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

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

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Epidemiology

• According to statistics, post-injection abscesses most often develop in patients over 50 years old. In second place are patients from 30 to 50 years old, but there are about two times fewer of them than in the first group.
• Abscesses after injections occur more often in women. Experts attribute this to the fact that women have a more pronounced subcutaneous fat layer than men.
• The majority of post-injection abscesses occur when injections are administered independently, at home.
• Most often, abscesses occur after injections of magnesium sulfate and painkillers (analgin, baralgin, etc.).
• The risk of developing abscesses after injections is higher in those patients who suffer from diabetes or immunodeficiency diseases.

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Causes post-injection abscess

The main reason why post-injection abscesses are most often formed is considered to be ignoring the rules of disinfection when performing an injection. Thus, bacteria can penetrate the patient's skin through unwashed hands of medical personnel, through unsterile syringes or injected solution, from poorly treated skin of the person undergoing the procedure.

In addition to failure to follow proper disinfection measures, there are other known risk factors that can lead to the development of an abscess after an injection:

• Incorrect administration of medicinal solutions (for example, if a drug for subcutaneous administration is administered intramuscularly, the drug is not distributed throughout the tissues, but is transformed into an inflammatory infiltrate, which then turns into a post-injection abscess).
• Incorrect injection (for example, if a shortened needle is used for an intramuscular injection, or if it is not inserted deeply enough, the medicine will simply not reach the muscle, but will remain in the overlying layers of the skin).
• Long courses of injections performed on the same area of the body.
• A small muscle layer against the background of an increased fat layer (for example, in an obese person, even a standard needle inserted before the cannula may not reach the muscle layer).
• Damage to a vessel during an injection, when intra-tissue hemorrhage occurs with subsequent formation of an abscess after the injection.
• Failure of the patient to comply with hygiene rules (if the patient constantly touches or scratches the area where the injection was given).
• Dermatitis and other skin diseases, especially in areas where injections are routinely given.
• Severely weakened immunity, autoimmune pathologies, hypertrophied allergic status.

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Pathogenesis

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

This type of post-injection abscess is characterized by the formation of a limited capsule with a pyogenic membrane, due to which the penetration of antimicrobial drugs from the bloodstream directly into the inflamed purulent cavity is difficult.

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

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Symptoms post-injection abscess

The first signs of an abscess after an injection can be observed already at the initial stages of development. At first, a compaction without clear contours is formed, and only after that a true post-injection abscess gradually appears, which has well-known characteristic symptoms - pain, redness, tissue edema, capsule mobility, high temperature.

If the lesion is located in the superficial tissues, then the mobility of the capsule (the so-called fluctuation) can be noticed almost immediately, and if the lesion is deeply localized, sometimes it is necessary to use additional diagnostic methods (ultrasound, puncture).

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

An abscess on the arm after an injection is most often superficial.

An abscess on the thigh after an injection is particularly painful, since the thigh muscles have a large number of nerve endings. In addition, this type of post-injection abscess may be accompanied by a slight muscle spasm and muscle twitching.

For convenience, we can highlight local and general signs of the development of a post-injection abscess:

• Local signs include:
  • redness at the injection site;
  • swelling;
  • pain when pressing;
  • pain without pressure;
  • mobility of the capsule (as if it “plays” between the fingers);
  • local increase in temperature.
• Common features include:
  • feeling of weakness, fatigue;
  • lack of desire to eat;
  • sweating;
  • increase in temperature;
  • fatigue, drowsiness.

How does an abscess start after injections?

• After an incorrectly administered injection, a seal (the so-called infiltrate) first forms at the injection site, which, under favorable circumstances, resolves, but under unfavorable circumstances, transforms into an abscess: pain appears when pressing on the seal, then pain without pressing, redness, and other signs listed above.

An abscess after an injection in a child often occurs in response to the introduction of vaccines. At first, pain and a small nodule appear, which later turns red and swells. This reaction is explained by the accumulation of a huge number of lymphocytes at the site of the introduction of a foreign substance, which are responsible for the immune defense of the body. Normally, the external reaction with redness should be small, while the compaction should resolve on its own. It is not worth accelerating this process, since a false abscess can develop into a full-fledged post-injection 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 pronounced local manifestations. As a rule, the process occurs quite quickly, with an increase in symptoms. If this happens, then contacting a doctor should not only be mandatory, but also immediate: a correctly performed injection should not have the reaction described above.

Forms

Post-injection abscess most often develops as a purulent infiltrate, clearly delimited from the nearest tissues. A purulent abscess after an injection begins with redness and gradual compaction of the lesion. In the final stage, the lesion becomes soft, with a purulent accumulation inside the capsule.

Pus is a mass containing leukocytes, proteins and other structures that act as a limiter of the spread of pathogenic microorganisms. A purulent abscess always has a number of typical signs. These are redness, swelling (edema), local increase in temperature, soreness and mobility of the capsule. As a rule, such symptoms develop within three to four days from the moment of infection. A general increase in temperature is observed with an already formed post-injection abscess.

A cold abscess after an injection develops much less frequently: it is called “cold” because it is not accompanied by the local symptoms of inflammation described above, despite the fact that pus accumulates in it in the same way as in a normal abscess.

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Complications and consequences

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

However, if the purulent process is not treated or treated incorrectly, the amount of pus in the capsule can reach such a level that its walls cannot withstand it and break through. This condition is accompanied by the penetration of purulent contents into nearby tissues: extensive phlegmonous inflammation is formed, which over time can be complicated by the appearance of fistulas and perforations.

What is the danger of an abscess after an injection, besides the development of phlegmon? In advanced situations, a septic lesion can develop - a generalized infectious disease caused by the entry of bacteria from a localized focus into the general bloodstream. Another common name for sepsis is blood poisoning, which is considered a severe 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 nearby soft tissues.

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Diagnostics post-injection abscess

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

• at the initial stage, swelling, pain and redness are observed;
• at the next stage, the infiltrate softens, a purulent “crown” appears, and general manifestations increase;
• In the final stage, spontaneous opening of the abscess occurs.

When examining a patient, the doctor will definitely check the condition of the lymph nodes closest to the inflamed area: they may be enlarged, but there should be no pain in them. If pain is present, then one can suspect the development of lymphadenitis - one of the possible complications indicating the beginning of the spread of infection.

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

• General blood test – will allow you to verify the presence of an inflammatory process. This is indicated by an increase in the level of leukocytes, an increase in ESR.
• Bacterial culture of pus taken from the site helps to determine the type of pathogen for a more accurate selection of an effective antibacterial drug.

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

Instrumental diagnostics are also not always used, but only in complex or advanced cases of post-injection abscess. Among instrumental studies, ultrasound scanning, computed tomography or magnetic resonance imaging are most often used.

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Differential diagnosis

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

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Treatment post-injection abscess

Treatment of small post-injection abscesses is permitted on an outpatient basis. Large and deep abscesses are subject to hospital treatment. In any case of abscess, immediate surgical opening of the inflamed focus is performed after the injection.

Surgical treatment consists of opening and draining the purulent cavity with its simultaneous sanitation. The procedure can be performed using either local or general anesthesia, depending on the situation.

The surgeon makes an incision along the lines of force in the area with the most pronounced fluctuation. When examining the pathological focus, he separates all the interchamber membranes to clean out all possible pockets with pus, after which he removes the dead tissue. Then the doctor rinses the cavity with an antiseptic solution, dries it with tampons, and installs a drain to drain the resulting fluid. After this, the wound is sutured.

Another option for the final stage of the operation can be used for deep post-injection abscesses: the doctor drains the cavity under ultrasound control, followed by disinfection with an antiseptic solution using a drainage device. After the inflammation subsides, the drainage is removed.

After the operation to open the abscess after the injection, the doctor prescribes empirical antibacterial treatment using penicillins, cephalosporins, fluoroquinolone drugs, aminoglycosides. If a bacterial culture was performed with the identification of the pathogen, then the drug is prescribed depending on the results of the study.

What medications can be used to treat an abscess after an injection?

For large and deep purulent foci, the following is prescribed:

• antibiotics – for example, penicillin in the amount of 600,000 - 1 million IU daily;
• sulfonamides - streptocide from 0.5 to 1 g three times a day;
• nitrofuran drugs - furazidin orally 0.1-0.2 g three times a day after meals, for a week;
• antihistamines that neutralize free histamine - for example, tavegil orally 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, then antibiotic therapy may not be prescribed: treatment is limited to local treatment of the wound - for example, with fucorcin or hydrogen peroxide.

When intoxication begins, with a rise in temperature and headaches, detoxification measures should be taken:

• drink enough alkaline liquid;
• Take 200 ml of saline solution intravenously by drip daily for 4 days.

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

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

B vitamins (especially B ₆ ), ascorbic acid, vitamins A and E are natural active substances that help increase resistance and normalize the body's reactivity. They are prescribed as a general tonic and supportive treatment, taking into account their compatibility with other drugs included in the therapeutic regimen.

Physiotherapy treatment

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

1. In the first phase of the inflammatory reaction, after surgical opening of the abscess, it is important to reduce swelling and eliminate pain, as well as accelerate wound cleansing. This is facilitated by such physiotherapeutic procedures as UFO, laser therapy, aerosol therapy, ultrasound frequency 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 blood circulation and tissue nutrition, accelerating tissue recovery and granulation formation, and preventing complications. The following physiotherapy methods meet all of the above requirements: ultrasound frequency electrotherapy, ultraphonophoresis, laser therapy, electrophoresis with medications, magnetic therapy, darsonvalization, and infrared radiation therapy.
3. In the third phase, physiotherapy should promote accelerated epithelialization of the wound surface, the formation of high-quality scar tissue. For these purposes, such procedures as medicinal electrophoresis, ultraphonophoresis, paraffin and ozokerite application, laser therapy are suitable.

Physiotherapy should not be used until adequate surgical treatment of the post-injection abscess, as well as in cases of a tendency to thrombosis and bleeding, during pregnancy, at elevated temperature, as well as in cases of tuberculosis and syphilis.

Treatment at home

At the initial stage of abscess formation after an injection, it is quite possible to use ordinary home remedies to stop the inflammatory process. But it is important to remember that such treatment cannot exclude or completely replace traditional drug therapy. Therefore, if the situation with a post-injection abscess worsens or does not improve, you should immediately contact a medical specialist.

Thus, many claim the benefits of an iodine mesh for eliminating an abscess after an injection. A cotton swab is dipped into a bottle of iodine and the iodine is applied in the form of a mesh to the affected area of the skin. The procedure must be repeated twice a day, and always at night.

In addition, the following method is considered effective: high-quality laundry soap is grated and mixed in a metal container with double the amount of milk, put on low heat and boiled for 90 minutes. During this time, the mass usually boils down to a sour cream-like state. The warm mass is applied to the affected area.

It is equally useful to apply grated raw potatoes to the site of the post-injection abscess. This compress is changed every three hours until the condition is relieved.

Folk remedies

Post-injection abscess can be eliminated using the following folk remedies:

• attach a fresh cabbage leaf to the site of the abscess, which should first be lightly beaten with a hammer (the leaf is changed every 5-6 hours);
• apply a mixture of black Borodino bread and honey to the affected area;
• attach a fresh burdock leaf to the sore spot, preferably overnight;
• apply a compress of mullein tincture (bear's ear) to the sore spot;
• Instead of mullein tincture, you can use propolis tincture, which is sold in pharmacies.

To avoid complications, folk remedies are allowed to be used only at the initial stages of development of post-injection abscess. But even in this case, a doctor's consultation should be mandatory.

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Herbal treatment

To prevent the appearance of an abscess after an injection, you can use some recipes using herbs:

• Echinacea tincture is taken orally, 30 drops three times a day.
• Eucalyptus infusion (2 tbsp. per 200 ml of boiling water) is drunk warm, 50 ml three times a day after meals.
• Eucalyptus alcohol tincture is taken 20 drops three times a day after meals.
• An infusion of field horsetail (4 tbsp. per 200 ml of boiling water) is taken orally, 50-80 ml three times a day, 60 minutes after meals.
• An infusion of caraway seeds (3 tablespoons per 200 ml of boiling water) is taken warm, 100 ml twice a day 15 minutes before meals.

Homeopathy

Complex homeopathic preparations in the treatment of abscess after an injection help both to prevent suppuration and to ripen the abscess quickly and without complications. After opening, the post-injection abscess heals faster and better, without negative consequences.

• Arnica Salbe Heel S is well tolerated by most patients, and only in rare cases can an allergy occur when using the drug. The ointment is applied to the site of the inflammatory infiltrate - post-injection abscess - and rubbed in a little, twice a day (morning and evening). At the very beginning of the abscess development after the injection, the ointment can be used under the bandage.
• Belladonna gommacord in the form of drops successfully eliminates the inflammatory process. Standardly take 10 drops in the morning, before lunch and at night, however, in the acute stage of the disease, the drug can be taken for two hours every 15 minutes, after which you should switch to the usual dosage.
• Echinacea compositum C is a solution in ampoules that can be injected or drunk after dissolving 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.
• Diarhel S is prescribed as an auxiliary drug in case of increasing symptoms of intoxication in case of post-injection abscess. Usually taken under the tongue 1 tablet three times a day, and in case of acute course of the disease – 1 tablet every 15 minutes for 2 hours.

Prevention

The following rules should be used as preventive measures:

• Only disposable syringes and needles should be used for injections;
• Do not use blunt or curved needles;
• For intramuscular administration of drugs, needles originally intended for other types of injections cannot be used;
• with frequent injections it is necessary to change the injection site;
• an injection solution intended for intravenous or subcutaneous infusion must not be administered for intramuscular injection;
• it is forbidden to administer a drug that is obviously not sterile, or unusable, or contains foreign impurities or sediment;
• Immediately before administering the drug, the skin at the injection site should be disinfected with alcohol;
• During the injection, do not touch the needle with your fingers, even if they have been treated with a disinfectant liquid;
• an injection cannot be performed if an intra-tissue hemorrhage has formed at this site the day before;
• Do 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 abrupt so that the drug can gradually distribute in the tissues.

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

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Forecast

If the abscess after the injection was adequately and timely treated, without subsequent development of complications, then the prognosis in this case can be considered favorable. Spontaneous opening of a post-injection abscess most often ends with a breakthrough of pus to the outside, and with an inadequate course, a fistula is formed. With minor abscesses, fibrosis of the capsule with further growth of scar tissue may occur.

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