Abscess

Abscess

An abscess refers to a localized collection of pus that gathers in a cavity created by the disintegration of tissue, stemming from an infectious process (generally caused by bacteria or parasites) or the presence of foreign substances (like splinters or bullet wounds). It represents a defensive mechanism of the tissue to restrict the spread of infectious agents to other body areas.

Tuberculous cold abscess with sinuses

Tuberculous cold abscess with sinuses

Etiology

Upon the invasion of tissues by organisms or foreign substances, the affected local cells are destroyed. These invaders release toxins, leading to a robust inflammatory response. This draws an immense amount of white blood cells to the site, augmenting the regional blood flow. The composition of pus encompasses dead local tissue cells, white blood cells, infectious agents or foreign substances, and toxins released by both the infecting agents and the blood cells. To prevent the spread of this infection, adjacent healthy cells create an abscess wall, forming a barrier around the pus.

Manifestations

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Liver with purulent deposits

The universal symptoms and signs associated with inflammatory processes comprise:

• Redness
• Heat
• Swelling
• Pain

Abscesses can manifest in any solid tissue, but they predominantly appear on the skin surface, either as superficial pustules (boils) or deep skin abscesses. Other potential locations include the lungs, brain, kidneys, and tonsils. Major risks involve the dissemination of the abscess content to nearby or distant tissues and the emergence of extensive regional tissue necrosis (gangrene).

Notably, most abscesses throughout the body do not heal autonomously, necessitating immediate medical attention at the first sign.

Clinical signs and symptoms

Skin abscesses are easy to detect. They are red, raised and painful. The main symptoms and signs of a skin abscess are redness, heat, swelling, pain and loss of function. There may also be high temperature (fever) and chills.

Internal abscesses are more difficult to find. The abscess can be painful, and a person will have a high temperature, and generally feel unwell. Internal abscesses do not usually heal without medical treatment. In some cases an abscess could even cause death, for example where an abscess in the neck put pressure on the trachea.

Internal abscesses

Abscesses inside your body may not be obvious and can damage organs, including the brain, lungs and others. Treatments include drainage and antibiotics.

Treatment

Upon suspecting an abscess, an examination is crucial to determine if foreign objects are the underlying cause, which might demand surgical extraction. When an abscess transitions from a firm serous inflammation to a soft pus-filled stage, surgical drainage (e.g., lancing) becomes the standard treatment. Since Staphylococcus aureus bacteria are frequently responsible, anti-Staphylococcus antibiotics, such as Flucloxacillin or dicloxacillin, are administered. However, relying solely on antibiotic therapy without draining the abscess proves ineffective in most cases.

In anatomical locations where surgery poses a significant risk, like the brain, surgical interventions might be deferred or only used as a final resort. Draining a lung abscess might entail positioning the patient to facilitate content discharge via the respiratory tract. Warm compresses and limb elevation can also aid in treating skin abscesses.

Perianal Abscess

Patients with conditions like inflammatory bowel disease (e.g., Crohn's disease) or diabetes might develop perianal abscesses. These typically initiate as internal wounds from ulcerations or hard stools. Given the natural occurrence of feces in the rectal area, these wounds are prone to infection, culminating in an abscess. Clinically, this is observed as a growing, increasingly painful lump near the anus.

Pyomyositis MRI

Pyomyositis MRI

Like their counterparts, perianal abscesses demand immediate medical care, including procedures like incision, debridement, or lancing.

Management

Treatment for most skin or soft tissue abscesses is to cut it open and drain out the pus.

Epidemiology

Skin abscesses are common and have become more common in recent years. They are usually on the skin surface (such as a boils, or deep skin abscesses), in the lungs, brain, teeth, kidneys and tonsils. The condition can become more complicated if the pus and the infection spread to other parts of the body. This can lead to gangrene, where areas of body tissue die.

If abscess is on the surface, it may be "fluctuant", that is it feels like it is full of fluid, when touched.

Cold abscess

Abscesses caused by tuberculosis are called cold abscesses.

FAQS

Which locations do people get abscess(es)?

You can get an abscess almost anywhere in your body.

How does one get an abscess?

When an area of your body becomes infected, your body's immune system tries to fight the infection. White blood cells go to the infected area, collect within the damaged tissue, and cause inflammation. During this process, pus forms. Pus is a mixture of living and dead white blood cells, germs, and dead tissue.

Which organisms lead to abscess formation?

Bacteria, viruses, parasites and swallowed objects can all lead to abscesses.

See also

• Boil
• Sterile abscess

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