Abscess

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An abscess is a cavity containing pus surrounded by inflamed tissue,formed as a result of localized infection. Bacteria commonly causes abscess such as Staphylococcus  aureus and Streptococcus which enter the skin through any injury and the area of the skin becomes red, tender and swollen.

Boil is a localized infection in the skin, which is referred to as a skin abscess.
An abscess is a painful condition. It appears as a swollen area and the area is warm to touch. Any part of the body can develop abscess. Commonly affected sites are armpits, external vaginal area and groin. If inflammation occurs around hair follicles or sweat glands it also results in the occurrence of abscess. Abscess can also develop in internal organs and they are dangerous such as, brain, liver, kidneys, lungs, neck, breast, tonsils and teeth.

Sometimes an abscess opens itself and drains on the skin surface but often it needs incision and drainage.

Anatomy of skin:
The skin is the largest organ of the body; it performs lot of functions that includes:
• Protects us from microbes and the elements.
• Helps in regulating body temperature.
• Permits the sensations of touch, heat, and cold.

There are three layers of skin:
• The epidermis: it is the outermost layer of skin that provides a waterproof barrier and creates our skin tone.
• The dermis: it lies beneath the epidermis. It contains tough connective tissue, hair follicles, and sweat glands.
• The hypodermis: it is made of fat and connective tissue.

Pathophysiology of an abscess:
Abscess is a series of immune reactions. Abscess develops in the damaged tissue when our body’s immune system protects body against entrance of foreign substance and prevents spread of harmful micro-organisms.

During an infection by bacteria a large number of white blood cells especially neutrophils migrates to the infected wound. This mechanism occurs as a result of getting signals from cytokines. The cytokines are responsible to alert the neutrophils to injury and cell death.

The infected site is then filled with pus, i.e. collection of dead cells and chemical mediators of immune reaction. The infected site is separated from the surrounding healthy tissue by an abscess wall….
Classification of Abscess

• Furuncles / Carbuncles: Causative bacterium for development of an aabscess is staphylococcus aureus, fever may be associated with it and abscess occurs within the hair follicle.

• Cystic acne: Cystic acne occurs in deeper skin tissue. Its occurence is most common on the face and in the teenage years.

• Pilonidal cyst: It develops in the crease of the buttocks. Pilonidal cysts begin as tiny areas of infection in the skin from which hair grows.

• Perianal abscess (Anorectal abscess): it is an infection of the soft tissues that surrounds the anal canal, discrete abscess cavity forms, bacteria common in the digestive system, such as E.coli are responsible for causing rectal abscess.

• Lung abscess: it is the necrosis of pulmonary parenchyma that is caused by microbial infection, that is of two types-

– Acute or chronic depending on duration of symptoms.
– Primary or secondary depending on associated conditions.

• Breast abscess: it is a localized breast infection.

Mortality of Abscess

Abscess usually do not cause any serious complications. But it can cause a life-threatening condition if it is formed in any internal organ.
Age/sex prevalence of abscess

Individuals of any age and sex can have abscess formation.

Races affected by abscess

Individuals of any race can develop abscess.

Causes of abscess

The major cause of formation of abscess is obstruction of sweat glands or sebaceous (oil) glands of skin, inflammation of hair follicles or minor breaks and punctures of the skin.
Infectious agents or germs get into these glands through dirty skin and then body gives response to these germs in the form of inflammation as a body defenses to kill these germs.
The center part of abscess liquefies and contains dead cells, bacteria and other waste. Then this area begins to grow and hence lead to pain under the skin and along with it inflammation of areas of skin adjoining the eruption.

Individuals with weak immune system are prone to get certain abscess more often. Diseases weakening the immune system of body are as follows
•Leukemia
•Diabetes
•Cancer
•AIDS
•Peripheral vascular disorders
•Crohn’s disease
•Ulcerative colitis
•Severe burns
•Sickle cell disease
•Chronic steroid therapy
•Chemotherapy
•Drug abuse

Other risk factors leading to formation of abscess are as follows
•Poor personal hygiene
•Dirty environments
•Exposure to certain type of skin infections
•Poor circulation system of body

Sign and symptoms of abscess

Mostly abscess is a painful mass within the skin that appears red, warm and tender to touch.
Some abscess come to a head and can rupture.
If cure is not given on time, abscess gets worse. Infection can spread to the tissues below it and even to the blood.
When infection travels in blood it can lead to fever also.

Investigations of abscess

If there is fever along with abscess then following lab tests to be done
WBC
Platelets
ESR
TLC
DLC
X-ray chest are done to diagnose abscess in lungs.

Treatment of abscess

Incision and drainage is done
Antibiotics are given
Surgical drainage of abscess is done

Prognosis of abscess

Abscess burst naturally and need a course of antibiotics to cure.

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