What is lung abscess, symptoms, causes and how to treat

Lung abscess is a cavity that contains pus in it, originated by a necrosis of the lung tissue due to a microbial infection.

Generally, the abscess forms between 1 to 2 weeks after contamination by the microorganism, which, in most cases, occurs due to a complication of pneumonia caused by aspiration of the contents of the mouth or stomach, as they contain bacteria more likely to develop this type. injury. Understand how comes to aspiration pneumonia . 

The diagnosis is made by the doctor through the evaluation of the clinical picture, pulmonary radiography and blood tests. Then, it is essential to start treatment with antibiotics that help fight the microorganisms that cause it, in association with nutritional support and physiotherapy. In more severe cases, pulmonary drainage may be necessary.

Lung abscess symptoms

The main symptoms of lung abscess include:

  • Fever;
  • Shortness of breath and tiredness;
  • Cough with mucopurulent discharge, which may contain an unpleasant odor and streaks of blood;
  • Chest pain that worsens with breathing;
  • Loss of appetite;
  • Weight loss;
  • Night sweat and chills.

The worsening of the clinical picture can take days to weeks, depending on the bacteria that caused the infection, the health conditions and defenses of the affected person’s body. Generally, only one abscess is formed, measuring more than 2 cm in diameter, however, in some cases, multiple abscesses may appear during infection. 

When signs and symptoms appear that may indicate this type of lung infection, it is necessary to consult the pulmonologist as soon as possible, or to go to the emergency room, so that the cause is identified and the appropriate treatment is started immediately.

How is the diagnosis

The diagnosis of lung abscess is made by the doctor, through the analysis of symptoms, physical examination, in addition to tests such as chest radiography, which shows the presence of secretion infiltrates in the lung and the cavity area, usually rounded, filled with pus and air. 

Blood tests, such as a blood count, can help demonstrate the presence of an infection and assess severity. Computed tomography of the chest, on the other hand, can help to better define the location of the abscess, and to observe other complications such as a lung infarction or accumulation of pus in the pleural fluid.

The identification of the microorganism may be necessary in some cases, especially to guide treatment, for which a culture of pulmonary sputum may be performed, or the collection of material from infection by tracheal aspirate or thoracentesis, for example, or even by a blood culture. . See how the test is done to identify the best antibiotic to treat the infection . 

What causes lung abscess

Lung abscess is caused when microorganisms, usually bacteria, settle in the lung and cause tissue necrosis. The penetration of microorganisms can happen through the following mechanisms:

  • Aspiration of infectious material (most frequent cause): more common in cases of alcoholism, drug use, coma or anesthesia, in which the loss of consciousness facilitates the aspiration of contents from the mouth or stomach, as well as in cases of sinusitis, infections in the gums, tooth decay or even when you can’t get an effective cough;
  • Pulmonary infection;
  • Cancer;
  • Direct traumatic penetrations into the lungs;
  • Spread of infections from a neighboring organ;
  • Pulmonary embolism or infarction.

When lung abscess arises from direct infection of the lung, it is characterized as  primary . In cases where it arises due to complications of pulmonary changes, such as the spread of infection from other organs or pulmonary embolism, it is called secondary . 

Some of the most common microorganisms as a cause of lung abscess are Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa or Streptococcus pyogenes, or anaerobic bacteria, such as Peptostreptococcus, Prevotella or Bacteroides sp , for example. Fungal or mycobacterial abscesses are rarer and occur more frequently in people with very weak immunity.

How the treatment is done

Treatment for lung abscess is done with antibiotics such as Clindamycin, Moxifloxacin or Ampicillin / Sulbactam, for example, for an average of 4 to 6 weeks, depending on the causing microorganism and the patient’s clinical conditions. 

During the acute phase, nutritional support and respiratory physiotherapy are also indicated. If the initial treatment is not effective, surgery should be performed to drain the abscess, and in the last case, remove the part of the necrotic lung.

Physiotherapy for lung abscess

Physiotherapy is important to assist recovery, and is done through:

  • Postural drainage: after localization of the lung abscess, the individual is positioned in the direction of the source bronchus for later elimination of secretions through coughing;
  • Respiratory kinesiotherapy: breathing exercises are oriented to increase chest expansion and normalize lung volumes;
  • Incentive spirometry: the person is instructed to take a deep breath (pull the air into the lungs) and keep it for a few seconds. It can be done through devices such as Respiron;
  • Aspiration of secretions if the person is unable to cough.

Physical therapy for lung abscess is most effective in collaborative people who respond to requests for coughing and breathing exercises. Learn more about how respiratory physiotherapy is done and what it is for .

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