Abscesses found inside the body start to manifest compression symptoms when they reach considerable size. The signs and symptoms associated with organ abscesses depend on the primary organ that is infected. Cutaneous abscesses are more visible and noticeable during the early phase of the clinical course. The following symptomology are commonly seen among patients suffering from cutaneous abscesses:

• Small reddish swellings that are sometimes painful
• Swollen skin around the swelling
• Progressive increase in size of the swelling
• Rupture of abscess when size increases

• Fever

  The presence of fever requires hospitalisation and evaluation for the presence of endocarditis. [ncbi.nlm.nih.gov]

  Symptoms may include: Fever or chills, in some cases Local swelling around the infected spot Hardened skin tissue Skin lesion that may be an open or closed sore, or a raised area Redness, tenderness, and warmth in the area Fluid or pus drainage Your health [medlineplus.gov]

  He then tells us that he's even had a fever. He's been feeling really hot, and we ask him, "Have you had a high fever, or have you had a low fever?" because we want to collect more data, and he says it's been a high fever. [khanacademy.org]

  If the infection spreads into deeper tissue, you may develop a fever and begin to feel ill. [webmd.com]

• Chills

  Prior to incision and drainage, prophylactic antimicrobial agents should be administered to every patient and as therapy for high-risk patients, such as immunocompromised patients and patients with fevers and chills. [ncbi.nlm.nih.gov]

  Symptoms may include: Fever or chills, in some cases Local swelling around the infected spot Hardened skin tissue Skin lesion that may be an open or closed sore, or a raised area Redness, tenderness, and warmth in the area Fluid or pus drainage Your health [medlineplus.gov]

  Let your doctor know right away if it gets worse or if you develop a fever or chills. [kidshealth.org]

  ‘A history of fever, chills or urinary tract infection suggests an infected cyst or an abscess.’ ulcer, ulceration, cyst, boil, blister, sore, pustule, carbuncle, pimple, spot, papule, wen, whitlow, vesication, furuncle, canker View synonyms Origin Mid [en.oxforddictionaries.com]

• Weakness

  Headache, sleepiness, nausea, weakness on one side of the body, or seizures may result. Imaging of the head is required. Antibiotics are given, sometimes followed by surgery. Brain abscesses are fairly uncommon. [msdmanuals.com]

  Previous to the formation of abscess something has occurred to lower the vitality of the affected tissue—some gross injury, perchance, or it may be that the power of resistance against bacillary invasion was lowered by reason of constitutional weakness [en.wikisource.org]

  On postoperative day 1, the patient went to the emergency department describing bilateral weakness and pain of the lower extremities (LE). [ncbi.nlm.nih.gov]

  The patient's urinary retention, low-back pain, and right leg weakness improved within several weeks after the surgery, and he soon discontinued the Foley catheter and narcotics. [doi.org]

  Davis et al. found that about 75% of SEA patients had a delay before imaging was performed, leading to a significant increase in motor weakness with 45% of these patients demonstrating residual weakness compared to 13% who did not have a diagnostic delay [aliem.com]

• High Fever

  CASE PRESENTATION: A 13-year-old boy presented with occasional high fever and lower back pain. He was diagnosed with spondylitis of the L4-5 vertebral bodies and paravertebral abscess. [ncbi.nlm.nih.gov]

  He then tells us that he's even had a fever. He's been feeling really hot, and we ask him, "Have you had a high fever, or have you had a low fever?" because we want to collect more data, and he says it's been a high fever. [khanacademy.org]

  Call your doctor if you have a high fever, or if the abscess is larger than ½ inch across, is near your rectal area or groin, or if red streaks are radiating out from the abscess. [healthcentral.com]

• Pathologist

  American Society of Clinical Pathologists, 2100 West Harrison Street, Chicago IL 60612. (312) 738-1336. 〈http://www.ascp.org/index.asp〉. College of American Pathologists, 325 Waukegan Road, Northfield, IL 60093. (800) 323-4040. [encyclopedia.com]

  Adamkiewicz Albert, Polish pathologist, 1850–1921. See artery of A.. Adams Sir William, British surgeon, 1760–1829. Adams Robert, Irish physician, 1791–1875. See A.-Stokes disease, Stokes-A. disease, A.-Stokes syncope, A. [theodora.com]

• Overeating

  Emergency department visits for abscesses more than doubled over the 10-year study period (1.2 million in 1996 to 3.28 million in 2005; trend, P < .01). [ncbi.nlm.nih.gov]

  However, it can grow over time and resemble a cyst filled with fluid. Depending on the cause of the abscess, other symptoms may also be present. [healthline.com]

  Boils are superficial infections with a thin layer of skin over fluid. Abscesses are generally larger and deeper than boils with redness and painful swelling over an area filled with pus. [healthychildren.org]

  You can also try over-the-counter pain medicine, including acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin). Be safe with medicines. Read and follow all instructions on the label. [northshore.org]

• Lower Abdominal Pain

  They usually are tachycardic and tachypneic and have lower abdominal pain and tenderness. [glowm.com]

• Jaundice

  ‘If untreated, jaundice can lead to infection and abscesses in the liver, which can be fatal.’ ‘However, subcutaneous injections can cause abscesses and granulomas.’ [en.oxforddictionaries.com]

  […] transplant recipients malignancy end-stage renal disease 18 intravenous drug use trauma ERCP 3 cryptogenic: 15% 1 liver cirrhosis 19 biliary disease 20 inflammatory bowel disease 21 The typical presentation is one of right upper quadrant pain, fever and jaundice [radiopaedia.org]

  For example, a liver abscess may cause jaundice, whereas an abscess in or near the lungs may cause a cough or shortness of breath. [nhsdirect.wales.nhs.uk]

  (pale) stools. acholuria (a-ko-loo′re-a) Absence of bile pigments from the urine in certain cases of jaundice. [theodora.com]

• Tachycardia

  […] aureus, ( the usual bacterium present in an abscess) as an adjunct to incision (cutting) and drainage should be made based on the presence or absence of systemic inflammatory response syndrome (SIRS) such as temperature >38°C or 24 breaths per minute, tachycardia [blackpoppymag.wordpress.com]

  […] into the upper genital tract coincident with vaginal examinations during labor and/or instrumentation during surgery. 4 Diagnosis The most common clinical manifestations of endometritis and pelvic cellulitis are fever within 24–48 hours of surgery, tachycardia [glowm.com]

  […] almost exclusively in the past by mercury poisoning: in children, characterized by erythema of the extremities, chest, and nose, gastrointestinal symptoms and by polyneuritis (in Japan); in adults, characterized by anorexia, photophobia, sweating, and tachycardia [theodora.com]

• Quickening

  In physiology, a nerve, muscle, or substance that quickens movement or response. 3. A catalytic agent used to hasten a chemical reaction. SYN: accelerant. 4. [theodora.com]

• Fracture

  Damage to the tooth, such as a fracture or a chip, are also a major cause of this oral health problem. Frankly, any sort of trauma to a tooth can result in an abscess forming if it’s not fixed or resolved in some way. [emergencydentistsusa.com]

  Know who is truly at risk A wide variety of at-risk conditions include: Diabetes mellitus IV drug use Chronic kidney/liver disease Recent spine procedure or indwelling spinal hardware Indwelling vascular catheter Recent spine fracture Immunocompromised [aliem.com]

  Dental abscesses may also result from injuries such as a fracture in the tooth. If the cause is a dental cavity, the infection begins when the bacteria enter the pulp * portion inside the tooth. [humanillnesses.com]

  The majority of minor head injuries do not lead to injuries such as skull fractures or bleeding in the brain that need to be diagnosed by a CT scan. [choosingwisely.org]

• Nipple Discharge

  Cosmetically, a breast abscess can also cause deformation of the nipple and areola. Sub and periareolar (around the nipple) abscesses also frequently cause nipple discharges. [breast-cancer.ca]

• Facial Swelling

  Signs of serious infection include sharp, deep pain and facial swelling and you should get to a dentist right away -- or to an emergency room if after office hours. [health.howstuffworks.com]

  A lot of times people with an infection will have facial swelling, she says, but it’s pretty uncommon that it would actually break through a person’s skin. When this kind of thing does happen, it’s serious. [self.com]

  These symptoms, as mentioned above, include: A high temperature is one sign of an abscess Severe tooth pain A nasty taste in their mouth A lump or swelling in the mouth Facial swelling Discomfort while eating A high temperature Dental abscess treatment [dentaly.org]

  Fever and facial swelling may indicate that the infection has spread deeper into your jaw and surrounding tissue, or even to other areas of your body. If you can’t reach your dentist, go to an emergency room. [yourdentistryguide.com]

• Facial Pain

  Dental and facial pain. In: Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW, eds. Practical Management of Pain. 5th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 31. Pedigo RA, Amsterdam JT. Oral medicine. [mountsinai.org]

• Flank Pain

  Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial. Eur Radiol. 2003 Nov;13(11):2513-20. Katz SI, Saluja S, Brink JA, Forman HP. [choosingwisely.org]

The diagnosis is easily made with the aid of a careful clinical history taking and a detailed examination of the skin. However, ancillary tests and diagnostic modalities may be needed to ascertain the diagnosis of abscess. The following tests and diagnostic methods may be implored to patients suffering from abscess:

Laboratory tests

Pus aspirates from the abscess may be brought to the laboratory for examination of its contents and the identification of the offending bacteria. Skin swabs may be taken from the abscess sites and placed on a culture media. The bacterial culture may be studied to accurately identify the causative agent. Sensitivity testing determines which antibiotics are most effective against the offending bacteria or agent.

Ultrasound

Abscesses found within the body may require imaging studies like ultrasound to visualize the abscess formation. Liver and lung abscesses are sensitively detected by the sonogram in most cases.

Computed tomography (CT scan)

The CT scan is most useful in diagnosing brain abscess to assess its location, size and the structures that it impinges. Brain abscess must be identified and treated promptly because of its potentially lethal nature [5].

Magnetic resonance imaging (MRI)

This is a more detailed rendering of the internal structures as compared to the CT scan. MRI are arbitrarily used in the imaging of perianal abscesses [5].

The treatment modalities used is dependent on the size and location of the abscess formation. The following treatment modalities are implored for the treatment of abscess:

• Empiric topical antibiotics: Cutaneous abscess are usually treated with empiric antibiotics like bacitracin and mupirocin [6]. 
• Oral and parenteral antibiotics: Cutaneous abscess with larger diameters and unresponsive to topical antibiotics may require oral doses of cloxacillin or flucloxacillin given in a period of 7 to 10 days [7]. Intravenous or parenteral antibiotics are reserved for more serious forms of abscess like brain abscess, empyema, and hepatic abscess. 
• Surgical incision and drainage: This surgical procedure is implored on large abscesses and those that cause severe discomfort and pain. The incision will drain the pus from the cavity to relieve pressure signs and hasten healing of the lesion [8]. Tooth abscess are usually drained to control the toothache. 
• Surgical debridement: For large confluent abscesses and complicated fasciitis, there is an immediate need to remove dead tissues to get rid of the source of infection.

Small cutaneous abscesses that resolve with minimal intervention carry a very good prognosis. Boils like carbuncles and furuncles rarely complicate, but infection might reach the blood stream and cause a systemic infection.

Life threatening abscess variants like the necrotizing fasciitis are treated promptly to prevent serious complications [3]. Brain abscess, lung abscess, and liver abscess however should be treated instantly because of their probable serious complications [4].

Bacterial infections are commonly implicated as the causative factors in the formation of abscess. Less commonly abscess is caused by viruses and protozoans among susceptible patients. The more common bacterial pathogens associated with cutaneous abscesses include: Staphylococcus aureus, Beta-hemolytic streptococcus, Bacteroides fragilis, Eneterobacter sp, and Pasteurella multocida [1].

Abscess is fairly common in worldwide population. Because mild cutaneous abscess resolves spontaneously with home remedy treatment, most cases are not brought to medical attention and are not subsequently recorded. For this reason, the exact epidemiologic data is not available. There is no sexual and racial predilection for abscess. Abscesses are more common in countries with warmer climates.

The incidence among children belonging to the lower socioeconomic status is high. This is probably related to the poor health conditions, poor hygiene, dirty environment, malnutrition, and poor access to medicines and medical care.

Pathogenesis of abscess formation depends on the site of the formation. Abscesses from acne are formed after the cutaneous oil glands and sebaceous glands are obstructed. The obstructed gland propagates the growth of the pathogenic organisms within the sebum sac where pus forms, and the swelling starts to bulge out of the skin.

Breaks in the skin may cause abscess of the hair follicles giving rise to folliculitis. Soft tissue organs like the lungs, liver and the brain may also develop abscesses from systemic sources by sepsis [2].

The pus collection found in the middle of the abscess is a collection of dead cells, bacteria, and some cellular debris. Patients who have diminished immune response can easily develop abscess formation because of an incompetent cell mediated immunity.

Frequent hand washing and proper bathing should regularly be done to prevent the propagation of pyogenic bacteria in the skin. Persistent bumps and lumps must be promptly brought in for medical attention to prevent the untoward complications of such. Patients with low immune response like those on chronic steroids and anti-cancer regimens must take oral antibiotics when treating simple cutaneous abscess. Smoking must also be controlled for it increases the risk for anal abscess formation [9]. A good glucose control among diabetics may prevent the emergence of cutaneous and internal abscess formation.

Abscess is a bump or lump that contains a collection of pus. Often, abscess is a result of a bacterial infection. It may occur almost anywhere in the body with soft tissues. It is a clinical condition characterized by the local collection of pus within a confined tissue space. Abscesses are usually caused by an infectious agent that causes localized redness, pain, tenderness, and swelling of the affected tissue. Abscess can be further classified to carbuncles, and furuncles (boils) according to its size and clinical course. These are usually treated with surgical drainage and oral antibiotics. 

Definition

Abscess is a clinical condition characterized by the local collection of pus within a confined tissue space. This may occur on the skin or any other soft tissue organ in the body.

Cause

Abscesses are basically caused by bacterial infections that invade the skin and other organs. A decreased cell mediated immune response among the immunecompromised patients, and long term steroid users predisposes one from developing abscess in any part of the body.

Symptoms

Cutaneous abscesses will present as lumps and bumps on the skin. The lesion may appear initially as a reddish lump or bump with a painful localized swelling. The lesion may later evolve a whitish punctum in the center through pus may drain with the abscess ruptures. Internal organ abscess may present in the later stages of its development when the size is big enough to cause pressure symptoms.

Diagnosis

The accurate diagnosis of abscess is done with a detailed clinical history and physical examination of skin. Ancillary tests like culture and sensitivity may be done to determine the causative agent and the antibiotics through which they are sensitive. Imaging studies like ultrasound, MRI and CT scan are used to identify abscess located within the body.

Treatment and follow-up

Abscesses are initially treated with empiric antibiotics in topical, oral, and parenteral form depending on the severity. Surgical incision and drainage may be needed to relieve the abscess and hasten its recovery. The active removal of tissues that are no longer viable through surgical debridement may be necessary to eliminate the source of the infection and prevent further complications.

1. Tintinalli JE, Stapczynski JS, Ma OJ, et al. Emergency Medicine: A Comprehensive Study Guide. 7th Ed. New York: McGraw Hill Medical Publishing; 2010:1001-1008.
2. Salahi R, Dehghani SM, Salahi H. Liver abscess in children: a 10-year single centre experience. Saudi J Gastroenterol. 2011; 17(3):199-202 
3. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clin Infect Dis. Jul 15 2014; 59(2):e10-52.
4. Tam MH, Wong GK, Ip M, Kam MK. Management outcome of NPC-related and non-NPC-related brain abscess in Hong Kong. Clin Neurol Neurosurg. 2012; 114(6):560-3 
5. Sankararaman S, Riel-Romero RM, Gonzalez-Toledo E. Brain abscess from a peritonsillar abscess in an immunocompetent child: a case report and review of the literature. Pediatr Neurol. 2012; 47(6):451-4 
6. Li X, Qiang JW, He C, Ji XS, Zhang B. Magnetic resonance imaging study of perianal abscess. Zhonghua Wei Chang Wai Ke Za Zhi. 2011; 14(11):868-70 
7. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. Feb 1 2011; 52(3):e18-55.
8. Barclay L. IDSA: skin and soft tissue infections guidelines updated. Medscape Medical News. Accessed November 16, 2014.
9. Holtzman LC, Hitti E, Harrow J. Incision and drainage. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Saunders Elsevier; 2013: chap 37.
10. Devaraj B, Khabassi S, Cosman BC. Recent smoking is a risk factor for anal abscess and fistula. Dis Colon Rectum. 2011; 54(6):681-5