Definition and Overview

Abscess is the buildup of pus in one site of the body, although it can also occur in many different areas (for example, pimples, as bacteria can spread across the skin when they are pricked). Pus, on the other hand, is a fluid that is enriched with protein and contains dead white blood cells. It can have different degrees of yellow or white.

The site of the inflammation can differ. An abscess can appear on the surface of the skin, in which case it is referred to as boils. However, it can also develop in internal tissues and organs, including the vital parts such as the liver and colon.

Some types of abscesses go away on their own especially when they rupture and the pus begins draining. More often than not, though, they require some form of intervention, which can range from medications to needle pricking and even surgery, especially in a more invasive type of abscess.

Abscesses can also complicate. For instance, a dental abscess may eventually lead to sinusitis as the bacteria travel through the sinus cavity. In some occasions, they can lead to sepsis.

Sepsis is often a life-threatening condition since it signifies that the body is inflamed as the immune system goes into an overdrive to fight the infection, which can travel through the bloodstream. While some cases of sepsis are due to specific bacteria, it can also begin at the site of a wound.

As sepsis becomes progressively worse, the patient is at risk of developing septic shock, where blood clots can appear in blood vessels, eventually cutting off the supply of blood to vital organs, especially the brain.

Causes of Condition

The actual cause of abscess largely depends on the site of its origin. For example, a skin abscess may be due to bacterial infection or an overreaction of the immune system to a foreign body like a needle. Dental abscess, meanwhile, can build up due to the presence of cavities and the environment the teeth are in. As a person eats food, it is broken down into sugar, which mixes with calcium from the saliva, making the mouth more acidic. The acidity can then lead to the weakening of the tooth and formation of cavities.

The abscess may also develop after a surgical operation. The bigger the incision or the cut on the skin is, the higher is the probability of abscess mainly due to a bacterial infection.

In a much deeper perspective, however, abscess develops in relation to the body’s immune system.

The immune system is designed to fight off different types of infection from foreign bodies including microorganisms like bacteria, viruses, and parasites. These threats can enter the body in many ways including an opening or break in the skin or the mouth through the food a person eats.

Once bacteria, for example, get inside the body, the body’s immune system produces white blood cells or leukocytes in the bone marrow. These cells then travel to the site of infection. White blood cells are composed of many other types of cells such as neutrophils, which are meant to attack bacteria. They work closely with macrophages that send an alarm to the neutrophils if bacteria are still present.

As the leukocytes fight, they can cause the death of the tissue, which can then leave a space where they can accumulate along with bacteria and dead leukocytes. Since these cells can travel to the infection site in a short time, they can also accumulate fast, forming pus.

Key Symptoms

  • Buildup of pus
  • Inflammation
  • Redness and soreness
  • Pain
  • Presence of a sac or bump on the skin that is actually filled with pus
  • Elevated body temperature (which is a sign that the white blood cells are fighting off infection)
  • Difficulty in movements
  • Difficulty in eating
  • Sinusitis symptoms (especially when tooth abscess has already affected the sinus cavity)
  • Elevated white blood cell count
  • Oozing of yellowish, yellow-white, or white fluid
  • Neurological problems including disorientation (when abscess is present in the brain)
  • Digestive issues if the abscess is in any part of the digestive tract including the colon and rectum

For a person to be diagnosed with sepsis due to the significant presence of abscess, he or she should have an increased heart rate of about more than 90 beats a minute even when at rest, increased breathing of over 20 breaths a minute, high count of white blood cells, and a body temperature that is more than 38 degrees Celsius.

Who to See & Types of Treatment Available

Different types of doctors can help in treating an abscess. Adults can go to internists while children can visit their pediatrician. The family care physician is also trained to handle this type of case, as well as dentists and dermatologists, depending on the site of the abscess. If the abscess develops after surgery, the surgeon should be responsible for treating or managing it.

It’s easy to diagnose an abscess when it can be physically seen, such as when it develops on the skin, tonsils, or teeth. For internal abscess, tests including complete blood count or white blood cell count and imaging exams can give the doctor an idea if there’s pus accumulation.

Treatment options for abscess are the following:

  • Antibiotics – The main purpose of the antibiotics is to help control and eventually eliminate the presence of bacteria that could be causing the infection and thus the abscess. Keep in mind, however, that antibiotics may also kill off good bacteria, which can assist in boosting immunity. It is therefore necessary to follow the doctor’s instructions on how to take them.

  • Pain relievers –They are intended to reduce the swelling, redness, tenderness, and pain associated with an abscess. Since they can also have side effects, it’s best to take them only when necessary.

  • Drainage – Drainage refers to the process of making a small incision on the abscess to allow the pus or fluid to drain, which can significantly reduce the pain. The area is cleaned with sterile solution before and after to reduce the risk of infection.

  • Surgery – This is more ideal when typical drainage is impossible or when the abscess is invasive. It involves making a bigger incision on the site to allow the pus to drain.

  • 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

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