Soft-Tissue Abscesses

Although the first-generation cephalosporins are broad spectrum and relatively nontoxic, they are rarely the drug of choice for any infection. Oral drugs may be used for the treatment of urinary tract infections, for staphylococcal, or for streptococcal infections including cellulitis or soft tissue abscess. However, oral cephalosporins should not be relied on in serious systemic infections. 

Respiratory symptoms, cough and hemoptysis may occur due to pulmonary infiltrates of Salmonella typhi and secondary pneumococcal infection. Bacteremia leads to focal disease, which presents with osteomyelitis, endocarditis, particularly in valvular disease, meningitis, soft-tissue abscesses, glomerulonephritis and skin lesions. CNS complications, such as meningitis, mental disturbances, delirium or depressed level of consciousness may occur in severe cases. 

Imaging studies may identify abscess formation, gas in the soft tissues, or osteomyelitis. 

Signs and Symptoms Symptoms in immunocompromised individuals may include fever, difficulty breathing (dyspnea), nonproductive cough, bloody sputum (hemoptysis), bloody nose (epistaxis), a vague feeling of bodily discomfort (malaise), pneumonia, weakness, chest pain, and anorexia. May progress to inflammation of the eyes (endophthalmitis), sensitivity to light (photophobia), and/or inflammation of the heart (endocarditis). May also cause abscesses in the heart, kidneys, liver, spleen, other soft tissue, or the bone. If the central nervous system becomes involved, can cause altered mental states and seizures. 

It is used for peritonitis, sepsis, meningitis, cholangitis, empyema of the gaU bladder, pneumonia, lung abscesses, pyelonephritis, infections of the bones, joints, skin, soft tissues, abdominal and gynecological infections, and for infected wounds and bums. The main synonym of this drug is rocefm. 

Cefepime is used for bacterial infections caused by microorganisms that are sensitive to drugs in septicemia, bacteriemia, complicated infections of the upper and lower sections of the urinary system, pneumonia, pulmonary abscesses, emphysema of the pleura, fever in patients with neutropenia, and infected skin and soft tissue wounds. Synonyms of this drug are maxipime, cepim, cepimex, and others. 

It is used for severe bacterial infections peritonitis, sepsis, meningitis, osteomyelitis, endocarditis, pneumonia, pleural empyema, pulmonary abscess, purulent skin infections and soft tissue infections, and infections of the urinary tract caused by microorganisms that are sensitive to the drug. Synonyms of this drug are nebicine, obracine, and others. 

Anaerobes Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess serious skin and soft tissue infections septicemia, intra-abdominal infections such as peritonitis and intra-abdominal abscess (typically resulting from anaerobic organisms resident in the normal Gl tract) infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection. 

Prompt diagnosis of intra-abdominal infections or of abscess formation elsewhere in the body by liberal use of ultrasound and other imaging techniques should lead to subsequent surgical treatment without delay. Soft tissue infections (superficial and deep) can have a dramatic clinical course. Timely diagnostic imaging and surgical treatment will equally reduce morbidity and mortality. 

It is valuable in critically ill patients with impaired host defence Pseudomonas or Proteus infections in burns, urinary tract infections, lung abscesses, osteomyelitis, middle ear infection, septicaemia meningitis caused by gram negative bacilli, peritonitis, in skin and soft tissue infections and postoperative infection. 

Clindamycin is indicated for the treatment of skin and soft-tissue infections caused by streptococci and staphylococci. It is often active against community-acquired strains of methicillin-resistant S aureus, an increasingly common cause of skin and soft tissue infections. Clindamycin is also indicated for treatment of anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses and aspiration pneumonia. Clindamycin is now recommended rather than erythromycin for prophylaxis of endocarditis in patients with valvular heart disease who are undergoing certain dental procedures. Clindamycin plus primaquine is an effective alternative to trimethoprim-sulfamethoxazole for moderate to moderately severe Pneumocystis jiroveci pneumonia in AIDS patients. It is also used in combination with pyrimethamine for AIDS-related toxoplasmosis of the brain. 

Serum transferrin is normally only about 30% saturated with iron. This explains why it has a relatively high capacity for binding other metals and so is implicated in the transport of 67Ga,1139 which is used as an imaging agent for various soft tissue tumours and inflammatory abscesses.1140 Transferrin also facilitates movement of gallium across tumour cell membranes.1141... 

Longer term occupational exposure to white phosphorus can result in a condition (phossy jaw) that is potentially life-threatening. Two white phosphorus-related deaths were reported in a study of 71 workers from three plants involved in the production of fireworks (Ward 1928). Both workers developed phossy jaw, a degenerative condition affecting the soft tissue, bones, and teeth of the oral cavity, after chronic exposure to the atmosphere at the factory. It is likely that white phosphorus-related necrosis results from a direct local effect following contact of phosphorus with tissues in the oral cavity. The cause of death in both cases was listed as septicemia, with abscess of a tooth and necrosis of the jaw listed as contributory causes. Thus, death in both cases resulted from infections, probably secondary to the degenerative effects of white phosphorus on the oral cavity (Ward 1928). 

The most characteristic toxic effects of white phosphorus are musculoskeletal effects. Victims of phosphorus poisoning tend to develop necrosis of both bone and soft tissue in the oral cavity. As a result, the j awbone may deteriorate and become brittle, a condition called phossy jaw. Instances of this malady have been reported among workers handling white phosphorus, and it is believed that direct exposure of the mouth and oral cavity have occurred as the result of poor hygiene practices. Those afflicted with phossy jaw tend to develop abscessed teeth, and the sockets remaining from the extraction of teeth heal poorly. Infections of the jaw around teeth accompanied by severe pain are common symptoms of phossy jaw. 

Clavulanic acid is manufactured by SmithKline Beecham and is sold as oral and parenteral products in combination with amoxycillin under the trade name of Augmentin, and as an injectable product in combination with ticarcillin under the trade name of Timentin. Augmentin is prescribed for infections of the respiratory tract such as bronchitis, and ear, nose and throat infections such as otitis media and sinusitis. It is also indicated for infections of the urinary tract, such as gonorrhoea, and skin and soft tissue infections, which include cellulitis, impetigo and abscesses. Timentin meanwhile is used for the treatment of severe infections in hospitalised patients with impaired or suppressed host defences. 

Toxic shock syndrome occurs in circumstances that include healthy women using vaginal tampons, abortion or childbirth, and occasionally with skin and soft tissue infection. The clinical problem is due to systemic effects of toxins produced by staphylococci while this is not strictly an infection of the blood, flucloxacillin is used to eliminate the source. Elimination of the source by removal of the tampon and drainage of abscesses, and circulatory support are also important. 

Skin and soft-tissue infections Cellulitis Abscess... 

After the source of infection is identified, prompt efforts to remove or eliminate the source should be initiated. With an infected intravascnlar catheter, the catheter should be removed and cnltured. Urinary tract catheters should be removed if association with sepsis is suspected. Suspicion of soft tissue (cellulitis or wound infection) or bone involvement should lead to aggressive debridement of the affected area. Evidence of an abscess or sepsis associated with any intraabdominal pathology should prompt surgical intervention. 

Almost all patients with disease located outside the lungs should receive antifungal therapy therapy usually is initiated with 400 mg.day of an oral azole. Amphotericin B is an alternative therapy and may be necessary in patients with worsening lesions or with disease in particularly critical locations such as the vertebral column. Approximately 50% to 75% of patients treated with amphotericin B for nonmeningeal disease achieve a sustained remission, and therapy usually is curative in patients with infections localized strictly to skin and soft tissues without extensive abscess formation or tissue damage. The efficacy of local injection into joints or the peritoneum, as well as intraarticularor intradermal administration, remains poorly studied. Amphotericin B appears to be most efficacious when cell-mediated immunity is intact (as evidenced by a positive coccidioidin or spherulin skin test or low CF antibody titer). Controlled trials that document these clinical impressions are lacking, however. ... 

MR imaging is valuable for identifying soft tissue collections, bones and abscesses and can also identify foreign material, such as wood, which will not be visible on plain radiographs (Fig. 8.16). 

An increasing number of examinations are being performed for the evaluation of known or suspected musculoskeletal infection. Multislice CT with 2D and 3D reconstructions are useful tools for detecting infections and abscesses, determining which compartments are involved and for describing the extent of an infection. For this question it is necessary to apply intravenous contrast medium. Multislice CT is also used to evaluate cortical bone and associated soft-tissue masses in suspected osteomyelitis. The presence of sequester can be verified and the response to therapy monitored (Knollmann and COAKLEY 2006). 

---