1. INTRODUCTION<br />An abscess is a hollow space in the body that is filled with pus and surrounded by inflamed tissue. Abscesses can be serious and lead to gangrene and permanent organ damage if they are not recognized and treated promptly. An abscess forms from a bacterial infection, parasitic infection or foreign body and can develop in many places in the body. One type of bacteria that commonly causes abscesses is Staphylococcus aureus. Examples of abscesses include skin abscess, brain abscess, lung abscess, kidney abscess, bones abscess, abdominal abscess, rectal abscess, breast abscess, liver abscess, spinal cord abscess and tooth abscess. An abscess develops when harmful bacteria or parasites infect an area of body tissue, such as the gums or the skin. The body tries to attack the infection by sending a surge of white blood cells (infection fighting cells) to the infected area. During this process living and dead white blood cells, fluid, bacteria, and dead tissue collect within the diseased tissue and form pus. The surrounding tissue also becomes inflamed and painful. Symptoms and complications of an abscess vary depending on the area of the body where it develops. Symptoms often include swelling and pain. Some types of abscesses can lead to serious, even life-threatening complications, such as sepsis, kidney failure, shock, and death. For more information on complications and symptoms, refer to abscess. People at risk for an abscess and its complications include those who have a compromised immune system due to such diseases as HIV/AIDS or combined immunodeficiency. People who take certain medications, such as corticosteroids or chemotherapy, which suppress the body's natural immune response, are also at risk for contracting an abscess. Other risk factors include having diabetes, cancer, Crohn's disease, ulcerative colitis, severe burns, or severe trauma. Making a diagnosis of an abscess begins with taking a thorough medical history, including symptoms, and completing a physical examination. The types of diagnostic testing performed for a suspected abscess varies depending on the symptoms. A complete blood count (CBC) is a blood test is often performed. A complete blood count measures the numbers of different types of blood cells, including white blood cells (WBCs). Different types of WBCs increase in number in characteristic ways during an infectious or inflammatory process, such as an abscess. A culture and sensitivity test (C and S) may also be performed and involves taking a small sample from the abscess and growing it in the laboratory. This test determines the type of organism causing the abscess, as well as which antibiotics would be most effective in treating it. Imaging tests, such as X-ray, CT, or MRI, may be performed to assist in the diagnosis of some internal abscesses, such as a pancreatic abscess, liver abscess or kidney abscess. Additional tests may be performed in order to rule out or confirm other diseases that may accompany an abscess or cause similar symptoms. It is possible that a diagnosis of an abscess can be missed or delayed because some symptoms, such as fever and inflammation are similar to symptoms of other diseases of conditions. For more information on misdiagnosis, refer to misdiagnosis of abscess. Treatment of an abscess varies depending on its location and other diseases and conditions that may coexist with the abscess.<br />PATHOPHYSIOLOGY OF ABSCESS <br />Clinical and experimental data provide evidence for interactions between aerobic and anaerobic organisms in abscess formation. The organisms present represent a subset of those normally found at nearby mucosal surfaces. Certain organisms, most notably B. fragilis, emerge from the normal flora as important in abscess formation. Suspected virulence factors for B. fragilis include oxygen tolerance, capsular polysaccharide and the other enzymes produced by this organism. Other factors, as yet incompletely understood, probably play a role. In addition, the large number of organisms present in an abscess, the presence of antibiotic inactivating enzymes, the hostility of the anaerobic environment to antimicrobial activity and host defenses, as well as the fibrous capsule surrounding an abscess, contribute to the persistence of infection despite antibiotic therapy and the need for drainage. The contribution of both aerobic and anaerobic organisms in the formation of abscesses must be remembered when one chooses antibiotic therapy for such infections.<br />PATIENT’S PROFILE<br />NAME: Micheal C. Batugal<br />ADDRESS: Centro Norte Sto.Niño, Cagayan<br />AGE: 23 yrs old<br />GENDER: Male<br />CIVIL STATUS: Single<br />BIRTHDAY: September 27, 1986<br />IRTH PLACE: Lipatan Sto. Niño<br />CCUPATION: Baker<br />NATIONALITY: Filipino<br />RELIGION: Roman Catholic<br />CHIEF COMPLAINT: Swelling at the left upper leg for 2 months and afternoon fever at times.<br />ATTENDING PHYSICIAN: Dr.C. Paraggua<br />NURSING HISTORY<br />CHIEF COMPLAINT: Swelling at the left upper thigh.<br />HISTORY OF PRESENT ILLNESS: Started 2 months PTA as pain and swelling of the left thigh. Consultation done for a private physician, gives ciprofloxacin, no improvement noted.<br />LABORATORY FINDINGS<br />DATE: July 06, 2010AP: Dr. C. Paraggua<br />FINDINGS<br />Hemoglobin133 g/L<br />WBC11.75<br />Hematocrit40<br />DIFFERENTIAL FINDINGS<br />Segmenters85<br />Lymphocytes15<br />DATE: July 07, 2010AP: Dr. G. Paraggua<br />FINDINGS<br />Hemoglobin126 g/L<br /> <br />