Cutaneous abscess: Difference between revisions
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Nontuberculous mycobacteria, blastomycosis, nocardiosis, and cryptococcosis.<ref name="pmid7548575">{{cite journal |vauthors=Summanen PH, Talan DA, Strong C, McTeague M, Bennion R, Thompson JE, Väisänen ML, Moran G, Winer M, Finegold SM |title=Bacteriology of skin and soft-tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use |journal=Clin. Infect. Dis. |volume=20 Suppl 2 |issue= |pages=S279–82 |year=1995 |pmid=7548575 |doi= |url=}}</ref> | Nontuberculous mycobacteria, blastomycosis, nocardiosis, and cryptococcosis.<ref name="pmid7548575">{{cite journal |vauthors=Summanen PH, Talan DA, Strong C, McTeague M, Bennion R, Thompson JE, Väisänen ML, Moran G, Winer M, Finegold SM |title=Bacteriology of skin and soft-tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use |journal=Clin. Infect. Dis. |volume=20 Suppl 2 |issue= |pages=S279–82 |year=1995 |pmid=7548575 |doi= |url=}}</ref> | ||
==Differentiating cutaneous abscess from other Diseases== | ==Differentiating cutaneous abscess from other Diseases== | ||
{| class="wikitable" | |||
!Disease | |||
!Clinical features | |||
|- | |||
|[[Folliculitis]] | |||
|Hair follicle inflammation, presents as pruritic rash or pustule. | |||
|- | |||
|[[Hidradenitis suppurativa|Suppurative hydradenitis]] | |||
|Inflammation in intertriginous areas (axillae, inguinal area, inner thighs, perianal and perineal areas, mammary,..) | |||
Presents as painful inflamed nodule, sinus tract and commedons. Associated with systemic symptoms. Needs surgical debridement and systemic antibiotic. | |||
|- | |||
|[[Epidermoid cyst]] | |||
|Cyst or nodule presents with central punctum. May be secondarily infected. | |||
|- | |||
|Nodular [[lymphangitis]] | |||
|Subcutaneous swelling along with lymphatics | |||
|- | |||
|[[Myiasis]] | |||
|Enlarging nodule secondary to insect bite and due to penetration of fly larvae into subdermal tissue. | |||
|} | |||
==References== | ==References== | ||
Revision as of 18:09, 27 March 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Cutaneous abscess is defined as a collection of pus in skin layers and may occur in any body surface. Although, there is a rare type of sterile skin abscess that is secondary to injection mostly in diabetic patients who use insulin. diagnosis is clinical and consist of a painful, tender, indurated, and usually erythematous nodule or mass that is varying in size. Systemic sign and symptoms are rare except in sever and multiple abscess especially in immunocompromised patients. Treatment is based on incision and drainage associated with antibiotics.
Historical perspective
Alexander Ogston, a scottish surgeon first described the pyogenic abscess in the late 19th century.[1]
Classification
Cutaneous abscess may be classified as sterile abscess and infectious abscess.
- Sterile abscesses are mainly seen in diabetic patients secondary to insulin injection.
- Infectious abscesses are mostly secondary to staphylococcus aureus infection.
Pathophysiology
abscess is usually caused by staphylococcus aureus bacterial infection to an injured breast skin. Staphylococcus aureus could form abscess by secretion of several killing agents like enzymes and toxins. In a reaction to these bacterial substances, assembled white blood cells in this tissue produces anti-bacterial anti-bodies that help in killing the bacteria. However, these cells cause damage to the soft tissue contributing in the abscess formation.[2]
Pathogenesis
Skin serves as a barrier from pathogen entry. Breech in the skin surface allow the pathogen entry to cause local inflammation. PMNs are the first and the most important responding cells in abscess formation.[3] Neutrophils, are responsible for phagocytosis. Once the pathogen is opsonized by complement system, it will be recognized by neutrophils and the phagocytosis process will begin. After phagocytosis the bactricidal process will begin by producing superoxide radicals and other reactive oxygen species (ROS).[4]
Genetic factors
PMNs are the most important cellular defense. Genetic disorders that negatively affect PMN function may predispose persons to recurrent cutaneous abscess formation. For example, chronic granulomatous disease, which is a genetic disorder characterized by the inability of PMNs and other phagocytes to produce superoxide, often presents with severe and recurrent S. aureus infections.[5]
Causes
Common causes
- S. aureus (either methicillin-susceptible or methicillin-resistant S. aureus) is counting for 75% of cases.[6]
- Mixed flora (including S. aureus together with S. pyogenes and gram-negative bacilli with anaerobes)[7][8]
- Anaerobes, mostly seen in injecting drug users.[7]
Less common causes
Nontuberculous mycobacteria, blastomycosis, nocardiosis, and cryptococcosis.[7]
Differentiating cutaneous abscess from other Diseases
| Disease | Clinical features |
|---|---|
| Folliculitis | Hair follicle inflammation, presents as pruritic rash or pustule. |
| Suppurative hydradenitis | Inflammation in intertriginous areas (axillae, inguinal area, inner thighs, perianal and perineal areas, mammary,..)
Presents as painful inflamed nodule, sinus tract and commedons. Associated with systemic symptoms. Needs surgical debridement and systemic antibiotic. |
| Epidermoid cyst | Cyst or nodule presents with central punctum. May be secondarily infected. |
| Nodular lymphangitis | Subcutaneous swelling along with lymphatics |
| Myiasis | Enlarging nodule secondary to insect bite and due to penetration of fly larvae into subdermal tissue. |
References
- ↑ "Classics in infectious diseases. "On abscesses". Alexander Ogston (1844-1929)". Rev. Infect. Dis. 6 (1): 122–8. 1984. PMID 6369479.
- ↑ Kobayashi SD, Malachowa N, DeLeo FR (2015). "Pathogenesis of Staphylococcus aureus abscesses". Am J Pathol. 185 (6): 1518–27. doi:10.1016/j.ajpath.2014.11.030. PMC 4450319. PMID 25749135.
- ↑ Kolaczkowska E, Kubes P (2013). "Neutrophil recruitment and function in health and inflammation". Nat. Rev. Immunol. 13 (3): 159–75. doi:10.1038/nri3399. PMID 23435331.
- ↑ Quinn MT, Gauss KA (2004). "Structure and regulation of the neutrophil respiratory burst oxidase: comparison with nonphagocyte oxidases". J. Leukoc. Biol. 76 (4): 760–81. doi:10.1189/jlb.0404216. PMID 15240752.
- ↑ Bieluch VM, Tally FP (1983). "Pathophysiology of abscess formation". Clin Obstet Gynaecol. 10 (1): 93–103. PMID 6872404.
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC (2014). "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. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
- ↑ 7.0 7.1 7.2 Summanen PH, Talan DA, Strong C, McTeague M, Bennion R, Thompson JE, Väisänen ML, Moran G, Winer M, Finegold SM (1995). "Bacteriology of skin and soft-tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use". Clin. Infect. Dis. 20 Suppl 2: S279–82. PMID 7548575.
- ↑ Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, Talan DA (2006). "Methicillin-resistant S. aureus infections among patients in the emergency department". N. Engl. J. Med. 355 (7): 666–74. doi:10.1056/NEJMoa055356. PMID 16914702.