Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.

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Symptoms and Risk Factors

The Insidious and Deceptive Onset

Lung abscesses can be tricky to spot because their symptoms vary and often develop slowly, depending on the type of bacteria and the patient’s immune system. Unlike regular pneumonia, which starts suddenly, a lung abscess from mouth bacteria usually comes on gradually. The event that causes the infection, like inhaling food or saliva, may have happened one or two weeks before symptoms start, and patients often do not remember it. Early symptoms can look like mild pneumonia or bronchitis, with low fever, tiredness, and feeling unwell. As the abscess grows, symptoms get worse. At Liv Hospital, we teach our doctors to watch for this slow pattern, especially in patients with risk factors, to avoid missing the diagnosis.

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The Hallmark Respiratory Symptoms

PULMONOLOGY

Breathing symptoms are usually the main reason people with a lung abscess go to the doctor.

  • Cough: Present in almost all cases. Initially, during the pneumonitis phase, it may be dry or minimally productive. As necrosis occurs, it becomes more persistent.
  • Vomica: The defining clinical event for many patients is the sudden coughing up of a large amount of purulent material, known as vomica. This occurs when the abscess erodes into a bronchus, establishing a drainage pathway. The volume can be substantial, sometimes filling cupfuls per day, and can be frightening for the patient.
  • Putrid sputum: In about half of cases with anaerobic bacteria, the sputum smells very bad and can be noticed from a distance. This strong odor is a key sign of this type of infection, but not having it does not rule out a lung abscess.
  • Hemoptysis: Coughing up blood happens in about a third of patients. It is usually just blood-streaked sputum from irritated airways, but sometimes it can be a lot of blood if the infection damages a blood vessel, which can be life-threatening.
  • Pleurisy: If the abscess is near the edge of the lung, it can cause sharp chest pain that gets worse with deep breaths, coughing, or moving, making it hard to breathe deeply.
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Constitutional Symptoms: The Wasting Disease

PULMONOLOGY

A chronic lung abscess uses up the body’s energy and causes ongoing inflammation by releasing certain chemicals into the bloodstream.

  • Fever: Fevers can be high and spiking in acute cases or low-grade and persistent in chronic cases. They are often accompanied by drenching night sweats that require the patient to change bedclothes.
  • Weight loss: Losing a lot of weight without trying is common in chronic lung abscesses. When combined with anemia and tiredness, these symptoms can look like lung cancer or tuberculosis, so doctors often check for those first.
  • Clubbing: The fingertips can swell and the nails change shape within weeks in people with a lung abscess. This happens faster than in other lung diseases and usually goes away once the abscess is treated.
  • Anemia: Ongoing infection often causes anemia, which leads to pale skin and feeling weak.

Aspiration: The Primary Risk Factor

Aspiration is the main way bacteria enter the lungs to cause a primary abscess. Anything that affects swallowing, coughing, or staying alert increases the risk.

  • Altered Consciousness: Alcohol intoxication is the single most common risk factor associated with lung abscess. Other significant causes include general anesthesia, drug overdose involving sedatives or opioids, seizures, particularly during the post-ictal state, and cerebrovascular accidents or strokes.
  • Neurologic Dysphagia: Patients with neurodegenerative diseases such as Parkinson’s disease, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, or dementia often have uncoordinated swallowing mechanisms. This leads to silent aspiration of saliva or food particles, often without a protective cough response.
  • Esophageal Disorders: Conditions like Achalasia, Zenker’s diverticulum, esophageal strictures, and severe Gastroesophageal Reflux Disease facilitate the regurgitation and aspiration of gastric contents and food particles into the lungs, causing chemical pneumonitis that can become secondarily infected.
PULMONOLOGY

Periodontal Disease: The Bacterial Reservoir

How severe a lung abscess gets is often linked to the person’s dental health.

  • Gingivitis and periodontitis: Deep gum pockets allow bacteria like Fusobacterium and Prevotella to grow. People with gum disease have much more bacteria in their saliva than those with healthy mouths.
  • Edentulous protection: People without teeth rarely get primary anaerobic lung abscesses because the bacteria need gum pockets to grow. If someone without teeth develops a lung abscess, doctors should look for another cause, like a tumor.

Bronchial Obstruction

Any blockage in the airway lets mucus collect behind it, giving bacteria a place to grow where the lung cannot clear them out.

  • Bronchogenic carcinoma: In adults over 45, especially smokers, a lung abscess can be the first sign of lung cancer. The tumor blocks the airway, and infection develops in the lung tissue behind the blockage.
  • Foreign body: Children may inhale peanuts or toys, while adults can inhale tooth fragments or food. This can cause a long-lasting infection and abscess, and the cause is often missed if no one saw it happen.

Immunosuppression and Host Factors

Primary abscesses usually happen in people with normal immune systems, but people with weak immunity can get more severe infections from a wider range of germs.

  • HIV and AIDS: These patients have an increased susceptibility to opportunistic pathogens such as Pneumocystis jirovecii, Rhodococcus equi, and Mycobacterium tuberculosis, all of which can cause cavitary lung disease.
  • Neutropenia: Patients on chemotherapy or with hematologic malignancies are at risk for rapidly progressive necrotizing pneumonia caused by Pseudomonas aeruginosa or Aspergillus species.
  • Diabetes Mellitus: Poorly controlled diabetes impairs neutrophil function, making patients more susceptible to infections caused by organisms such as Klebsiella pneumoniae.

Septic Emboli

Abscesses can also start when bacteria travel through the blood to the lungs, not just through the airways.

  • Tricuspid Valve Endocarditis: Infection of the correct heart valve, often seen in intravenous drug users, sheds septic bacteria and clots into the pulmonary circulation. This typically results in multiple small peripheral lung abscesses in both lungs.
  • Lemierre’s Syndrome: A rare condition in which a clot in the internal jugular vein, usually following a severe sore throat caused by Fusobacterium, sends septic emboli to the lungs, resulting in abscesses.

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Assoc. Prof. MD. Engin Aynacı Assoc. Prof. MD. Engin Aynacı Pulmonology Overview and Definition
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FREQUENTLY ASKED QUESTIONS

Why did I lose so much weight?

A long-lasting infection uses up your body’s energy to fight bacteria and releases chemicals that make you less hungry, causing you to lose weight quickly.

Yes, if bacteria are released during dental work and then inhaled while you are numb or sedated, it can cause an abscess. However, this is rare with today’s dental methods.

Yes, coughing up blood (hemoptysis) means the infection is damaging blood vessels. It is often just a small amount, but sometimes it can become a lot and be life-threatening.

Silent aspiration happens when saliva or food goes into the lungs without causing a cough. This is common in people who have had a stroke or in older adults and can lead to lung infections.

Alcohol increases risk by relaxing the muscles that protect your airway, making it easier to inhale food or saliva, and by weakening the immune cells in your lungs.

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