pulmonary abscess Pulmonary abscess is a condition in which lung tissue is invaded by a variety of pathogens, primarily anaerobic bacteria, leading to inflammation, necrosis, liquefaction, and ultimately the formation of a localized pus-filled cavity. Patients often present with high fever, cough, and the production of large amounts of foul-smelling sputum. This condition is non-communicable, and with early, timely, and effective anti-infective treatment, the cure rate can be significantly improved.

A lung abscess is a localized collection of pus that forms as a result of anaerobic bacteria predominantly infecting lung tissue, leading to inflammation, necrosis, and liquefaction. Patients often present with high fever, cough, and expectoration of large amounts of foul-smelling sputum. The condition is non-communicable, and with early, timely, and effective antimicrobial therapy, the cure rate can be significantly improved.

Primary lung abscess (aspiration lung abscess)

It is often a mixed infection, with pathogens such as streptococcus and anaerobic bacteria (such as Enterococcus and Bacteroides) being the primary culprits, entering the lungs through oral, nasal, or pharyngeal aspiration. Due to the steep and relatively large right main bronchus, aspirated material often enters the right lung, leading to the formation of a single abscess cavity. Additionally, the location of abscess formation is also related to the position of the body during aspiration.

Secondary lung abscess

Pathogens often originate from pre-existing lung diseases (such as bacterial pneumonia, bronchiectasis, cavitary pulmonary tuberculosis, etc.), or from purulent lesions in adjacent organs (such as subphrenic abscess, perinephric abscess, amebic liver abscess, etc.). Furthermore, bronchial obstruction by foreign bodies is a common cause of lung abscess in pediatric patients.

Hematogenous lung abscess

Most commonly, it is caused by pathogenic bacteria from extrapulmonary foci of infection (such as skin and soft tissue infections, furuncles, pyogenic osteomyelitis, liver abscess, etc.) spreading to the lungs through the bloodstream. Hematogenous lung abscesses are often small in size and distributed in the periphery of both lungs. Common pathogens include Staphylococcus aureus and Klebsiella pneumoniae.

Early stage

The onset is relatively sudden, often presenting with chills, high fever, cough, and expectoration, but the cough is mild, and sputum production is low.

Progressive stage

If the infection is not promptly controlled, the cough may worsen after about 1 to 2 weeks. At this stage, if the abscess ruptures into the bronchus, there can be a significant increase in sputum production (up to 300-500 ml per day) with a foul odor, and some patients may experience bloody sputum.

Chronic stage

If the condition persists for more than 3 months, in addition to cough and sputum production, there may also be varying degrees of hemoptysis, weight loss, fatigue, and low-grade fever.

In traditional Chinese medicine, lung abscess is referred to as "lung carbuncle". The condition is mostly caused by pathogenic heat invading the lungs, and the basic principles of treatment involve clearing heat and toxins, and resolving stasis and draining pus. During the treatment process, the progression of the disease varies in urgency, and treatment should be tailored accordingly.

Early stage: Treatment should focus on dispersing wind-heat and clearing lung heat.

Formation stage: Treatment should aim at clearing lung heat, resolving toxins, cooling the blood, and resolving phlegm.

Pus discharge stage: Treatment should focus on clearing heat, resolving toxins, and draining pus.

Recovery stage: Treatment should emphasize nourishing qi, nourishing yin, and supporting the body's recovery, while also clearing any residual pathogenic factors.

Maintain a clean environment: Regularly open windows for ventilation to keep the indoor air fresh, while ensuring warmth and avoiding exposure to cold.

Maintain appropriate body temperature: In winter, pay attention to keeping warm, using air conditioning, hot water bags, and bedding as necessary.

Maintain skin hygiene: For patients who sweat excessively, family members should assist with warm water baths, timely changing of clothes and bedding, and ensuring skin cleanliness and dryness.

Assist with expectoration: Encourage effective coughing, regular movement, and changing of body position, gently patting the patient's back 2-3 times a day for 10-15 minutes each time to facilitate the discharge of sputum.

Rest and exercise: Bed rest is necessary, and strenuous activities should be avoided. After complete resolution of symptoms, appropriate indoor and outdoor activities can be gradually resumed.

Diet: Increase fluid intake and consume high-calorie, high-protein, and easily digestible foods, while avoiding spicy and greasy foods.

Oral hygiene: Actively maintain oral hygiene, such as frequent mouth rinsing and tooth brushing, to keep the mouth moist and clean, preventing the inhalation of contaminated secretions into the lungs. For elderly patients with lung abscess resulting from aspiration during bedridden eating, it is recommended to use a gastric or jejunal feeding tube to reduce the risk of aspiration. Additionally, oral hygiene should be strengthened.

After discharge, patients still need to follow the doctor's instructions for oral antibiotic therapy. Medication should not be discontinued without medical advice, and regular follow-up visits are necessary to ensure complete resolution of inflammation. Patients should be vigilant against respiratory infections and avoid inhaling dust after recovery.

In daily life, regular oral hygiene, frequent mouth rinsing, and tooth brushing are recommended for the general population. Those with chronic infections in the oral, nasal, or pharyngeal area should seek timely medical treatment. Actively avoid factors that could compromise the body's immune defenses and airway clearance function, such as alcohol abuse, exposure to cold, and extreme fatigue. Additionally, prompt treatment of primary lesions, such as pneumonia, skin abscesses, furuncles, or extrapulmonary purulent lesions, is crucial in preventing lung abscess.