• Abscess

• What makes an abscess just that: an abscess, and not another kind of infection or inflammation, has to do with the body's reaction.
  • Some microbes, like the bacteria known as Staph aureus, are very likely to incite abscess formation. It's also true that there are plenty of bacteria and fungi that sometimes cause abscesses, but also cause other kinds of infections - like cellulitis.
  • Bacterial abscesses are generally very painful.
  • Abscess-type infections are very likely to occur if there is a foreign body introduced into the flesh.
  • • • That's why stepping on a splinter that is so tiny that it itself did not cause much pain going in, can turn into a foot that's too sore to step on. Curing an infection that is associated with a foreign body requires getting rid of the foreign body, in this example- the splinter.
      • Sometimes a foreign body will extrude on its own, other times it must be extracted.
• The walling off of an area of the body, and an active inflammatory response in that area producing pus, can happen sometimes even without infection.
  • Finally, when an area of the body dies (that is, becomes necrotic), the body's defenses sometimes form an abscess wall around it, and it may form what is known as a sterile abscess. Although this is technically an abscess, it is not so equisitely tender and painful as a significantly sized bacterial abscess.
• Superficial abscesses can often be treated with local care to encourage draining.
• Deep abscesses are usually life-threatening.

Pathogens are germs that can cause disease by invading the body, and any microbe that causes an abscess is, by definition, a pathogen.

Pathogenic bacteria are known to either incite abscess formation- or not- when they infect human tissues.

• Staph aureus, for example, is a type of bacteria that is known to cause abscesses, where as Pneumococcus, a common cause of pneumonia, very rarely does. The appearance of infection as an abscess gives a hint to the doctor of what the infecting organism is likely to be.
• Culture of the organism can yield a specific diagnosis, but can be misleading at times. For example, the surface of a tonsil that contains an abscess often does not harbor the bacteria that are growing inside the abscess, and so a needle aspirate or the taking of material at the time of surgical drainage is often the best way to confirm the kind of infection causing the abscess. This is true not only of the throat, but of any abscess where the infection is not yet freely draining.
• When an abscess forms around a contaminated retained foreign body or around necrotic (dead) tissue, there may well be more than one type of pathogen causing the infection.

Since abscesses contain infectious material that is sequestered (to at least some extent) from the rest of the body - antibiotics in the blood-stream ordinarily have difficulty reaching and curing the infection.

Further, although the body is using abscess formation to fight the infection - still, the conditions within the walled-off area frequently allow the infection to persist and even to flourish. Although the inflammatory response is "good", in that it bought the body time over the overwhelming harm that would have come about without walling off the infection, it's also "bad". That's because the abscess may pint and drain internally instead of externally in some cases, and because - if large enough- maintaining this big wall-ed off infection within the body is itself potentially life-threatening.

• Treating an abscess requires judgement. Whereas a "whitehead" pimple on the skin is almost always best left off to resolve naturally; an abdominal abscess will nearly always be fatal if not treated correctly.
• Generally, the treatment for an abscess involves opening up the tissues - and giving local care to the area, such as washes and compresses. Antibiotics usually have only a secondary role in the treatment of bacterial abscesses.
• Although that role is secondary to resolving the abscess, it is often vital in treating the patient. That's because surrounding areas of cellulitis and invasion of the bloodstream by bacteria happen despite the walling off of infection in may kinds of abscess. Antibiotics may do little to resolve the abscess itself, but they are very effective in treating bacterial cellulitis and the "blood poisoning" of scepticemia (bacteria in the bloodstream).

Most abscesses are formed over a substantial period of time, generally - at least days. Although the time course may be rapid, abscess formation generally has distinct stages - and the 'mature abscess' stage is a late one.

Understanding the evolution of stages is important in choosing and timing treatment. Depending on the cause (which kind of bacteria or other organism) and the place (skin, deeper tissues, internal organs) or regions of the body (foot, neck, tooth root) the treatment of an abscess may change according to the stage of formation. In many cases, drainage of an abscess is avoided until it is well-formed. However, antibiotic treatment of the infection to reduce surrounding cellulitis ( a diffuse infection of skin and/or deeper tissues) can be essential, and local care of the abscess (with warm soaks, for example) can speed maturation and help influence where the abscess will point and drain.

This is a large abscess of the buttock and upper thigh.

• The area where it is pointing is the place on the skin where it is beginning to drain. That's where the liquid is dripping.
• Most of the skin in the picture has cellulitis, it is not only red- but it will blanche (turn lighter) with pressure and be very painful.
• Where the cellulitis has caused the deep layer of skin to swell there is an "orange peel" kind of appearance.

(click the picture for links to higher resolution)

An abscess is a localized collection of pus in any part of the body that is surrounded by swelling (inflammation). [Click for rest of article]