From: Daum: N Engl J Med, Volume 357(4).July 26, 2007.380-390
Figure 1. Anterior Abdominal-Wall Abscess in
a 15-Year-Old Boy. There was a 3-day history of drainage from this abscess,
which had increased in size to 1 cm in length and become more painful. It was
fluctuant and tender on examination. Incision and drainage were performed; about
2 ml of purulent material was obtained. A culture yielded MRSA that was
susceptible to clindamycin. The results of the D-zone test were negative .
Figure 2. Swelling and a Small Amount of
Drainage Involving the Left Naris in a 10-Year-Old Girl. There was a 5-day
history of drainage from the lesion. The child appeared well and did not have a
fever. Incision and drainage yielded 0.5 ml of purulent material. A culture
yielded MRSA that was susceptible to clindamycin. The results of the D-zone test
were negative .
Figure 4. Buttock abscess in a 22-month-old
boy. The abscess had increased in size over 2 days. A previous buttock abscess
had required therapy 6 months earlier. On physical examination, he was afebrile.
The right buttock had an area of fluctuance 1.5 cm in diameter surrounded by
erythema, warmth, and tenderness approximately 5 cm in diameter. Incision and
drainage was performed, yielding approximately 3 cc of purulent material, and
the wound was loosely packed. Oral clindamycin was prescribed. Culture of the
purulent material revealed S. aureus, resistant to methicillin, susceptible to
clindamycin. The D-zone test was negative.
Figure 5. Rapidly progressive left sided
neck swelling in a 9-month-old boy. He had a 2-day history of increasing
swelling and tenderness, and possible fever. One examination, he was afebrile
and appeared mildly ill, but not toxic. Erythema and tenderness extended
approximately 10 cm. A CT scan of the neck revealed a multiple, loculated
abscesses. The child was hospitalized; intravenous clindamycin was administered
and incision and drainage was performed under general anesthesia. Culture of the
material obtained at surgery revealed S. aureus, resistant to methicillin,
susceptible to clindaymcin. The D-zone test was negative.
Figure 6. Rapidly progressive swelling of
the left labia majora in a 10-month-old girl. A small amount of spontaneous
drainage from the inferior aspect of the labia was noted prior to presentation
to the emergency department. On physical examination, the child was fussy and
illappearing. The temperature was 40.1 degrees C. The lesion was 8 cm in
diameter with surrounding erythema and warmth extending 2 to 3 cm lateral to the
inguinal crease, but not fluctuant. Attempted incision and drainage yielded a
scant amount of fluid. The child was started on intravenous clindamycin and
admitted to the hospital. Culture revealed S. aureus, resistant to methicillin,
susceptible to clindamycin. The D-zone test was negative.
Figure 7. Abdominal wall abscess
approximately 4 cm in diameter in a 6-year-old boy with a history of
increasingly painful swelling near the umbilicus. The child was well-appearing
and afebrile. Incision and drainage revealed a large amount of purulent
material. Culture revealed S. aureus, resistant to methicillin, susceptible to
clindamycin. The D-zone test was megative.