Definition

Abscess is a pocket containing a collection of pus in a certain part of the body. The body that experiences abscesses will feel pain. Abscess is generally caused by bacterial infection and can arise in any part of the body. In general, abscesses are divided into 2, namely:

• Skin abscess, i.e. abscess that forms under the skin
• Internal abscess, namely abscess that is formed inside the body, namely in the internal organs, or in the space between organs.

When the body is infected, the immune system will try to fight the infection. The infection resistance is mainly carried out by white blood cells that will gather in the infected area. The white blood cell response to the infection can cause inflammation. Pus will be formed in the inflammatory process. Pus is a mixture of living or dead white blood cells, germs, and dead body tissues.

Skin abscesses are easy to detect because they are generally red, prominent, and painful. Abscesses that form on the inside of the body may not be clearly visible and can damage organs. 

Cause

Most abscesses are caused by bacterial infections. Staphylococcus sp. When bacteria enter the body, the immune system sends white blood cells to fight the infection. This causes swelling, inflammation, and tissue death around the site of infection.

Due to inflammation, a cavity is formed that will be filled with pus and form an abscess. The pus contains a mixture of dead tissue, white blood cells and bacteria. Abscesses can get bigger and more painful as the infection continues and produces more pus.

Some types of bacteria Staphylococcus sp. produces a toxin called Panton-Valentine leukocidin (PVL) toxin which can kill white blood cells. This plays a role in the occurrence of recurrent infections. Therefore, the body needs to make more white blood cells to continue to fight the infection. In rare cases. abscesses can be caused by viruses, fungi or parasites.

Skin abscesses

Skin abscesses are formed when there is an excess of bacteria under the skin. Skin abscesses can occur anywhere on the body, although they tend to be more common in the armpits, hands, feet, genitals, and buttocks.

Bacteria can enter the skin and cause abscesses if you have a wound on the skin, even if the wound is small and not visible to the eye. Bacteria can also enter through the hair roots or through clogged oil glands and sweat glands.

Internal abscesses

Internal abscesses are abscesses that form in the internal organs of the body. For example, an abscess in the abdominal cavity can occur due to injury, abdominal surgery, or an infection that spreads from the area around the abdomen, such as a lung abscess that spreads to the abdomen. Lung abscesses can form after bacterial infections in the lungs, such as pneumonia.

Risk Factors

Factors that increase the risk of abscesses include:

• Having a weak immune system, such as in HIV patients or those undergoing chemotherapy treatment.
• Suffering from diabetes
• There is inflammation in one part of the body, such as hidradenitis suppurativa, which is inflammation in areas that have hair and sweat glands such as the armpits
• Being a carrier of bacteria Staphylococcus sp.

Symptoms

Skin abscesses

Signs and symptoms of skin abscesses include:

• Soft swelling under the skin
• Pain and pressure pain in the area that is experiencing and surrounding it
• Warm and reddish
• A white or yellow pus buildup under the skin is visible.
• Fever
• Shivering

Boils is the most common example of a skin abscess.

Internal abscesses

Abscesses that develop within organs or in the inter-organ space are more difficult to diagnose than skin abscesses because they cannot be seen directly and the symptoms tend to be non-specific.

Symptoms of internal abscesses also vary depending on their location. For example, a liver abscess can cause jaundice (yellowing of the skin and eyes), while a lung or lung abscess can cause coughing or shortness of breath.

Common symptoms of internal abscesses include:

• Uncomfortable feeling in the abscess area
• Fever
• Excessive sweating
• Feeling unwell
• It feels painful in the area that has experienced
• Shivering
• Pain or swelling in the area that has experienced
• Loss of appetite
• Weight loss

Diagnosis

Skin abscesses

If you have a skin abscess, your doctor will examine the area and ask about the duration of your abscess, the history of wounds or injuries in the abscess area, and other symptoms you feel.

A sample of pus will be taken from the abscess and sent to the laboratory for testing for specific bacteria that cause the abscess, so that it can help in choosing the best treatment.

If you have more than one skin abscess, a blood sugar test can be done which is a sign of diabetes. People with diabetes have a higher risk of skin abscesses. 

If you have recurrent boils and abscesses, your doctor will ask for further bacterial testing to see if the bacteria produce Panton-Valentine leukocidin (PVL) toxins.

Internal abscesses

Abscesses that develop inside the body are more difficult to diagnose than skin abscesses because they are not visible. Doctors will ask about your symptoms and overall health. If necessary, you can be referred to a more complete health facility for further examination.

Procedure

There are several ways to treat and treat abscesses, depending on their type and size. The main treatment options for abscesses are antibiotics, drainage procedures or removing pus, and surgery. 

Skin abscesses

Some small skin abscesses can dry out on their own and improve without treatment. A warm compress on the affected area can reduce swelling and speed up healing. However, the compress must be washed clean after use and not used by others to avoid spreading the infection.

For larger or persistent skin abscesses, doctors may prescribe antibiotics to treat and prevent the spread of infection. 

However, antibiotics alone are sometimes not enough to treat skin abscesses and need to be drained to heal the infection. If the pus is not removed, the abscess will continue to grow and be filled with more pus until it bursts. If this happens, it will be very painful and cause the infection to spread or recur.

Insisi and Drainage

If a skin abscess needs to be drained, you need to undergo a small operation with local anesthesia to remove the pus. The doctor will also take a sample of the pus to be examined in the laboratory.

Internal abscesses

In internal abscesses, pus needs to be removed or drained. Drainage can use a needle inserted through the skin (percutaneous abscess drainage) or by surgery. The method used depends on the size and location of the abscess.

Drainage procedures will be combined with antibiotics to kill bacteria and prevent the spread of infection. Antibiotics are given in the form of tablets or through the veins (injection). 

Percutaneous drainage

If the internal abscess is small in size, the doctor can remove the pus using a fine needle. This procedure can be done with local or total anesthesia, depending on the location of the abscess. The surgeon uses ultrasound to help direct the needle to the right place. After the abscess is found, the surgeon removes the pus using a needle. 

Doctors can also make a small incision over the abscess to insert a thin plastic tube called a drainage catheter into it. The catheter helps the pus flow out and into a collection bag. As with incision and drainage procedures on skin abscesses, percutaneous drainage can leave a small scar.

Surgery

Surgery or surgery is needed if:

• Internal abscess too large to be drained with a fine needle.
• The needle cannot reach the abscess safely.
• Needle drainage is not effective for removing all pus

The type of surgery depends on the type and location of the internal abscess. Generally, the surgical procedure is carried out by making a larger incision in the skin to remove the pus.

Complications

In some cases, skin abscesses can cause complications, such as:

• Multiple carbuncles or abscesses are formed
• Fever and swelling of the lymph nodes
• Endocarditis, which is inflammation of the heart muscle
• Gangrene or tissue death in the abscess area
• Osteomyelitis or bone infection
• The infection spreads throughout the body through the blood vessels or lymph nodes and can be life-threatening. Infection that spreads throughout the body through the bloodstream is called sepsis.
• Treatment will be more difficult if the infection is caused by MRSA bacteria

Prevention 

Prevention of abscesses can be done through:

• Routine hand washing with soap and running water
• Do not share towels and clothes with others
• Wait until the skin abscess is completely healed before using public equipment or facilities such as gym equipment, saunas, or swimming pools.
• Do not squeeze the abscess with your hands because it will spread bacteria to other areas of the skin.
• If you use tissue to clean the pus, throw the tissue into the trash properly so as not to spread bacteria. Wash your hands after cleaning the pus and throw away the tissue
• Be careful when shaving hair on the face, legs, armpits, or areas above the genitals so as not to injure the skin of the area.
• Clean and treat the wound properly if the wound is small in size.
• Seek medical help immediately if you have a puncture wound, especially if there is suspected dirt or foreign objects in the wound; the wound is caused by human, insect, or animal bites; you have one of the risks of abscess; or are on steroid or chemotherapy treatment.
• Healthy and balanced diet
• Maintain an ideal body weight
• Quit smoking

It tends to be difficult to prevent internal abscesses because they are often also caused by complications of other health conditions. 

When should you see a doctor? 

Consult a doctor if you experience the signs and symptoms of an abscess as mentioned above.

Immediately seek medical help if you experience:

• Signs of serious illness, such as fever
• Recurrent abscesses
• Abscess with a weakened immune system or having chronic diseases, such as diabetes.

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