Lung Abscess

A lung abscess is a condition in which a sac or cavity containing pus forms in the lungs. This condition causes the main symptom of coughing up phlegm that often contains blood or pus.

Lung abscesses are most often caused by bacterial infections. They can last less than 6 weeks (acute), or they can last longer than 6 weeks (chronic).

If treated properly, lung abscess has a good chance of healing. On the other hand, untreated lung abscess can cause serious complications and be fatal.

Causes of Lung Abscess

Based on the cause, lung abscesses are divided into two types, namely:

Primary lung abscess

Primary lung abscess occurs due to infection in the lungs themselves. The emergence of infection in the lung tissue is generally caused by the entry of fluid 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 a tumor, foreign object, or enlarged glands in the lungs.
• Bronchiectasis, which is the widening, thickening and damage of the airways (bronchi)
• Cystic fibrosis, a respiratory tract disease that causes mucus or phlegm in the respiratory tract to become thicker so that the flow of breath to or from the lungs is blocked.

Secondary lung abscess

A secondary lung abscess occurs when an infection in another part of the body spreads and infects the lungs. This infection can spread in a number of ways, including:

• The entry of bacteria that cause infections in the mouth or upper respiratory tract into the lungs
• Blood flow, which originates 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 experiencing a lung abscess, namely:

• Experiencing alcohol addiction or drug abuse
• Under the influence of drugs or sedatives
• Suffering from diabetes mellitus
• Suffering from severe tooth and gum disease
• Experiencing a coma for a long time
• Suffering from congenital heart disease
• Having a weak immune system, for example due to suffering from cancer or HIV/AIDS

Symptoms of Lung Abscess

The main symptom of a lung abscess is a persistent cough. Cough can be accompanied by sputum containing blood or pus that smells bad.

Other symptoms that may arise due to a lung abscess are:

• Chest pain
• Hard to breathe
• Weight loss
• Easily tired
• High fever, which is more than 38 ⁰ C
• Loss of appetite
• Bad breath (halitosis)
• Excessive sweating, especially at night

When to see a doctor

See a doctor immediately if you experience the symptoms mentioned above, especially if the symptoms persist or even worsen. Through early examination and treatment, the risk of complications of lung abscess can be prevented.

Diagnosis of Lung Abscess

To diagnose a lung abscess, the doctor will ask questions about the patient’s symptoms and medical history, followed by a physical examination. Next, the doctor will perform several supporting examinations to confirm the diagnosis, namely:

• Sputum test, to detect infection and determine the type of bacteria causing the infection.
• Chest X-ray, 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 ultrasonic waves.
• CT scan, to get a clearer picture compared to an X-ray so that lung abscesses are easier to detect.
• Bronchoscopy, to examine the inside of the lungs and take a sample of lung tissue (biopsy) for examination in the laboratory.

Lung Abscess Treatment

Treatment for lung abscess depends on the cause and severity. There are several treatment methods that can be done, 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 so that it 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 antibiotic use can vary from patient to patient, depending on the severity of the abscess. However, treatment for lung abscess is generally long, ranging from 3 weeks to 6 months.

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

Drainage

If antibiotics do not improve the patient within 10–14 days, the doctor will perform drainage to remove the abscess. Drainage is done by inserting a tube into the lungs, then the pus in the abscess will be sucked out.

Operation

Although rare, doctors can also perform surgery on patients who have experienced complications, such as the accumulation of pus in the lung membrane (empyema) or the formation of an abnormal channel (fistula).

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

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

Complications of Lung Abscess

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

• Empyema, which is a condition where pus accumulates and spreads into the cavity of the protective membrane of the lung.
• Bronchopleural fistula, which is a condition where 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 where an abscess damages blood vessels in the lungs, causing life-threatening bleeding.
• Death of lung tissue (pulmonary gangrene)
• Spread of infection to other organs of the body, such as the brain (brain abscess or meningitis)

Prevention of Lung Abscess

Given that the common cause of lung abscess is pulmonary aspiration, efforts that can be made are to prevent the occurrence of this condition. 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.
• 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 due to illness.
• Take medication according to your doctor’s instructions, especially medications that have the side effect of drowsiness.
• Keep your teeth and mouth clean.

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