Abscess

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Abscess
Classification and external resources
Five-day-old abscess. The black dot is a clogged hair follicle.
ICD-10L02
ICD-9682.9, 324.1
MedlinePlus001353
MeSHTemplate:Mesh2

An abscess (Template:Lang-lat) is pus that has built up within the tissue of the body.[1] Signs and symptoms of abscesses include: redness, pain, warmth, and swelling. This swelling feels like it is filled with fluid if it is pressed.[1] The area of redness is often bigger than the area of swelling.[2] Carbuncles are an abscess in the hair follicles.[3]

An abscess is usually caused by a bacterial infection.[4] Often many different types of bacteria can be part of a single infection.[2] In the United States and many other areas of the world the most common bacteria present is MRSA (methicillin-resistant Staphylococcus aureus).[1] Rarely parasites can cause abscesses and this is more common in the developing world.[5] Diagnosis of a skin abscess is usually made based on what it looks like and is proved by cutting it open.[1] Ultrasound imaging may be useful in cases in which the diagnosis is not clear.[1] In abscesses around the anus, computer tomography (CT) may be important to look for deeper infection.[5]

Treatment for most skin or soft tissue abscesses is to cut it open and drain out the pus.[6] Antibiotics are usually not needed for healthy people.[1] New studies have found that it is better to close the wound after draining, instead of packing it with gauze.[1] This can speed healing and not increase risk of the abscess returning.[7] Sometimes simply sucking out the pus with a needle is not enough.[1]

Skin abscesses are common and have become more common in recent years.[1] As many as 65% of people who take intravenous drugs get abscesses[8] In 2005 in the United States 3.2 million people went to the emergency department for an abscess.[9] In Australia around 13,000 people were put in hospital in 2008 for the disease.[10]

Signs and symptoms

An abscess

Abscesses can form in any kind of solid tissue. 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.

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.

If abscess is on the surface, it may be "fluctuant", that is it feels like it is full of fluid, when touched. This is a wave-like motion caused by movement of the pus inside the abscess.[11]

Causes

Abscesses are caused by bacterial infection, parasites, or foreign substances. Bacterial infection is the most common cause.[4] Often many different types of bacteria are involved in a single infection.[2] In the United States and many other areas of the world the most common bacteria present is MRSA.[1] Among spinal subdural abscesses, methicillin-sensitive Staphylococcus aureus is the most common organism involved.

Rarely parasites can causes abscesses and this is more common in the developing world.[5] Specific parasites known to do this include: dracunculiasis and myiasis.[5]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Singer, Adam J.; Talan, David A. (Mar 13, 2014). "Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus" (PDF). The New England Journal of Medicine. 370 (11): 1039–47. doi:10.1056/NEJMra1212788. PMID 24620867.
  2. 2.0 2.1 2.2
  3. 4.0 4.1
  4. 5.0 5.1 5.2 5.3
  5. American College of Emergency Physicians, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Emergency Physicians, retrieved January 24, 2014
  6. Singer, Adam J.; Thode, Henry C., Jr; Chale, Stuart; Taira, Breena R.; Lee, Christopher (May 2011). "Primary closure of cutaneous abscesses: a systematic review" (PDF). The American Journal of Emergency Medicine. 29 (4): 361–6. doi:10.1016/j.ajem.2009.10.004. PMID 20825801.
  7. Taira, BR; Singer, AJ; Thode HC, Jr; Lee, CC (Mar 2009). "National epidemiology of cutaneous abscesses: 1996 to 2005". The American journal of emergency medicine. 27 (3): 289–92. doi:10.1016/j.ajem.2008.02.027. PMID 19328372.CS1 maint: multiple names: authors list (link)
  8. Vaska, VL; Nimmo, GR; Jones, M; Grimwood, K; Paterson, DL (Jan 2012). "Increases in Australian cutaneous abscess hospitalisations: 1999-2008". European Journal of Clinical Microbiology & Infectious Diseases. 31 (1): 93–6. doi:10.1007/s10096-011-1281-3. PMID 21553298.
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