I have seen a lot of abscesses in my career. They're quite different now than they used to be -- in training, in an inner-city program, I used to see lots of IV drug abusers with cutaneous abscesses due to injecting dirty drugs. Those pusbags were hot, red, tense, and exquisitely painful. When lanced, with good local anesthesia, they produced fountains of pus and immediate relief from the pain, and they healed well without antibiotics.
Now, of course, we all know about CA-MRSA, and 99% of the cutaneous abscesses I see are due to this germ. But they look quite different than the "classic" abscesses. Generally, they are notable for a central, shallow pustule, with minimal purulent material, and significant surrounding erythema. You can de-roof the pustule, but you never really get anything out -- just enough to culture -- and evacuating the pus is not sufficient for healing. Antibiotics are always, it seems, necessary.
The MRSA seems different in children, especially infants and toddlers. Those can look similar to the superficial pustules that adults get, but seems to have a much higher incidence of harboring a large subcutaneous collection of pus, which will fountain out under pressure when lanced. The kids seem to be much sicker (febrile, high white counts, etc) and way more likely to require hospitalization.
It's hard to know whether this is a regional thing, or whether I am seeing the typical presentation of the CA-MRSA lesions. Is this consistent with what you all are seeing?
19 June 2008
Posted by shadowfax at 12:28 PM