Teaching Bangsal I

CELLULITIS

GROUP MEMBER

Livia Sagita RuslimAndi Nadya FebriamaRismawatiNajdah HidayahAna Zaharina HasyimPrisca Yuliani SubanKu Azlan Ku Azhar

Zafirnur Amrin B. JasmanIrfan ThamrinMuhammad Assadul malik OesmanMunawir MulfaSulfadli AnggunawanRahma

PATIENT ID• Name : Mr. MN• Sex : Male• Age : 65 years old• Marital Status: Married• Religion : Moslem• Address : Gowa• Occupation : a mechanic at Telkomsel• Race : Makassar• Nationality : Indonesia• Date of Entry : 1st May 2013• Medical Record no. : 162462

History Taking

• Chief Complaint : pus at right foot for 2 days.• Present history : Mr. MN has been suffered

from the pain and pus at his right foot since 2 days ago. 6 days ago he had “terasi” in his lunch then at afternoon he had 1 small vesicle in his right foot and felt itchy. He scratched it all day until this vesicle ruptured, clear fluid exposed.

History Taking

• The lesion was itchy, redness, pain, edema. He got fever for 1 day and had taken paracetamol. 2 days ago he came to Labuang Baji clinic and was diagnosed foot ulcer. And he received NaCl 0.9% to compress the ulcer, Fusicom cream b.i.d, Mefenamat Acid 500mg t.i.d but got worse.

History Taking

• 1 day ago,he came again to Labuang Baji Clinic and was admitted to hospital. The lesion become worst and widen, itchy (+),redness(+),pain (+),edema (+), fever (-).

History Taking

• Past history :previous health status : wellallergies : crabs,shrimp, terasi.trauma history : -surgery history : -

History Taking

• Personal HistorySmoking (+) for >40 years ½ pack/day Alcohol intake (-)

• Family historyFather (†) old agedmother (†) hypertension2 siblings healthy

CURRENT STATUS• General Condition : Mild Illness• Consciousness : Compos Mentis• Nutrition : Normal• Hygiene : Moderate• Vital Sign : BP : 120/80 Pulse : 84x/ minute RR : 22 x / minute Temperature : 36,5 C

PHYSICAL EXAMINATION• Face : Anemis (-), ikterus(-), sianosis(-)• Neck : Stiffness (-), Kernig Sign (-)• Chest :

– Respiratory System :• inspection : symmetrical• Palpation : crepitation (-), tenderness (-)• Percussion : resonance

• Auscultation : vesicular bilateral • ARS : Rh - - wh -/-

Heart : S1/S2 pure reguler

• Abdomen : Peristaltic (+) normal, palpable liver and spleen (-)

• Lower Extremity: warm, pitting edema (+) at right dorsal foot

Right Lower Extremity

DERMATO-VENEROLOGY STATUS

• Location : Regio right dorsal foot

• Effloresensi : erythema, edema, ulcer (subcutaneous,

circumscribed, irregular border,granula tissue (+) )

LABORATORY EXAMINATIONS

• GDP : 87 mg/ dL (normal : < 126 mg/dL)• GD2PP : 161 mg/dL (normal: <140 mg/dL)

RESUME

A 65 years old male, went to hospital with chief complaint pain and pus at his right foot since 2 days ago. There is ulcer at right dorsal foot, circumscribed, irregular border, granula tissue (+). There is uncircumscribed erythema, pitting edema (+), pain (+), warm (+) at his right dorsal foot. He got fever for 1 day and relieved with paracetamol. He had food allergy history (crab, shrimp, terasi). Hypertension (-), DM(-).

DIAGNOSIS

CELLULITIS FOOT ULCER

DIFFERENTIAL DIAGNOSIS

- Erysipelas- Dermatitis Allimentary

Treatment

• OralCefadroxyl 500 mg b.i.dMefenamic acid 500 mg

t.i.d• Topical

NaCl 0.9% to compress the ulcer

Fuson cream 10 gr b.i.d (morning-afternoon)

PROGNOSIS

• Dubia ad bonam- ulcer treatment- hygiene

DEFINITION

• Cellulitis is a common bacterial infection of the skin, which can affect all ages.

• It usually affects a limb but can occur anywhere on the body.

• Symptoms and signs are usually localised to the affected area but patients can become generally unwell with fevers, chills and shakes (bacteraemia)

ETIOLOOGY

Streptococcus pyogenes (two thirds of cases)Staphylococcus aureus (one third)

PATHOGENESIS

Bacteria attacks the skin and tissue

Invade to deepest tissue

Acute inflammation

Spread to systemic

Local erythema on the skin Erythema of oedema

lesion tenderness

Lack integrity of skin Discomfort and pain

Clinical menifestation

• Symptoms of cellulitis include:–Fever–Pain or tenderness in the affected area–Skin redness or inflamation that gets

bigger as the infection spreads–Skin sore or rash that starts suddenly,

and grows quickly in the first 24 hours

–Tight, glossy, "stretched" appearance of the skin

–Warm skin in the the area of redness

Clinical menifestation

• Signs of infection:–Chills or shaking–Fatigue–General ill feeling–Muscle aches and pains–Warm skin–Sweating

Clinical menifestation

DIAGNOSE

Sign and symptoms of cellulitis

Prodromal symptoms

Febris, fatigue, arthralgia, cold

predilection Upper and lower extremity, face, body and genital

lesion Light Eryhtema

border irreguler

Further Examination

• The diagnosis of cellulitis is based on the clinical features.

• Laboratory testing is useful to judge the severity of infection and to guide therapy.

Further Examination

• If any pustules, crusts or erosions are present, a swab should be taken for culture.

• A complete blood count is likely to show leucocytosis . Blood cultures may be use if a patient has a high fever or is otherwise very unwell.

Treatment

-Bed rest- antibiotic Ampicillin 500mg q.i.d 1 hour before meal.Amoxicillin 500mg q.i.d 1 hour after mealClindamycin 150mg q.i.d /dayErythromycin 500mg q.i.dCephalosporin (Cefadroxyl 500mg b.i.d)

Treatment

• TopicalRivanol Yodium PovidonNaCl 0.9%

Oral Antimicrobials for Mild Infection Caused by Streptococci, MSSA, and MRSA

Streptococci only : Phenoxymathyl penicillin, amoxicillin.Streptococci or MSSA : Amoxicillin-clavulanate, Cloxacillin, dicloxacillin, cephalexin, Clindamycin or macrolide (if allergic to penicillins; and is sensitive)MSSA or MRSA : Clindamycin (If sensitive) Doxycycline or minocycline Trimethorphan- Sulfamethoxazole Linezolid (very expensive) Advanced fluoroquinolon- moxifloxacin and levofloxacin.