High fever, cough, and yellow sputum, beware of lung abscess!

Author: Fang Baomin, Chief Physician, Beijing Hospital

Reviewer: He Quanying, Chief Physician, Peking University People's Hospital

Have you ever heard of lung abscess?

It sounds like a very serious disease, but in fact, with active treatment, most patients can be completely cured within three months without any remaining lung damage.

However, if not treated promptly, it may cause sepsis or even multiple organ failure, leading to death.

1. What exactly is lung abscess?

Lung abscess, formerly known as lung abscess, is actually a purulent inflammation of the lungs. Most of the time, it is caused by one or more bacterial infections that lead to damaged lung tissue function, suppuration and necrosis, and then the formation of an abscess.

Figure 1 Original copyright image, no permission to reprint

There are many pathogens that can cause lung abscesses, the most common ones are Pneumococcus, Staphylococcus aureus, Klebsiella pneumoniae and other bacteria. In addition, the fungus Aspergillus can also cause lung abscesses. Some patients also have lung abscesses caused by infection with amoeba.

In the acute stage of lung abscess, patients often experience high fever, chills, cough, sputum, and even large amounts of yellow sputum or purulent and smelly sputum. These manifestations are often the initial changes of the disease.

If the disease is not controlled in time, particularly serious patients may develop sepsis or septic shock, such as a drop in blood pressure.

If it is not treated promptly for a long time, it may even lead to the failure of other organ functions, such as decreased heart function or kidney failure, etc. Therefore, lung abscess must be diagnosed and treated promptly.

If the medication is used properly and after adequate treatment, the symptoms will gradually improve. The body temperature will drop to normal, the white blood cell count will drop to normal, the sputum volume will gradually decrease, and chest CT or X-ray examinations will show that the abscess is getting smaller and smaller, and the disease will gradually be cured.

Of course, some patients will not be completely cured and will have long-term symptoms of cough, sputum, and low-grade fever. These patients need long-term follow-up to monitor changes in their condition.

2. What are the causes of lung abscess?

There are many causes of lung abscess, the main ones are as follows:

The first is inhalation, which mainly involves inhaling pathogens from the oral cavity, nasal cavity, and pharynx. For example, after a gum infection, the pathogens in the oral cavity may be inhaled into the airway, along the trachea and bronchi, to the distal small bronchi, where suppuration occurs and destroys the local bronchial tissue, forming an abscess cavity. Some patients also have swallowing disorders, especially the elderly. If they have swallowing disorders, they may aspirate and cause lung abscesses. This type of lung abscess is called aspiration lung abscess.

The second is blood-borne infection. When there are infection foci in other parts of our body, such as pyelonephritis, cystitis in the urinary tract, infection in the bile duct, or even infection in the intestine, or infection after surgery, bacteria can reach the lungs through the blood, thus causing lung abscess. This type of lung abscess is called hematogenous lung abscess.

The third is primary lung lesions, such as lung tumors, bronchiectasis, or pulmonary lobe deformities, bronchial deformities, which lead to secondary infection after obstruction of lung tissue and can also form lung abscesses. This type of lung abscess is called secondary lung abscess.

There is also a situation that is particularly rare now, which is the infection of amoeba mentioned above. After the amoeba pathogen enters the body and reaches the lungs, it can also cause lung abscess. This type of lung abscess is called amoebic lung abscess.

3. How to treat lung abscess?

Once you have a lung abscess, you must seek treatment immediately.

For acute lung abscesses, since most of them are bacterial infections, we need to identify the specific pathogen, so we need to do a sputum culture test and choose different antibiotics for treatment based on the results.

Figure 2 Original copyright image, no permission to reprint

However, before the results of sputum culture test come out, we need to conduct empirical treatment, because more than 90% of lung abscesses are caused by anaerobic infection. We can first use antibiotics against anaerobic bacteria for treatment, and then make adjustments after the results of sputum culture come out.

Generally, after one to two months of treatment, we judge the treatment effect of the disease based on changes in body temperature, cough, sputum volume, and imaging review, especially dynamic changes in X-rays or CT.

If all these symptoms are improving, we will continue the treatment. Some patients may need to continue treatment for three months or even longer.

In addition, in the acute stage of lung abscess, in addition to using antibiotics, we can also use postural drainage according to the location of the lung abscess. Because lung abscesses are often connected to the bronchus, for example, if the lesion is in the left upper lung, the patient should be placed in the right side lying position, and then the back should be patted to drain the sputum. This postural drainage is a more common method.

There is also symptomatic and supportive treatment. During the acute infection process, if there is hypoproteinemia, protein should be actively transfused. If there is anemia, anemia should be actively corrected, as well as systemic nutritional support and symptomatic treatment.

If the patient does not improve after three to six months of our strict medical treatment, and thick-walled cavities and chronic lung abscesses are formed, surgical intervention may be necessary.

At the same time, if combined with empyema, bronchopleural fistula, lung cancer, massive hemoptysis, systemic symptoms of poisoning, or recurrent pneumothorax, etc., these conditions may also require surgical intervention.

In short, the treatment of lung abscess is relatively complicated, and appropriate treatment measures should be taken according to the different conditions of each patient.