Abscess

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Abscess Main page
Patient Information
Overview
Causes
Classification Anal Abscess Appendicular Abscess Brain Abscess Breast Abscess Colon Abscess Cutaneous Abscess Liver Abscess Lung Abscess Pancreatic Abscess Retropharyngeal Abscess Splenic Abscess Tonsillar and Peritonsillar Abscess
Differential Diagnosis

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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

Abscess is defined as collection of pus in a specific part of body. Abscess can form in any tissues secondary to initial inflammation or trauma. Skin is the most common site for abscess formation. Abscess may be classified based on pathogen. Pathogen is varied depending on abscess' location however, Staphylococcus aureus is the leading cause of abscesses. Secondary to local inflammation and cytokine release, polymorphonuclear cells (PMNs) are the first and the most important responding cells in abscess formation. 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). Conditions that may result in immunosuppresion, such as chronic steroid therapy, chemotherapy, diabetes, cancer, and AIDS are predisposing factors for abscess formation. Diagnosis is based on clinical features, laboratory, and imaging findings. Treatment depends on location and etiology and it is mostly drainage and antibiotics.

Causes

Abscesses are caused by many different pathogens based on their anatomical location. The following table summarizes pathogenic causes of abscesses.

Anatomical location Common causes Less common causes Comments Brain abscess Staphylococcus aureus Streptococcus spp Cryptococcus neoformans Cysticercosis Toxoplasma gondii Pseudomonas aeruginosa Enterobacter spp Haemophilus spp Causes of brain abscess depends on the source of infection. To see a complete list of brain abscesses's causes, click here. Tonsillar and peritonsillar abscess Streptococcus pyogenes Fusobacterium necrophorum Streptococcus milleri Staphylococci Haemophilus Prevotella Acinetobacter Candida albicans Peptostreptococcus spp Pseudomonas spp Enterobacter spp Klebsiella Porphyromonas -- Retropharyngeal abscess Beta-hemolytic streptococcus Streptococcus pyogenes (group A streptococcus [GAS]) Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA]) Haemophilus Influenzae Haemophilus parainfluenzae Neisseria species Bacteroides Fusobacterium Retropharyngeal abscess are usually caused by polymicrobial flora. To see a complete list of retropharyngeal abscess' causes, click here. Lung Abscess Bacteroides Fusobacterium Peptostreptococcus Prevotella Streptococcus milleri Legionella Lemierre's syndrome Listeriosis Melioidosis About 90% of the lung abscess is caused by polymicrobial infection. Anaerobes are the predominant pathogens involved in primary lung abscess, followed by Streptococcus pneumoniae. Klebsiella pneumoniae is the more commonly seen in alcoholics. To see a complete list of lung abscess' causes, click here. Breast Abscess Staphylococcus aureus Streptococcus pyogenes Lactobacillus Clostridium Bacteroides spp Enterobacteria -- Liver abscess Pyogenic Streptococcus sp Staphylococcus aureus Staphylococcus epidermidis Escherichia coli Salmonella typhi Yersinia enterocolitica Bacteroids sp Fusobacterium  Mycobacterium tuberculosis Actinomyces sp Enterococcus sp Streptococcus milleri K.pneumonia Pseudomonas sp To see a complete list of pyogenic liver abscess' causes, click here. Amoebic Entamoeba histolytica -- -- Fungal Candida species Aspergillus species -- -- Splenic abscess Staphylococcus species Streptococcal species Bacteroides Actinomyces Candida albicans Entamoeba histolytica Aureobasidium pullulans Bacillus cereus Brucella Citrobacter freundii Cryptococcus neoformans To see a complete list of splenic abscess' causes, click here. Pancreatic abscess Enterococcus Escherichia coli Klebsiella pneumoniae Bacteroides fragilis Candida albicans Entamoeba histolytica Pseudomonas aeruginosa Staphylococcus aureus Proteus Clostridium perfringens Candida tropicalis -- Appendicular abscess Enterococcus Escherichia coli Staphylococcus aureus Bacteroides fragilis Clostridium perfringens Klebsiella pneumoniae Pseudomonas aeruginosa Proteus -- Colonic abscess Enterococcus Escherichia coli Staphylococcus aureus Bacteroides fragilis Clostridium perfringen Klebsiella pneumoniae Pseudomonas aeruginosa Proteus -- Anal abscess E.coli Staphylococcus aureus MRSA -- -- Cutaneous abscess S. aureus (either methicillin-susceptible or methicillin-resistant S. aureus) Mixed flora (including S. aureus together with S. pyogenes and gram-negative bacilli with anaerobes) Anaerobes Nontuberculous mycobacteria Blastomycosis Nocardiosis Cryptococcosis

Classification

Abscesses may be classified based on their location. These are listed below.

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Differential diagnosis

The following table summarizes differential diagnosis list for different abscesses.

Abscess Common disease Less common disease Anal abscess Anal fissure Fistula in ano Proctatitis Hidradenitis suppurativa Bartholin's abscess Appendicular abscess Psoas abscess Cellulitis of right thigh Crohn's disease Gastroenteritis Primary peritonitis Ovarian torsion Pelvic inflammatory disease Brain abscess Metastatic tumors Lymphomas Subarachnoid hemorrhage Stroke Neurosyphilis Subdural empyema Breast Abscess Mastitis Inflammatory breast cancer Galactocele Cellulitis Fibroadenoma Colonic abscess Crohn's disease Gastroenteritis Primary peritonitis Pelvic inflammatory disease Cutaneous abscess Folliculitis Suppurative hydradenitis Epidermoid cyst Nodular lymphangitis Myiasis Liver abscess Echinococcal (hydatid) cyst Malignancy (Hepatocellular carcinoma/Metastasis) -- Lung Abscess Malignancy (primary lung cancer) Pulmonary Tuberculosis Necrotizing Pneumonia Empyema Bronchiectasis Sarcoidosis Pancreatic abscess Infected pancreatic pseudocyst Infected necrotic pancreas Retropharyngeal abscess Peritonsillar abscess Croup Epiglottitis Pharyngitis Tonsilitis Splenic abscess Splenic cysts Splenic infarct Splenic hematomas Subphrenic abscess Tonsillar and peritonsillar abscess Croup Epiglottitis Tonsilitis Pharyngitis Retropharyngeal abscess