Superficial infections and

sepsis

Gastrointestinal surgical department

of affiliated hospital of jining medical
college
Furuncles and
Carbuncles
Concept
 Furunculosis (furuncles) is a skin
infection that occurs around the
hair follicles following folliculitis.
 A carbuncle is two or more
confluent furuncles with separate
heads.
furuncle carbuncle
General consideration
 They are usually caused by
Staphylococcus aureus
 Furuncles and carbuncles begin in hair
follicles ,predisposed sites include the
nape, axilla, and buttocks
 Patients with certain systemic disorders
including HIV, malnutrition, blood
dyscrasias, and immunosupression may
be predisposed to the S. aureus carrier
state and furunculosis. Atopic dermatitis
and renal dialysis also predisposes to
the S. aureus carrier state.
Furuncles and carbuncles
 Symptoms
 Round, pus-filled bumps around the hair
follicles
 Fever (possible)
 Diagnosis
In addition to evaluating the
appearance of the skin, bacterial
cultures are conducted to determine the
infecting microbe.
Furuncles and carbuncles
 Treatment
Furuncles and carbuncles are
treated with warm compresses and
oral and topical antibiotics.
Patients are advised to practice
good hygiene (eg, keep the
infection clean and covered and
wash hands frequently) and
carefully launder clothing and
bedsheets.
Cellulitis and Erysipelas
Concept
 Cellulitis - Deep subcutaneous
infection of the skin typically by
bacteria that results in a localized
area of erythema and
inflammation
 Erysipelas is a unique form of
superficial cellulitis associated with
a marked swelling of the skin that
does not involve subcutaneous
cellulitis erysipelas
General consideration
 Erysipelas and cellulitis often coexist
 Cellulitis can be caused by normal skin
flora or by exogenous bacteria, Group A
Streptococcus and Staphylococcus
 Most cases of erysipelas are due to
Streptococcus pyogenes
 Erysipelas can be distinguished from
cellulitis by its raised advancing edges
and sharp borders
cellulitis
 Symptoms
Symptoms in the infected area
 Swelling
 Redness
 Warmth to the touch
 Tenderness
 Enlarged lymph nodes in the affected area
 Pus
Bodily symptoms
 Fever
 Chills
 Muscle aches
cellulitis
 Diagnosis
Doctors usually diagnose cellulitis
just by looking at the infection.
They may do a bacterial culture (to
determine the type of bacteria
causing the infection) if the patient
is experiencing fever, chills or
muscle aches or their treatment is
not working.
cellulitis
 Treatment
Based on the bacteria that caused the
infection.
 Treated with either oral or intravenous
antibiotics. Some of the antibiotics
commonly used are penicillin,
clindamycin, trimethoprim-
sulfamethoxazole, cephalexin,
clarithromycin and azithromycin, and
vancomycin
 If edema is obvious or abscess
form,incision drainge maybe necessary
Erysipelas
 Symptoms
Symptoms in the infected area
 Skin sore with a raised edge
 Pain
 Swelling
 Redness
 Hardened appearance
Bodily symptoms
 High fever
 Prolonged muscle stiffness
 Confusion or mental status changes, particularly in
elderly patients
Erysipelas
 Diagnosis
By the appearance of well-
demarcated rash and inflammation.
Blood cultures are unreliable for
diagnosis of the disease, but may
be used to test for sepsis.
Erysipelas must be differentiated
from herpes zoster, angioedema,
contact dermatitis, and diffuse
inflammatory carcinoma of the
breast
Erysipelas
 Treatment
 Depending on the severity,
treatment involves either oral or
intravenous antibiotics, using
penicillins, clindamycin or
erythromycin.
 Because of the risk of reinfection,
prophylactic antibiotics are
sometimes used after resolution of
the initial condition.
Sepsis
Terminology
 Systemic inflammatory
response syndrome or SIRS
 Sepsis
 Septic shock
 Multiple organ dysfunction
syndrome or MODS
Systemic inflammatory
response syndrome or
SIRS
 The systemic inflammatory response to
a variety of severe clinical insult
(infectious or not,for example in those
with burns, polytrauma, or the initial
state in pancreatitis and
chemical pneumonitis.)
 Two or more changes as follows: Body
temperature /Heart rate /Respiratory
rate /White blood cell count
 SIRS criteria
 • Heart rate > 90 beats per minute
(tachycardia)
 • Body temperature < 36 °C (96.8 °F) or >
38 °C (100.4 °F) (hypothermia or fever)
 • Respiratory rate > 20 breaths per minute
or, on blood gas, a PaCO2 less than 32 mm Hg
(4.3 kPa) (tachypnea or hypocapnia due to
hyperventilation)
 • White blood cell count < 4000 cells/mm³ or
> 12000 cells/mm³ (< 4 x 109 or > 12 x 109
cells/L), or greater than 10% band forms
(immature white blood cells).
 Sepsis
 Sepsis is a serious medical
condition characterized by a
whole-body inflammatory state
(called a systemic inflammatory
response syndrome or SIRS) and
the presence of a known or
suspected infection.
 Sepsis
 Specific evidence for infection
includes
 WBCs in normally sterile fluid
(such as urine or cerebrospinal
fluid ),
 evidence of a perforated viscus
(free air on abdominal x-ray or CT
scan, signs of acute peritonitis),
abnormal chest x-ray consistent
with pneumonia (with focal
septic shock
 Sepsis with hypotension despite
adequate fluid resuscitation along with
the presense of manifestations of
hypopefusion,including such as lactic
acidosis,oliguria,or an acute alteration
in mental status
 Refractory: if they have sepsis plus
hypotension after aggressive fluid
resuscitation (typically upwards of 6
liters or 40 ml/kg of crystalloid)
 Multiple organ
dysfunction syndrome or
MODS
 The presense of altered organ
function in an acutely ill patient
such that homeostasis cannot be
maintained without intervention
Organ dysfunction
 Lungs
 Acute lung injury (ALI) (PaO2/FiO2
< 300) or acute respiratory
distress syndrome (ARDS)
(PaO2/FiO2 < 200)
Organ dysfunction
 Brain
 encephalopathy

symptoms:
 agitation
 confusion
 coma

etiologies:
 ischemia
 hemorrhage
 microthrombi
 microabscesses
 multifocal necrotizing leukoencephalopathy
Organ dysfunction
 Liver
 disruption of protein synthetic function:
manifests acutely as progressive
coagulopathy due to inability to synthesize
clotting factors
 disruption of metabolic functions: manifests
as cessation of bilirubin metabolism,
resulting in elevated unconjugated serum
bilirubin levels (indirect bilirubin)
Organ dysfunction
 Kidney
 oliguria and anuria
 electrolyte abnormalities
 volume overload
 Heart
 systolic and diastolic heart failure, likely due
to cytokines that depress myocyte function
 cellular damage, manifest as a troponin leak
(although not necessarily ischemic in
nature)
Diagnosis
 The medical history and
clinical examination
 The identification of the causative
microbe in sepsis
 Imaging (such as chest X-rays or CT
scans) and laboratory techniques (such
as urine microscopy or lumbar
puncture)
 The exact causative organism is
confirmed by microbiological culturing
in the laboratory (blood cultures and
cultures from suspected sites of
infections such as urine cultures,
Treatment
 The therapy of sepsis rests on
antibiotics, surgical drainage of
infected fluid collections, fluid
replacement and appropriate
support for organ dysfunction.