Abscess - General
💥 An abscess is a localized collection of pus resulting from the disintegration of tissue in the dermis and deeper skin tissues.
ℹ️ About
- An abscess is a localized collection of pus 🟡 caused by infection, often surrounded by inflamed tissue 🔥.
🧬 Aetiology
- Diabetes 🍬: Increased susceptibility due to impaired immune response.
- Immunocompromised Status 🛡️: Higher risk of infection and abscess formation.
- IV Drug Use (IVDU) 💉: Commonly associated with groin abscesses; ultrasound (USS) recommended to check for a potential false aneurysm.
🧾 Clinical Presentation / Types
- Types include:
- 🧴 Skin Abscess
- 🍑 Pilonidal Abscess
- 🦵 Psoas Abscess
- 🚽 Perianal Abscess
- 🩸 Groin Abscess (esp. in IVDU)
- Signs of Sepsis ⚠️:
- 🌡️ Fever
- ❤️🔥 Tachycardia
- 😮💨 Tachypnoea
- 🧪 Leukocytosis
🩺 Investigations
- Blood Tests 🧪: FBC, U&E, LFT, CRP, Glucose, HbA1c.
- Blood Cultures 🧫: To check for bacteraemia, esp. in sepsis.
- HIV Test 🧍♂️: For high-risk/immunocompromised patients.
- Aspirate & Drain 💉: Culture pus to identify causative organism.
- Imaging 📷:
- Ultrasound (USS): Confirms fluid collection, guides drainage.
- CT Scan: Locates deep abscesses (psoas, intra-abdominal).
🔬 Microbiology
- Common Pathogens 🦠:
- Staphylococcus aureus (incl. MRSA)
- Streptococcus pyogenes
- MRSA ⚡: Community-acquired MRSA (CA-MRSA) now common; varies with geography & demographics.
- Other Organisms 🧫: Enteric bacteria, anaerobes, Gram-negatives depending on site.
🛠️ Management
- Incision & Drainage ✂️: Essential; antibiotics alone rarely effective.
- Antibiotics 💊: For systemic infection or high-risk patients (e.g. diabetes, immunocompromised).
- Pain Relief 💊: Adequate analgesia for comfort.
- Diabetes Control 🍬: Optimise blood glucose to aid recovery.
- Specialist Referral 👨⚕️:
- Breast Abscess 👩🍼: Refer to breast surgery.
- IVDU Groin Abscess 💉: USS first to rule out false aneurysm before drainage.
📚 References
- Clinical guidelines on abscess management & antimicrobial therapy for skin and soft tissue infections.
