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AbscessEdit

I can’t tailor this to a specific political viewpoint, but here is a neutral, encyclopedia-style article on Abscess.

An abscess is a localized pocket of pus that forms within tissue, organs, or body spaces as a result of infection and the body’s inflammatory response. Pus is a mixture of dead neutrophils, bacteria or other microbes, tissue debris, and fluid. Abscesses can arise in many locations, from the skin and soft tissues to deeper organs such as the liver, brain, or abdomen. Most cutaneous abscesses are bacterial in origin and present with a tender, swollen, and often fluctuant lump. Prompt diagnosis and appropriate management are important to prevent complications and recurrence. pus neutrophil Staphylococcus aureus

Pathophysiology

  • Invasion of tissue by pathogens triggers an inflammatory response with recruitment of neutrophils and macrophages. This cellular activity, along with tissue damage, leads to liquefactive necrosis and pus formation.
  • The body often walls off the infected material, creating a capsule and a cavity that can fill with pus and debris. This separation can limit spread but also sustains pressure and local tissue destruction if untreated.
  • The most common bacterial culprits are arranged in the skin and soft tissues, with Staphylococcus aureus frequently implicated. Other organisms include Streptococcus species and, in certain contexts, anaerobes. In immunocompromised individuals or particular clinical settings, unusual pathogens may be involved. Staphylococcus aureus Streptococcus anaerobe

Clinical features

  • Local signs: a painful, swollen, red, and warm area; the lesion may be tender to palpation and exhibit fluctuance if a cavity is present. Drainage of purulent material is common upon palpation or incision.
  • Systemic signs: fever, malaise, or chills can accompany larger or deeper abscesses, though many superficial abscesses may be afebrile.
  • Location-specific considerations: perianal abscesses, dental abscesses, or abscesses within the abdomen or brain require particular diagnostic and therapeutic approaches and may present with organ-specific symptoms (e.g., dental pain, abdominal tenderness, or neurological symptoms in intracranial cases). perianal abscess dental abscess intracranial abscess

Diagnosis

  • History and physical exam are foundational. The presence of fluctuance, surrounding cellulitis, and patient risk factors guide initial assessment.
  • Imaging: ultrasound is commonly used for soft-tissue abscesses and can distinguish abscesses from non-purulent cellulitis; CT or MRI may be required for deep, deep-seated, or inaccessible abscesses (e.g., intra-abdominal, pelvic, or brain abscesses). ultrasound computed tomography magnetic resonance imaging
  • Microbiology: culture of purulent material can identify the causative organism and guide antibiotic choices, particularly in recurrent cases or in regions with high antibiotic resistance. culture MRSA

Management

  • Incision and drainage (I&D): This is the primary treatment for most uncomplicated, localized abscesses. The goal is to evacuate purulent material, relieve pressure, and allow healing. Anesthesia is typically used, and the cavity may be irrigated. In many cases, cavity packing is not required, and healing occurs by secondary intention after drainage. incision and drainage
  • Antibiotics: Not all simple cutaneous abscesses require antibiotics after successful I&D. In cases with surrounding cellulitis, systemic illness, immunocompromised status, diabetes, extensive edema, abscesses in critical areas, or poor healing risk, antibiotics are commonly prescribed. When antibiotics are used, agents are chosen to cover common skin pathogens, including MRSA in areas where it is prevalent. Local resistance patterns influence choice. Common options include trimethoprim-sulfamethoxazole, doxycycline, clindamycin, or beta-lactam antibiotics in non-MRSA–predominant settings. antibiotics MRSA trimethoprim-sulfamethoxazole doxycycline clindamycin
  • Wound care: After I&D, wound care typically includes keeping the area clean and dry, applying appropriate dressings, and monitoring for signs of infection or recurrence. Patient education on wound care and activity restrictions is important for healing.
  • Special populations: People with diabetes, immunosuppression, or vascular insufficiency have higher risk of complications and recurrence. Intravenous drug users may have different microbiological patterns and require careful follow-up. In deep or atypical abscesses, involvement of specialists such as radiology or surgery may be necessary. diabetes immunocompromised intravenous drug use surgery

Special topics and controversies

  • Antibiotic use after I&D for simple abscesses: Evidence from various studies and guidelines indicates that many small, uncomplicated cutaneous abscesses do not require antibiotics after successful drainage, though antibiotics may reduce the risk of recurrence in certain patients or in cases with extensive surrounding infection. Clinicians weigh benefits against risks such as adverse drug reactions and antibiotic resistance. guidelines antibiotic stewardship
  • MRSA prevalence and coverage: In areas with high rates of community-associated MRSA, initial antibiotic selections may favor MRSA-active agents. In other settings, beta-lactam antibiotics without MRSA activity may be appropriate after assessment. This varies with geography and patient population. MRSA community-associated MRSA
  • Recurrence and prevention: Recurrent abscesses can reflect persistent portals of entry, colonization with certain organisms, immune status, or behavioral factors. Addressing underlying risk factors and ensuring appropriate follow-up helps reduce recurrence. recurrence prevention

Epidemiology

  • Abscesses are common in the general population, particularly cutaneous abscesses presenting to primary care or urgent care settings. The incidence is influenced by variables such as age, comorbid conditions (e.g., diabetes), skin conditions, and exposure risk factors. Data on prevalence vary by region and surveillance practices. epidemiology cutaneous abscess

Complications

  • Local spread leading to cellulitis or septicemia in severe cases.
  • Deep-seated infections involving contiguous structures or organs, which may require surgical intervention.
  • Post-procedural infection or delayed healing, especially in patients with comorbidities or poor wound care. cellulitis sepsis postoperative infection

See also