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African honey used on a nonhealing scalp wound.
Anna Kristina Grøndahl1,2,3, Mathilde Johnsdatter Guldvik1,2,3
An abscess is an encapsulated collection of pus. The most common types include: skin abscess, breast abscess, infected sacral cyst and perianal abscess . Clinical findings typically manifest themselves as increasing pain, swelling and tenderness over a couple of days, accompanied by fever and impaired function in the affected area. The abscesses can be divided into two groups; mature and immature abscesses. The treatment strategies are different, whereas small, immature abscesses are treated with antibiotics alone, treatment of a mature abscess consist of incision and drainage, often in combination with the use of antibiotics . History of needlestick or puncture injury, foreign body or trauma to the infected site are typical. The most common pathogens are Staphylococcus aureus where methicillin-resistant S. aureus is prevalent. In the developing world, parasites can also be a likely cause. It may not seem traditional to use honey in the treatment of an abscess. However, honey is one of the oldest wound-healing agents we know, and evidence shows that it has antibacterial and anti-inflammatory properties . The use of honey can help heal infected wounds that do not respond well to antibiotics, or in areas where antibiotics are limited.
We have decided to discuss a case of a 13-year-old girl with a peculiar disease history. She presented herself to the local hospital with a three days history of headache, intermittent fever, painful, progressive swelling of the eyelid. She was prescribed metronidazole, ampicillin and cloxacillin (Ampiclox) and diclofenac. Despite treatment, the swelling on the eyelid progressed into an abscess. The local hospital decided to drain it, however, shortly thereafter, an abscess developed on the scalp (Figure 1).
Figure 1. Presentation of the draining scalp abscess with puss and exposure of the skull bone.
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The patient was then referred to the regional hospital - Haydom Lutheran Hospital Tanzania for follow up. She tested negative for HIV but her blood tests showed evidence of microcytic anaemia secondary to iron deficiency.
At Haydom Lutheran Hospital drainage of the two abscesses under general anaesthesia was performed. The abscesses were irrigated with normal saline and iodine and the entry wound was packed with gauze. After drainage she was started on ceftriaxone, metronidazole and paracetamol IV. A central part of her treatment was daily irrigation of the abscesses with normal saline and filling the scalp abscess with honey (Figures 2 and 3).
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Figure 3. The scalp abscess wound being filled with African honey.
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Examination revealed a 1.5×2 cm opening into the scalp with well healed borders. Culture of the pus in the abscess showed no growth of bacteria. Despite treatment and cleaning, pus discharge was persisting. A possibility of osteomyelitis of the skull and developing meningitis secondary to the abscess formation was raising concern as the patient did not show significant signs of improvement.
Discussion with conclusion
Spread of the infection from the tissue surrounding the orbit to the scalp is possible due to the lack of natural tissue barrier in this area . Although the girl did not report any history of sinusitis, a rare complication of sinusitis includes both infection of the surrounding tissue of the eye and scalp abscess formation. Another theory is that we can be looking at two separate incidences, one isolated abscess of tissue surrounding the eye, and one scalp abscess that might have been caused by a parasite. On close examination, a small opening was noticed close to the wound in the scalp. Although there is no history of head trauma or puncture wound, a parasitic infection cannot be excluded as the prevalence of parasites in Tanzania is not uncommon and awareness of infection usually is not apparent until symptoms start to develop. Although such a theory is unlikely, it still cannot be disregarded.
As done in this case, incision and drainage with the use of antibiotics, is the recommended treatment of a mature abscess. As the antibiotics in this case showed limited effect, it's difficult to say whether the use of honey is beneficial, but according to modern approach: debridement, saline flushing and detailed pathological and molecular microbiological tests could show the reason. Further steps in the treatment could be to change the antibiotic, as methicillin resistant Staphylococcus aureus can be a likely pathogen. Healing of such an abscess takes time, often many weeks.
It is not known what happened to the girl in the end. Unfortunately, our stay at Haydom Lutheran Hospital ended before we saw the therapeutic end result. We have tried to contact the doctors at the hospital to obtain information but have not yet received a reply.
 PH Randsborg PH, Hammer OL. Chapter 10.2 - Abscess [in] Brudd- og skadebehandling, en metodebok. 2 edition. Univeristetsforlaget, Oslo 2017.
 Mandal MD, Mandal S. Honey: its medicinal property and antibacterial activity. Asian Pac J Trop Biomed 2011; 1:154-60.  Hoyt CJ, Goodman SJ, Cahan L, Chow AW. Scalp: Subgaleal abscess. Plastic Reconstructive Surgery 1978; 62:307.
Conflict of interest: none declared
Acknowledgements: To the staff of Haydom Lutheran Hospital in Tanzania.
1 Haydom Lutheran Hospital in Tanzania
2 School of Medicine in English, Jagiellonian University Medical College in Cracow, Poland
3 Parasitology Research Circle, Chair of Microbiology, Department of Bacteriology, Microbial Ecology and Parasitology, Jagiellonian University Medical College, Cracow, Poland
Mathilde Johnsdatter Guldvik
Phone: +47 971 33 176
e-mail : firstname.lastname@example.org
To cite this article: Grøndahl AK. Johnsdatter Guldvik M. African honey used on a nonhealing scalp wound. World J Med Images Videos Cases 2020; 6:e5-8.
Submitted for publication: 14 February 2020
Accepted for publication: 28 February 2020
Published on: 29 February 2020
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