Introduction
Abscess is a pocket of pus collection and can collect almost in any part of the body. Commonly abscess occurs in skin, muscles and rarely in solid organs. Usually caused by bacterial infections. Our body’s immune system fights against infection and localizes the infection into pus collection. Pus consists of microbes or germs, white blood cells, fluid and dead cells.
Different types of abscess
Pus collection can occur in the skin plane in various sites. Common skin abscess are under arm pit also called Hidradenitis suppurativa, breast abscess (common during breastfeeding), pilonidal abscess (pus collection in skin creases of buttocks), under the eyelids (external hordeolum). It can also develop via infection of hair follicle- boils or furuncle. Multiple furuncles coalesce to form carbuncles. Common areas are the back of neck, face, axillae and buttocks.
Another common site of pus collection is around tooth- dental abscess. Dental abscess can around gums (gingival abscess), tip of the root of the tooth (periapical abscess-commonly associated with caries tooth), periodontal abscess (bone and other supporting tissues of tooth). Pus collection can also happen in the mouth- tonsillar abscess and or retropharyngeal abscess (back of throat).
Abscess can also occur in solid organs like liver, brain, kidney etc. Abscess can also collect in muscles, in and around the spinal cord.
Symptoms:
Fever, chills, redness, raised temperature at abscess site, colour of abscess site may appear white or yellow due to pus collection. Other symptoms indicate the site of abscess- tooth sensitivity (dental abscess), difficulty swallowing (tonsillar abscess), weakness on one side of the body (brain abscess).
Diagnosis:
Most abscess are diagnosed on clinical examination. For deep seated abscess like retropharyngeal abscess, solid organ abscess may require additional imaging like ultrasound, Contrast with CT scan or MRI.
Treatment:
Initially your doctor will prescribe antibiotics along with analgesics (pain killers) and medicines for fever (antipyretics). Usually smaller abscess heal with antibiotics alone. Warm compresses can also be given.
Larger abscess and or if fever/ swelling persists despite antibiotics you may be advised for surgical drainage. Surgical drainage is a safe procedure and usually local anesthesia is given to reduce pain. Incision is given and pus is drained. Wounds are left to open for drainage for any remaining pus.
For deep seated abscess, may require sedation and or anesthesia in the operation theater. The drainage may also require drainage using image guidance (Ultrasound/CT scan). An external drain may be required for a deep and large collection of pus.
Outcomes:
Normally an abscess in skin or muscle may heal in 2-3 weeks leaving behind scar at incision site. Deep seated abscess may require 3-6 weeks. The healing may take longer if there is underlying immunodeficiency and or diabetes mellitus.
Prevention:
Abscesses are common in tropical conditions. Regular bathing, hand washing, good dental hygiene, and a healthy diet are common preventive measures.
Additional tests:
May require testing for unusual sites abscess- muscle associated with bone infection and or deep seated abscess (TB testing). Immunodeficiency testing will also be advised if there are frequent infections, poor weight gain or failure to thrive.