Postinjection abscess: causes, how it looks, what to do, how to treat

Postinjection abscess is one of the varieties of abscesses that occurs after any injection of drugs. Such an abscess after the injection, whether it is intramuscular or intravenous injection, is manifested by the development of a painful inflammatory element with purulent contents.

[1], [2], [3], [4], [5]

Epidemiology

• According to statistics, postinjection abscesses develop more often in patients older than 50 years. In second place - patients from 30 to 50 years, but they are about half as many as in the first group.
• Abscesses after injections are more common in women. Specialists attribute this to the fact that in women the subcutaneous fat layer is more pronounced than in men.
• The majority of postinjection abscesses occur when injections are done on their own, at home.
• Most often, abscesses occur after injections of magnesium sulfate and analgesics (analgin, baralgin, etc.).
• The risk of developing abscesses after injections is higher in those patients who suffer from diabetes mellitus or immunodeficiency diseases.

[6], [7], [8], [9], [10]

Causes of the post-injection abscess

The main reason for which the post-injection abscess is most commonly formed is the disregard for the rules of disinfection during the injection. Thus, bacteria can penetrate the patient's skin through unwashed hands of medical staff, through non-sterile syringes or injected solution, from poorly processed skin of the person undergoing the procedure.

In addition to not adhering to proper disinfection measures, other risk factors are known which can lead to the appearance of an abscess after a shot:

• Incorrect administration of drug solutions (for example, if the drug for subcutaneous administration is administered intramuscularly, the drug is not distributed across the tissues, but is converted to an inflammatory infiltrate, which then passes into the post-injection abscess).
• Incorrect injection (for example, if you use a shortened needle for intramuscular injection, or do not inject it deeply enough, the medicine will not simply enter the muscle, but remain in the overlying layers of the skin).
• Long courses of injections performed on the same part of the body.
• Small muscular layer on the background of an increased fat layer (for example, in a person with obesity, even a standard needle inserted before the cannula may not reach the muscle layer).
• Damage to the vessel during the injection, when interstitial hemorrhage occurs, followed by the formation of an abscess after the injection.
• Non-compliance of the patient with hygiene rules (if the patient constantly touches or combs the place where the injection was made).
• Dermatitis and other skin diseases, especially in places where injections are standard.
• Strongly weakened immunity, autoimmune pathologies, hypertrophic allergic status.

[11]

Pathogenesis

The abscess after the injection is most often caused by staphylococci or streptococci. If an infectious agent is ingested, an inflammatory reaction is triggered with further necrosis of the affected tissues, accumulation of exudative secretions and the formation of a cavity element in which leukocytes accumulate.

Such postinjection abscess is characterized by the formation of a limited capsule with a pyogenous membrane, because of which it is difficult to get the antimicrobial drugs from the circulation directly into the inflamed purulent cavity.

In neglected cases, when the pyogenic shell is damaged (for example, with purulent melting or with sudden creation of high intracavitary pressure), the infection enters the bloodstream, which can cause septic complications.

[12], [13], [14], [15], [16]

Symptoms of the post-injection abscess

The first signs of an abscess after a shot can be observed already at the initial stages of development. First, the compaction is formed without clear contours, and only after that a true postinjection abscess with well-known characteristic symptoms is manifested - pain, redness, tissue edema, mobility of the capsule, high temperature.

If the focus is located in the surface tissues, then the mobility of the capsule (so-called fluctuation) can be noticed almost immediately, and with deep localization of the focus, it is sometimes necessary to use additional diagnostic methods (ultrasound, puncture).

The abscess after the injection in the buttock can be quite deep - this must be taken into account when prescribing for treatment of the abscess.

The abscess on the arm after the injection often has a superficial location.

The abscess on the thigh after the injection is particularly painful, since the hip muscles have a large number of nerve endings. In addition, a similar version of post-injection abscess can be accompanied by a slight muscle spasm and muscle twitching.

For convenience, there are local and general signs of postinjection abscess development:

• Local features include:
  • redness of the place where the injection was made;
  • swelling;
  • pressure pain;
  • pain without pressure;
  • mobility of the capsule (as if "playing" between the fingers);
  • local temperature increase.
• Common features include:
  • feeling of weakness, fatigue;
  • lack of craving for food;
  • sweating;
  • temperature increase;
  • weakness, drowsiness.

How does the abscess start after the injections?

• After an incorrect injection, a seal is first formed at the injection site (the so-called infiltrate), which dissolves under favorable circumstances, and under unfavorable conditions it becomes transformed into an abscess: pain occurs when the seal is pressed, then pain without pressure, redness and other signs listed above .

An abscess after a nipple in a child often occurs in response to the introduction of vaccines. First there is pain and a small nodule that later turns red and swells. This reaction is explained by the accumulation of a large number of lymphocytes responsible for the immune defense of the organism at the site of introduction of a foreign substance. Normally, the external reaction with redness should be small, and the seal must resolve itself. It is not necessary to accelerate this process, since a full-fledged postinjection abscess can develop from a false abscess, which will have to be opened and drained.

The development of an abscess after a drug injection in a child is sometimes accompanied by a general increase in temperature and marked local manifestations. As a rule, the process proceeds fairly quickly, with the increase in symptoms. If this happens, then going to the doctor should be not only mandatory, but also immediate: a properly performed injection should not have the above described reaction.

Forms

Postinjection abscess most often develops as a purulent infiltrate, clearly restricted from the nearest tissues. Purulent abscess after the injection begins with reddening and gradual compaction of the focus. In the final stage, the focus becomes soft, with a purulent accumulation inside the capsule.

Pus is a mass containing leukocytes, proteins and other structures that act as a restrictor for the spread of pathogens. With a purulent abscess there are always a number of typical symptoms. This is redness, swelling (swelling), local fever, soreness and mobility of the capsule. As a rule, such symptoms develop within three to four days from the time of infection. A general increase in temperature is observed with the already formed postinjection abscess.

Cold abscess after the injection develops much less often: it is called "cold" because it is not accompanied by the local symptoms of inflammation described above, despite the fact that pus in it accumulates in the same way as in a common abscess.

[17], [18], [19]

Complications and consequences

A favorable difference between the post-injection abscess and other inflammatory-purulent lesions is the presence of a dense pyogenic shell, or capsule, due to which the inflammatory reaction has a clear localization and does not spread beyond its limits.

Nevertheless, if the purulent process is not treated, or treated incorrectly, the amount of pus in the capsule can reach a level where its walls can not stand and break through. This condition is accompanied by the entry of purulent contents into closely located tissues: extensive phlegmonous inflammation is formed, which in time can be complicated by the appearance of fistulas and perforations.

What is the risk of an abscess after a shot, other than the development of phlegmon? In neglected situations, a septic lesion may develop-a generalized infectious disease caused by the entry of bacteria from a localized focus into the total bloodstream. Another common name for sepsis is the infection of the blood, which is considered a serious pathology. Also, the entry of pathogenic flora into the circulatory system can result in the development of osteomyelitis, in which purulent necrotic processes are observed in bone tissue, bone marrow and a number of located soft tissues.

[20], [21], [22], [23], [24], [25]

Diagnostics of the post-injection abscess

In most patients, the diagnosis of postinjection abscess is established only on the basis of visual examination and questioning: the signs of such a disease are quite typical. Moreover, during the examination the doctor is able to determine the stage of the process:

• at the initial stage there is swelling, tenderness and redness;
• at the next stage the infiltrate softens, a purulent "corolla" appears, general manifestations increase;
• in the final stage there is a spontaneous dissection of the abscess.

When examining the patient, the doctor will check the condition of the lymph nodes closest to the inflamed focus: they can be enlarged, but there should be no pain in them. If the pain is present, then it is possible to suspect the development of lymphadenitis - one of the possible complications that indicate the onset of infection.

After the examination, the doctor will prescribe the necessary tests, which are handed over in the laboratory:

• A general blood test - will make sure that there is an inflammatory process. This is indicated by an increase in the level of leukocytes, an increase in ESR.
• Bacterial sowing of pus, taken from the hearth - helps determine the type of causative agent, for a more accurate selection of an effective antibacterial drug.

Bakposev do not in all cases of abscesses after the injection: the fact is that the results of such an analysis can be obtained only after a few days. And, since the treatment is usually prescribed immediately, the doctor simply prescribes an antimicrobial drug with the broadest spectrum of antibacterial activity.

Instrumental diagnosis is also not always used, but only in complicated or neglected cases of postinjection abscess. Among the instrumental studies most often use ultrasound scanning, computed tomography or magnetic resonance imaging.

[26], [27], [28]

Differential diagnosis

Differential diagnosis of the abscess after the injection is carried out with phlegmon, hematoma, lymphadenitis, hemangioma, actinomycosis. In order not to be mistaken when making a diagnosis, the doctor may resort to angiography and ultrasound scanning (with suspected hemangioma or aneurysm), to diagnostic puncture and ultrasound (if hematoma and lymphadenitis are suspected), to serological reactions (with a suspicion of actinomycosis) .

[29], [30], [31]

Treatment of the post-injection abscess

Treatment of insignificant postinjection abscesses is allowed to be performed on an outpatient basis. Large and deeply located abscesses are to be treated in a hospital. At any variant of an abscess after a nyxis an immediate surgical opening of the inflamed focus is carried out.

Surgical treatment consists of opening and draining the purulent cavity with simultaneous sanation. The procedure can be performed both with the use of local and general anesthesia, depending on the situation.

The surgeon makes a cut along the lines of force on the site with the maximum expressed fluctuation. When examining a pathological focus, it separates all the intercamera membranes in order to clean out all possible pockets with pus, after which it removes dead tissue. Further, the doctor performs the rinsing of the cavity with an antiseptic solution, dries it with the help of tampons, establishes drainage for the outflow of the formed liquid. After that the wound is sutured.

Another variant of the final stage of the operation can be used for deep postinjection abscesses: the doctor conducts the drainage of the cavity under ultrasound control, with its further disinfection with an antiseptic solution through a drainage device. After the inflammation subsides, drainage is eliminated.

After the operation of opening the abscess after the injection, the doctor prescribes an empirical antibacterial treatment with penicillins, cephalosporins, fluoroquinolone drugs, aminoglycosides. If a bacteriosis with identification of the pathogen was performed, the drug is administered depending on the results of the study.

What drugs can be used to treat an abscess after a shot?

At large and deep purulent foci appoint:

• antibiotics - for example, penicillin in the amount of 600 000 - 1 million units daily;
• sulfonamide drugs - streptocid from 0.5 to 1 g three times a day;
• nitrofuran preparations - furazidine orally 0.1-0.2 g three times a day after meals, during the week;
• antihistamines, detoxifying free histamine - for example, Tavegil inside at 0,001 g twice a day, or Suprastin 25 mg three times a day with food.

If the post-injection abscess was small and superficial, antibiotic therapy may not be prescribed: treatment is limited to local wound treatment - for example, fucorcin or hydrogen peroxide.

Whenever intoxication starts, if the temperature rises and headaches, detoxification measures should be taken:

• drink enough alkaline liquid;
• take intravenously drip in 200 ml of saline daily, for 4 days.

With severe pain at the site of the abscess after the injection, butadion is prescribed 0.2 g three times a day, paracetamol 0.4 g three times a day, antipyrine 0.5 g 4 times a day.

Treatment is carried out for 5-7 days. Occasionally, during the reception of the above mentioned drugs, side effects may appear, which are expressed in a digestive disorder, headache, heartburn, dizziness. After treatment, unpleasant symptoms go away on their own.

Vitamins of group B (especially B ₆ ), ascorbic acid, vitamins A and E are natural active substances, which contribute to increase of resistance and normalize the reactivity of the organism. They are prescribed as a general restorative and supportive treatment, given their compatibility with other drugs that are part of the therapeutic regimen.

Physiotherapeutic treatment

If there are no contraindications, at all stages of postinjection abscess development physiotherapy can be prescribed, against a background of general anti-inflammatory treatment.

1. In the first phase of the inflammatory reaction, after an operative dissection of the abscess, it is important to reduce puffiness and eliminate pain, and also to speed up the cleansing of the wound. This is facilitated by such physiotherapeutic procedures as UFO, laser therapy, aerosol therapy, ultrasound electrotherapy, microwave therapy, ultrasound therapy, diadynamic therapy, hyperbaric oxygenation.
2. In the second phase, the procedures should be aimed at reducing the inflammatory infiltrate, improving local circulation and tissue nutrition, accelerating tissue repair and granulation, and preventing the development of complications. All these requirements are met by such methods of physiotherapy: ultrasound electrotherapy, ultraphonophoresis, laser therapy, electrophoresis with medications, magnetotherapy, darsonvalization, infrared therapy.
3. In the third phase, physiotherapy should help accelerate the epithelization of the wound surface, and form a qualitative scar tissue. For these purposes, suitable procedures such as medical electrophoresis, ultraphonophoresis, fingering application of paraffin and ozocerite, laser therapy.

Physiotherapy can not be applied until the moment of adequate surgical treatment of the post-injection abscess, as well as with a tendency to thrombosis and bleeding, pregnancy, at elevated temperature, as well as tuberculosis and syphilis.

Home Treatment

At the initial stage of the formation of an abscess after a shot to stop the inflammatory process, it is also possible to use conventional home remedies. But it should be remembered that such treatment can not exclude or completely replace traditional drug therapy. Therefore, if the situation with postinjection abscesses worsens, or does not improve, then you should immediately turn to a medical specialist.

So, many argue about the benefits of iodine mesh to eliminate the abscess after the injection. The cotton swab is dipped in a vial of iodine and applied iodine in the form of a mesh on the affected area of the skin. The procedure must be repeated twice a day, and always at night.

In addition, the following method is also considered effective: a qualitative laundry soap is rubbed on a grater and mixed in a metal container with a double amount of milk, put on a small fire and boiled for 90 minutes. During this time, the mass usually boils down to a creamy state. Warm mass is applied to the affected area.

It is equally useful to apply grated raw potatoes to the place of postinjection abscess. Such a compress is changed every three hours, until the state is relieved.

Alternative treatment

Postinjection abscess can be eliminated in such alternative ways:

• attach a fresh cabbage leaf to the development site of the abscess, which should first be slightly repelled with a hammer (the leaf is changed every 5-6 hours);
• attach to the affected area a mixture of black Borodino bread and honey;
• attach a fresh leaf of burdock to the sore spot, preferably at night;
• apply a compress to the sore spot from the mullein tincture (bear ear);
• instead of Mullein tincture, you can use propolis tincture, which is sold at the pharmacy.

To avoid complications, alternative treatment can be used only at the initial stages of post-injection abscess development. But in this case, the doctor's consultation should be mandatory.

[32], [33], [34], [35], [36], [37],

Herbal Treatment

To prevent the appearance of an abscess after a shot, you can use some recipes with the use of herbs:

• Tincture of echinacea take inside 30 drops. Three times a day.
• Infusion of eucalyptus (2 tablespoons into 200 ml of boiling water) is drunk in a warm form 50 ml three times a day after eating.
• Spirituous tincture of eucalyptus is taken for 20 cap. Three times a day after meals.
• Infusion of field horsetail (4 tablespoons per 200 ml of boiling water) is ingested 50-80 ml three times a day 60 minutes after ingestion.
• Infusion of cumin seeds (3 tablespoons into 200 ml of boiling water) is taken in a warm form of 100 ml twice a day for 15 minutes. Before meals.

Homeopathy

Complex homeopathic remedies in the treatment of abscess after the injection help both prevent suppuration and ripen the abscess quickly and without complications. After opening, the postinjection abscess heals more quickly and qualitatively, without negative consequences.

• Arnika Salbe Heel C is well tolerated by most patients, and only in rare cases can an allergy occur when using the drug. Ointment is applied to the site of inflammatory infiltration - postinjection abscess - and gradually rub, twice a day (in the morning and in the evening). At the very beginning of the development of the abscess after the injection, you can use an ointment under the bandage.
• Belladonna gommakord in the form of drops successfully eliminates the inflammatory process. It is standard to take 10 drops in the morning, before dinner and at night, but in the acute stage of the disease the drug can be taken within two hours every 15 minutes, after which it should go to the usual dosage.
• Echinacea compositum C is a solution in ampoules that can be injected or drunk, previously dissolved in a small amount of water. The usual dosage for adults is one ampoule of the drug 1-3 times a week, depending on the intensity of the process.
• Diarchel C is prescribed as an auxiliary drug with the growth of symptoms of intoxication during post-injection abscess. Usually taken under the tongue of 1 tablet three times a day, and in the acute course of the disease - 1 tablet every 15 minutes for 2 hours.

Prevention

As a preventive measure, the following rules should be used:

• For injection use only disposable syringes and needles;
• Do not use blunt or curved needles;
• for intramuscular administration of drugs, needles that were originally designed for other types of injections should not be used;
• with frequent injections, it is necessary to change the place of administration of the drugs;
• It is not possible to inject an injectable solution for intravenous or subcutaneous infusion for intramuscular injection;
• Do not administer a drug that is known to be not sterile, or is not good, or contains foreign impurities or sediment;
• Immediately prior to the administration of the drug, disinfect the skin at the injection site with alcohol;
• During the injection, you should not touch the needle with your fingers, even if they are treated with a disinfectant;
• It is impossible to carry out an injection, if on the eve on this place the interstitial hemorrhage was formed;
• You can not mix several drugs in one syringe unless you are sure that they are pharmacologically and chemically compatible;
• intramuscular and subcutaneous administration of drugs should not be sharp, so that the medicine can gradually be distributed in the tissues.

Injections should be carried out under aseptic conditions, with strict adherence to all rules of disinfection and hygiene.

[38], [39], [40], [41], [42],

Forecast

If the abscess after the injection has been subjected to adequate and timely treatment, without the subsequent development of complications, then the prognosis in this case can be considered favorable. A spontaneous dissection of the postinjection abscess is most often completed by a breakthrough of pus outward, and with inadequate flow a fistula is formed. With minor abscesses, fibrosis of the capsule can occur with further overgrowth of scar tissue.

[43], [44]