ABSCESS
Pathological features
Contain PMNs/macrophages, lymphocytes (live and dead), bacteria (dead and viable), and liquefied tissue substances.
May lead to rupture (‘pointing’), discharge into another organ (fistula formation), or opening onto an epithelial surface (sinus) ( p.151).
Incomplete treatment due to resistant organisms (myocbacteria) or poor treatment may lead to a chronic abscess.
Complete elimination of the organisms in a chronic abscess without drainage can lead to a ‘sterile’ abscess (‘anti-bioma’).
Typical causes
Suppuration of tissue infection (e.g. renal abscess from pyelonephritis).
Contained infected collections (e.g. subphrenic abscesses).
Haematogenous spread during bacteraemias (e.g. cerebral abscesses).
Diagnosis
Deep abscesses are characterized by swinging fever, rigors, high WCC, and i CRP. Untreated they lead to catabolism, weight loss, and a falling serum albumin. Ultrasound, CT, MRI, or isotope studies may be necessary to confirm the diagnosis
Treatment
Drain the pus e.g. incision & drainage (perianal abscess), radiologically guided drain (renal abscess), closed surgical drainage (chest empyema), or surgical drainage and debridement (intra-abdominal abscess).
IV antibiotics (course may be prolonged).
P.153
