Abscess An abscess is a collection of pus within the body. Abscesses can be classified into various types based on their characteristics:

Pyogenic Abscess

This is the most common type of abscess and may result from cellulitis or acute lymphadenitis. The organisms gain entry either directly through a penetrating wound, by local extension from an adjacent focus of infection, or via haematogenous or lymphatic spread from a distant site. Initially, the infected area becomes red, hot, and quite tender. When pus forms, the pain typically becomes throbbing in nature. There will be brawny induration and oedema (which can be demonstrated by pitting on pressure). Fluctuation may or may not be present (as in the case of a parotid abscess).

Pyaemic Abscess

These are typically multiple, either developing simultaneously or appearing in succession, often only after one has been incised. This condition arises when infective emboli circulating in the blood become lodged in various parts of the body, resulting in the formation of multiple abscesses. A distinctive feature of these abscesses is that they commonly occur in the subfascial plane and do not exhibit the typical characteristics of a common abscess. They are non-reactive, meaning acute symptoms are absent. However, constitutional disturbances can be severe, presenting with high fever, rigours, and toxaemia.

Cold Abscess

As the name suggests, this abscess is cold and non-reactive. It does not produce the hot, painful abscess typically seen in pyogenic abscesses. Brawny induration, oedema, and tenderness are notably absent. A cold abscess is almost always a sequel of tuberculous infection, occurring commonly in the lymph nodes and bones. Caseation of the lymph nodes leads to the formation of a cold abscess. The most common sites are the neck and axilla. Occasionally, cold abscesses are seen in the loin, back, or at the side of the chest wall. These are sequelae of tuberculosis affecting the spine, ribs, and posterior mediastinal group of lymph nodes. Cold abscesses may also originate from the ends of the bones and joints, gradually coming to the surface through the fascial planes.

Anorectal Abscesses

Perianal abscesses develop between the internal and external anal sphincters and may drain through the perianal skin. Ischiorectal abscesses occur lateral to the sphincters in the ischiorectal fossa. They usually result from infection of the anal glands by normal intestinal bacteria, although Crohn’s disease is sometimes responsible. Patients typically complain of severe perianal pain, fever, and/or discharge of pus. Spontaneous rupture may lead to the development of fistulae. These may be superficial or tracked through the anal sphincters to reach the rectum. Abscesses are drained surgically, and superficial fistulae are laid open with care to avoid sphincter damage.

Cerebral Abscess

Bacteria may enter the cerebral substance through penetrating injury, direct spread from the paranasal sinuses or middle ear, or secondary to sepsis. Untreated congenital heart disease is a recognised risk factor. The site of abscess formation and the likely causative organism are related to the source of infection. Initial infection leads to local suppuration, followed by loculation of pus within a surrounding wall of gliosis, which, in a chronic abscess, may form a tough capsule. Haematogenous spread may lead to multiple abscesses. A cerebral abscess may present acutely with fever, headache, meningism, and drowsiness. However, more commonly, it presents over days or weeks as a cerebral mass lesion with little or no evidence of infection. Seizures, raised intracranial pressure, and focal hemisphere signs may occur alone or in combination. Lumbar puncture is potentially hazardous in the presence of raised intracranial pressure, and CT should always precede it. CT imaging reveals single or multiple low-density areas, which show ring enhancement with contrast and surrounding cerebral oedema. There may be an elevated white blood cell count and ESR in patients with active local infection. The possibility of cerebral toxoplasmosis or tuberculosis, secondary to IV drug use, should always be considered. Antimicrobial therapy is indicated once the diagnosis has been made. The likely source of infection should guide the choice of antibiotics. Some cases fall within the scope of neurosurgery and require intervention.

Intraabdominal Abscesses

Intra-abdominal abscesses are generally diagnosed through radiographic studies, with abdominal CT typically being the most useful.

Intraperitoneal Abscesses

Epidemiology: Of intra-abdominal abscesses, 74% are intraperitoneal (IP) or retroperitoneal, rather than visceral. Pathogenesis: Most intraperitoneal (IP) abscesses arise from colonic sources. Abscesses develop in untreated peritonitis as an extension of the disease process and represent the host defence activity aimed at containing the infection. Microbiology: Infection is typically polymicrobial; the most frequently isolated anaerobe is Bacteroides fragilis. Treatment: Antimicrobial therapy is adjunctive to drainage and/or surgical correction of an underlying lesion or process. Diverticular abscesses usually wall off locally, and surgical intervention is not routinely required. Antimicrobial agents with activity against gram-negative bacilli and anaerobic organisms are indicated.

Splenic Abscess

b>Epidemiology and Pathogenesis: Splenic abscesses are much less common than liver abscesses and usually develop via haematogenous spread of infection (e.g., due to endocarditis). The diagnosis is often made only after the patient’s death; the condition is frequently fatal if left untreated. Microbiology: Splenic abscesses are most often caused by streptococci; S. aureus is the next most common cause. Gram-negative bacilli can cause splenic abscesses in patients with urinary tract foci, associated bacteraemia, or infection from another intra-abdominal source; Salmonella species are fairly commonly isolated, particularly from patients with sickle cell disease. Clinical Manifestations: Abdominal pain or splenomegaly occurs in approximately 50% of cases, with pain localized to the left upper quadrant (LUQ) in approximately 25%. Fever and leukocytosis are common. Treatment: Patients with multiple or complex multilocular abscesses should undergo splenectomy, receive adjunctive antibiotics, and be vaccinated against encapsulated organisms (e.g., Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis). Percutaneous drainage has been successful for single, small (<3 cm) abscesses and may also be useful for patients at high surgical risk.

Scope of Homeopathy

An abscess falls within the scope of homeopathy. The remedy is chosen based on pathology, location, peculiar characteristic symptoms found on examination, type of pain, etc. Self-prescription is not advisable, and homeopathic treatment should be started in consultation with a registered and skilled homeopathic practitioner.

Medicines for Abscess with Their Symptoms

• • Apis Mellifica: Diffuse inflammation of the cellular tissues, ending in their destruction: stinging, burning pains in incipient abscesses.
  • Arnica Montana: Hot, hard, shining swelling; pricking pains and dull stitches in the part; general sinking of strength.
  • Arsenicum Album: Intolerable burning pains during the fever or when the abscess threatens to become gangrenous; pus copious, bloody, corroding, ichorous, watery, and of a putrid smell; great debility, muscular prostration, sleeplessness, and restlessness.

Diet Recommendations for Abscesses

Foods to be Taken: Fruits and vegetables (pineapple, juices), garlic. Foods to Be Avoided: Fried foods, sugar, white rice, white flour.

Yoga and Exercise

General aerobic exercises, such as walking, can be done. Pranayama.

Home Remedies

To be taken in consultation with your treating physician/homeopath.

• Apply warm compresses to the area for about 30 minutes, four times daily.
• Do not attempt to drain the abscess by pressing on it.
• Wash your hands thoroughly.
• Launder clothing, towels, or compresses that have touched the infected area.

References

1. Ralston S.H., Penman I.D., Strachan M.W.J., Hobson R.P. Davidson’s Principles and Practice of Medicine, 23rd ed. Edinburgh: Churchill Livingstone/Elsevier, 2018, p. 1417.
2. Dr. Das, S. A Manual on Clinical Surgery, 13th rev. ed. Kolkata: Dr. S. Das, 2018, p. 648.
3. Kasper D.L., Fauci A.S., Hauser S.L., Longo D.L., Jameson J.L., Loscalzo J. Harrison’s Manual of Medicine, 19th rev. ed. United States: McGraw Hill, 2016, p. 1222.
4. Boericke W. Pocket Manual of Homoeopathic Materia Medica. New Delhi: B. Jain Publishers (P) Ltd., 2011.
5. Dewey W.A. Practical Homeopathic Therapeutics, 3rd ed. New Delhi: B. Jain Publishers (P) Ltd., 2009.