An abscess (Latin: abscessus) is a collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue in which

the pus resides on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g., splinters, bullet wounds, or injecting needles). It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body. One example of an abscess is a BCG-oma, which is caused because of incorrect administration of the BCG vaccine. The organisms or foreign materials kill the local cells, resulting in the release of cytokines. The cytokines trigger an inflammatory response, which draws large numbers of white blood cells to the area and increases the regional blood flow. The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object. Abscesses must be differentiated from empyemas, which are accumulations of pus in a preexisting rather than a newly formed anatomical cavity. Signs and symptoms The cardinal symptoms and signs of any kind of inflammatory process are redness, heat, swelling, pain and loss of function. Abscesses may occur in any kind of solid tissue but most frequently on skin surface (where they may be superficial pustules (boils) or deep skin abscesses), in the lungs, brain, teeth, kidneys and tonsils. Major complications are spreading of the abscess material to adjacent or remote tissues and extensive regional tissue death (gangrene). Abscesses in most parts of the body rarely heal themselves, so prompt medical attention is indicated at the first suspicion of an abscess. An abscess could potentially be fatal (although this is rare) if it compresses vital structures such as the trachea in the context of a deep neck abscess.[citation needed] Treatment Wound abscesses do not generally need to be treated with antibiotics, but they will require surgical intervention, debridement and curettage.[1] Incision and drainage The abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics.[2] Surgical drainage of the abscess (e.g., lancing) is usually indicated once the abscess has developed from a harder serous inflammation to a softer pus stage. This is expressed in the Latin medical aphorism: Ubi pus, ibi evacua. In critical areas where surgery presents a high risk, it may be delayed or used as a last resort. The drainage of a lung abscess may be performed by positioning the patient in a way that enables the contents to be discharged via the respiratory tract. Warm compresses and elevation of the limb may be beneficial for a skin abscess. Packing In North America, after drainage, an abscess cavity is often packed. However, there is no evidence to support this practice and it may in fact delay healing.[3] To try to answer this question more definitely, a randomized double-blind study was started in September 2008 and was completed in March 2010.[4] Interim analysis of data from this study suggests that "wound packing may significantly increase the failure rates." [5] A small pilot study has found no benefit from packing of simple cutaneous abscesses.[6] Primary closure

With the emergence of community-acquired methicillin-resistant staphylococcus aureus MRSA.[11] In this randomized controlled trial. nasal recolonization with S.[8] However. aureus occurred at 12 weeks in 24% of nursing home residents receiving mupirocin ointment alone (6/25) and in 15% of residents receiving mupirocin ointment plus chlorhexidine baths daily for the first three days of mupirocin treatment (4/27).8). trimethoprim-sulfamethoxazole.[12] In a randomized controlled trial. alternative antibiotics effective against community-acquired MRSA often include clindamycin. To prevent recurrent infections due to Staphylococcus. This wound typically becomes infected as a result of the normal presence of feces in the rectal area. these traditional antibiotics may be ineffective. After this the body will usually repair the old infected cavity. Magnesium sulfate is therefore best applied at night with a sterile dressing covering it. Chlorhexidine baths.g. and doxycycline. Magnesium sulfate paste Historically abscesses as well as boils and many other collections of pus have been treated via application of magnesium sulfate (Epsom salt) paste. It is important to note that antibiotic therapy alone without surgical drainage of the abscess is seldom effective due to antibiotics often being unable to get into the abscess and their ineffectiveness at low pH levels. Magnesium sulfate paste is considered a "home remedy" and is not necessarily an effective or accepted medical treatment. primary closure healed faster. Whilst most medical texts advocate surgical incision some medical doctors will treat small abscesses conservatively with antibiotics. Although these results did not reach statistical significance.[citation needed] Perianal abscess Perianal abscesses can be seen in patients with for example inflammatory bowel disease (such as Crohn's disease) or diabetes. and doxycycline (unlike hospital-acquired MRSA that may only be sensitive to vancomycin IV). the rupture itself is not painful but the drawing up may be uncomfortable. and then develops into an abscess. (If the condition is thought to be cellulitis rather than abscess. This works by drawing the infected pus to the surface of the skin before rupturing and leaking out. it remains sensitive to alternative antibiotics. but 25% of abscesses healed by secondary intention and recurrence was higher. While resistant to most beta lactam antibiotics commonly used for skin infections.[10] Antibiotics As Staphylococcus aureus bacteria is a common cause. These antibiotics may also be prescribed to patients with a documented allergy to penicillin. another randomized controlled trial found primary closure led to 35% failing to heal primarily and primary closure longer median number of days to closure (8. consideration should be given to possibility of strep species as cause that are still sensitive to traditional antistaphylococcus agents such as dicloxacillin or cephalexin in patients able to tolerate penicillin).[9] In anorectal abscesses. e. patients used nasal mupirocin twice daily 5 days a month for 1 year. This often presents itself as a lump of tissue near the anus which grows larger and more painful with the passage of time.. clindamycin (Cleocin). Recurrent infections Recurrent abscesses are often caused by community-acquired MRSA.Primary closure has been successful when combined with curettage and antibiotics[7] or with curettage alone. trimethoprim-sulfamethoxazole (Bactrim). consider the following measures: y y Topical mupirocin applied to the nares. Often the abscess will start as an internal wound caused by ulceration or hard stool. . an anti-staphylococcus antibiotic such as flucloxacillin or dicloxacillin is used. the baths are an easy treatment.9 versus 7.

The body tries to attack the infection by sending a surge of white blood cells (infection fighting cells) to the infected area. An abscess forms from a bacterial infection. rectal abscess. Examples of abscesses include skin abscess. Making a diagnosis of an abscess begins with taking a thorough medical history. are also at risk for contracting an abscess. such as fever and inflammation are similar to symptoms of other diseases of conditions. A culture and sensitivity test (C and S) may also be performed and involves taking a small sample from the abscess and growing it in the laboratory. abdominal abscess. refer to misdiagnosis of abscess. perianal abscesses may require prompt medical treatment. breast abscess. Symptoms often include swelling and pain. A complete blood count measures the numbers of different types of blood cells. such as the gums or the skin. liver abscess or kidney abscess. The surrounding tissue also becomes inflamed and painful. may be performed to assist in the diagnosis of some internal abscesses. The types of diagnostic testing performed for a suspected abscess varies depending on the symptoms. An abscess develops when harmful bacteria or parasites infect an area of body tissue. Different types of WBCs increase in number in characteristic ways during an infectious or inflammatory process. such as X-ray. refer to symptoms of abscess.Like other abscesses. such as corticosteroids or chemotherapy. bones abscess. fluid. severe burns. Some types of abscesses can lead to serious. One type of bacteria that commonly causes abscesses is Staphylococcus aureus. kidney failure. and completing a physical examination. shock. Symptoms and complications of an abscess vary depending on the area of the body where it develops. ulcerative colitis. including white blood cells (WBCs). cancer. An abscess is a hollow space in the body that is filled with pus and surrounded by inflamed tissue. People who take certain medications. lung abscess. such as an abscess. For more information on complications and symptoms. CT. even life-threatening complications. During this process living and dead white blood cells. . bacteria. brain abscess. liver abscess. It is possible that a diagnosis of an abscess can be missed or delayed because some symptoms. Crohn's disease. such as a pancreatic abscess. This test determines the type of organism causing the abscess. Treatment of an abscess varies depending on its location and other diseases and conditions that may coexist with the abscess. Other risk factors include having diabetes. and dead tissue collect within the diseased tissue and form pus. kidney abscess. Abscesses can be serious and lead to gangrene and permanent organ damage if they are not recognized and treated promptly. parasitic infection or foreign body and can develop in many places in the body. or severe trauma. and death. A complete blood count (CBC) is a blood test is often performed. Imaging tests. which suppress the body's natural immune response. Additional tests may be performed in order to rule out or confirm other diseases that may accompany an abscess or cause similar symptoms. such as sepsis. including symptoms. spinal cord abscess and tooth abscess. For more information on misdiagnosis. such as an incision and debridement or lancing. as well as which antibiotics would be most effective in treating it. or MRI. People at risk for an abscess and its complications include those who have a compromised immune system due to such diseases as HIV/AIDS or combined immunodeficiencies.

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