Lung abscess: back for an encore?

The rise in incidence of lung abscess due to opportunistic organisms has reemphasized the need for early recognition and treatment. Opportunistic organisms can cause lung abscess in immunocompromised hosts. Most lung abscesses are primary, occurring as a result of aspiration of oral contents into the dependent portions of the lung in persons with dysphagia or decreased consciousness. Symptoms of lung abscess include productive cough, fever, leukocytosis, weight loss, and putrid sputum. Among the complications are progression to a chronic stage, empyema, massive hemoptysis, metastatic brain abscess, and bronchopleural fistula. Treatment of lung abscess is primarily medical, consisting of an appropriate antibiotic regimen and chest physical therapy. Surgery is reserved for unresponsive patients or those with complications.