Abscess, Cellulitis, Carbuncle, and Non-Specific Infections No.3

Debarment of Anesthesia Tech Abscess, Cellulitis, Carbuncle and Non-Specific Infections No.3 Abscess  An abscess is a localized collection of pus that forms within tissues, resulting from an infection. Abscesses can occur in various parts of the body, including...

Debarment of Anesthesia Tech Abscess, Cellulitis, Carbuncle and Non-Specific Infections No.3 Abscess  An abscess is a localized collection of pus that forms within tissues, resulting from an infection. Abscesses can occur in various parts of the body, including the skin, soft tissues, organs, and even within the deep spaces.  In the skin it typically presents as a painful, swollen, and erythematous area, often with a central area of fluctuance. Abscess Pathophysiology The development of an abscess is a defensive reaction to prevent the spread of infection. It follows a series of events:  Infection: microorganisms invade the tissue through a break in the skin or other entry points.  Inflammatory Response: The body's immune system responds, leading to localized inflammation.  Pus Formation: As immune cells and microorganisms accumulate, pus forms within a contained space. This consists of dead cells, microorganisms, and tissue debris. Risk factors Risk factors for developing abscesses include: 1. Poor hygiene 2. Impaired host defense mechanisms (e.g., impaired leukocyte defenses) 3. chronic diseases like diabetes 4. The presence of foreign bodies 5. Obstruction to normal drainage (e.g., in the urinary, biliary, or respiratory tracts) 6. Tissue ischemia or necrosis 7. Trauma Dr. Hisham Hammodat Etiology (Causes)  Bacteria: Examples: o Staphylococcus aureus, most commonly on the skin. o Pseudomonas aeruginosa: particularly in immunodeficient patients and chronic wounds. o Enterococcus species, usually intra-abdominal abscesses and deep-seated infections o Bacteroides fragilis: commonly cause intra-abdominal abscesses  Fungus: Candida species  Parasite: Entamoeba histolytica can cause abscesses, most commonly in the liver. Clinical Presentation of Abscess The clinical presentation of an abscess depends on the location and may include the following: 1. Localized Pain: Abscesses are often associated with pain, which may be throbbing or constant in nature. 2. Swelling and Inflammation: The affected area appears swollen (oedematous), red (erythematous), and warm to the touch. 3. Fluctuance: A characteristic feature of abscesses is the presence of a fluctuant, soft, and fluid-filled center. Clinical Presentation of Abscess Systemic Symptoms: Spike Temperature Chart 1. Pain and tenderness. 2. Fever is a common symptom that persists or recurs despite the use of antipyretics. it typically exhibits a pattern of spiking, and fluctuates throughout the day, being higher in the evening or at night, and lower in the morning. 3. chills. Fluctuation 4. Excessive sweating. Time 5. Fatigue. 6. Loss of appetite. Dr. Hisham Hammodat Diagnosis  The diagnosis of an abscess is typically made based on clinical examination findings. However, additional diagnostic procedures may be required, including:  Imaging Studies: Ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) scans can help visualize the abscess, assess its size and depth, and aid in surgical planning if necessary. CT Scan of a Liver Abscess  Laboratory tests: o Complete blood count: Leukocytosis o CRP and ESR o Blood culture o Pus culture: In certain cases, a needle may be inserted into the abscess to aspirate the pus for laboratory analysis, including culture and sensitivity testing. Needle Aspiration of an Abscess Abscess Treatment The primary goals of abscess treatment include: 1. drainage of pus 2. eradication of the infection 3. resolution of symptoms 4. prevention of complications. Dr. Hisham Hammodat The main treatment modalities are as follows: 1. Conservative: A minor skin abscess may resolve on its own. The application of a warm compress can encourage it to drain naturally 2. Drainage of pus:  Skin and Superficial abscesses: o Aspiration: For smaller abscesses or those located in sensitive areas, a needle and syringe maybe used to withdraw the pus. This is often done under imaging guidance. Ultrasound Guided Aspiration o Incision and Drainage (I&D): This is the standard for most abscesses. It involves making a small incision to allow the pus to drain out, followed by thorough cleaning and dressing of the wound.  Deep abscesses:  Image guided Percutaneous drainage: Either under Ultrasound, CT scan or MRI scan.  Surgical intervention: This can involve more extensive drainage procedures, debridement of infected tissue, or even excision of the abscess cavity. 3. Antibiotic Therapy: In some cases, especially when the infection is more extensive or associated with systemic symptoms, antibiotics may be prescribed to target the causative bacteria. 4. Follow-up: Regular follow-up is essential to monitor the healing process, ensure proper wound care, and assess for any signs of complications. Dr. Hisham Hammodat Abscess Complications Complications of abscesses include: 1. Systemic spread 2. Rupture into adjacent tissue 3. Bleeding from vessels eroded by inflammation 4. Impaired function of a vital organ 5. Excessive scar tissue: can develop in some cases, leading to a keloid or hypertrophic scar 6. Sinus or Fistula formation: In some cases, a sinus of fistula can develop after abscess surgery. A sinus is a tract which connects a cavity lined by granulation tissue (usually an old abscess) with an epithelial surface. A fistula is an abnormal connection between two epithelial surfaces usually lined Sinus fistula by granulation tissue. Cellulitis  Cellulitis is a common bacterial skin infection that affects the deeper layers of the skin, including the dermis and subcutaneous tissues. It is typically characterized by localized redness (erythema), swelling (oedema), warmth, and tenderness, usually with an indistinct border. Cellulitis  Causes and Pathophysiology: o Cellulitis is most commonly caused by Streptococcus pyogenes and Staphylococcus aureus bacteria. The infection occurs when bacteria enter the skin through a break or crack, such as a cut, wound, or insect bite. The bacteria then spread and trigger an inflammatory response, resulting in the characteristic clinical features of cellulitis. Dr. Hisham Hammodat Clinical Presentation The clinical presentation of cellulitis includes the following:  Skin Changes: Affected areas appear red (erythematous), swollen (oedematous), and warm, often with a poorly-demarcated border.  Pain and Tenderness: o Systemic Symptoms: develop in more severe cases, such as fever, chills, and malaise with/out lymphangitis and regional lymph node enlargement. Diagnosis The diagnosis of cellulitis is primarily clinical, based on history and physical examination findings. However, additional investigations may be performed in certain cases, including: 1. Blood Cultures: Blood cultures may be obtained in severe or complicated cases to identify the causative bacteria. 2. Imaging: Imaging studies, such as ultrasound or MRI, may be done to assess the extent of infection and evaluate for any underlying abscess formation. Treatment  Antibiotic Therapy: Antibiotics are the mainstay of cellulitis treatment. Mild cases can be treated with oral antibiotics, while severe cases may require intravenous antibiotics.  Elevating the Affected Limb: If cellulitis affects an extremity, elevating the limb can help reduce swelling and promote drainage. Complications 1. Necrotising fasciitis: (a more serious soft tissue infection recognised by severe pain, skin pallor, loss of sensation, purpura, ulceration and necrosis) 2. Gas gangrene 3. Severe sepsis (blood poisoning) 4. Infection of other organs: eg pneumonia, osteomyelitis, meningitis, or endocarditis (heart valve infection). Dr. Hisham Hammodat Carbuncle  A carbuncle is a cluster of interconnected abscesses that arise from multiple infected hair follicles. It is larger than a single abscess and often presents as a red, swollen area with multiple drainage points.  primarily caused by Staphylococcus aureus. Other bacteria, such as Streptococcus pyogenes, can also be involved. Risk Factors & Treatment Risk factors include 1. poor hygiene 2. diabetes 3. Obesity 4. Immunocompromised states (e.g., HIV, cancer) 5. Skin conditions (e.g., eczema) Treatment: 1. Surgical Intervention: Incision and Drainage (I&D) 2. Medical Treatment: Antibiotics Non-Specific Infections o Are infectious diseases or conditions characterized by a lack of specific signs and symptoms. They typically present with general symptoms that can occur with a wide range of infectious agents, such as fever, fatigue, body aches, headache, malaise, and sometimes mild respiratory, gastrointestinal, or urinary symptoms. o Examples include Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydia spp. Dr. Hisham Hammodat Questions 1. What is an abscess? o A) A viral infection o B) A localized collection of pus within tissues o C) A fungal infection o D) A type of skin rash o E) A genetic disorder 2. Which of the following is NOT a typical risk factor for developing an abscess? o A) Poor hygiene o B) Chronic diseases like diabetes o C) Adequate nutrition o D) Presence of foreign bodies o E) Tissue ischemia or necrosis 3. What is the most common bacterial cause of skin abscesses? o A) Pseudomonas aeruginosa o B) Streptococcus pyogenes o C) Enterococcus species o D) Staphylococcus aureus o E) Bacteroides fragilis 4. Which symptom is NOT typically associated with the clinical presentation of an abscess? o A) Localized pain o B) Swelling and inflammation o C) Fluctuance o D) Chronic fatigue o E) Systemic fever 5. Which diagnostic method is commonly used to visualize an abscess? o A) Blood glucose test o B) Ultrasound o C) Electrocardiogram (ECG) o D) Spirometry o E) Audiometry 6. What is the primary treatment goal for an abscess? o A) Increase pus formation o B) Drainage of pus o C) Restrict fluid intake o D) Ignore the symptoms o E) Apply cold compress Dr. Hisham Hammodat 7. What is cellulitis? o A) A viral infection of the skin o B) A fungal infection of the nails o C) A bacterial skin infection affecting deeper layers o D) A genetic skin condition o E) A type of allergic reaction 8. Which bacteria are most commonly responsible for cellulitis? o A) Escherichia coli o B) Staphylococcus aureus and Streptococcus pyogenes o C) Candida species o D) Mycobacterium tuberculosis o E) Helicobacter pylori 9. What is the primary treatment for cellulitis? o A) Antifungal therapy o B) Antiviral medication o C) Antibiotic therapy o D) Surgical excision o E) Radiation therapy 10.What is a carbuncle? o A) A single abscess o B) A cluster of interconnected abscesses o C) A type of fungal infection o D) A viral skin infection o E) A chronic skin condition 11.Which of the following is a common complication of untreated cellulitis? o A) Diabetes o B) Necrotising fasciitis o C) Hypertension o D) Asthma o E) Migraine 12.What is the primary method for treating a carbuncle? o A) Incision and drainage (I&D) o B) Radiation therapy o C) Cryotherapy o D) Antiviral medication o E) Dietary changes Dr. Hisham Hammodat