking slowly. 
  • Chew food well before swallowing it. 
  • Always eat and drink in a sitting position. 
  • Avoid lying down immediately after eating and drinking. 
  • Position the head higher than the body when eating or drinking, especially for people who can only lie down because of pain. 
  • Take drugs according to your doctor's recommendations, especially drugs that have drowsy side effects. 
  • Keep your teeth and mouth clean. 

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