ACUTE INFECTION [Autosaved].pptx

acute infection

1. ACUTE INFECTIONS BY NG

2. CELLULITIS Cellulitis is a spreading subcutaneous inflammation caused by haemolytic Streptococcus. Streptococci produce hyaluronidase and streptokinase. The net result is the inflammation of the subcutaneous tissue Whenever there is loose subcutaneous tissue as in scrotum or loose connective and interstitial tissue as in face and forearm, it spreads fast. Sources of infection Injuries-minor or major Graze or scratch Snake bite, scorpion bite, etc.

3. Precipitating factors • Diabetes • Low resistance of an individual Common sites • Lower limbs • Face • Scrotum

4. Clinical feature Redness Itching Fever Toxaemia

5. Cellulitis differs from absecess as CELLULITIS ABSCESS No edges Well circumscribed No limit Limit is present No pus Pus present No fluctuation Flactuation positive

6. TREATMENT Bed rest with elevated legs to prevent EDEMA of the legs Glycerin MgSO4 dressing which reduces edema by osmotic pressure Diabetes mellitus if present should be treated with insulin injection Antibiotic such as ampicillin or cephalosporins Antisnake venom should be given ( Crotalidae Polyvalent Immune Fab Ovine )

7. Complication of cellulitis Abscess Necrozing fascilitis (caused by certain invasive strain of S.pyogene can be treated by debridement) Toxaemia and septicemia Ketoacidosis(in diabetic paitient )

8. Ludwings angina Refers to cellulitis of the submandibular and submental region accompanied with inflammatory edema of the mouth Virulent streptococcus are responsible Anaerobic organism also play role PRECIPITATING FACTORS C ancer of the oral cavity C alculi in the submandibular gland C hemotherapy C achexia chronic diseases Caries tooth

9. CLINICAL FEATURES Swelling is submandibular and submental region(brawny edema) Oedema of the floor of the mouth High fever Putrid halitosis

10. Treatment Rest and hospitalization Appropriate antibiotic Intravenous fluid to correct dehydration If doesn't corresponding to conservative treatment surgery may be indicated NOTE: in surgical drainage Even pus is not found, the edematous fluid that comes out greatly improving the condition of the patient.

11. Complication Mediastinitis Septicemia Oedema of glottis

12. Lymphangitis It is also a nonsuppurative, poorly localized infection caused by streptococci, staphylococci or clostridia, filaria infection • i t presents as red painful streaks in affected lymphatics.

13. CLINICAL FEATURES High grade fever chills rigors Tenderness TREATMENT Rest Elevation MgSO4 Antibiotic Anti inflammatory Antifilarial

14. ABscess An abscess is a localized collection of pus CLASSIFICATION OF ABSCESS Pyogenic abscess Pyaemic abscess Cold abscess

15. Pyogenic abscess It is usually produced by Staphylococcal infections. The organisms enter soft tissues through an external wound, minor or major It can also spread by hematogenous PATHOPHYSIOLOGY Following an injury, there is inflammation of the part brought about by the organism such as Staphylococcus. The end-result is production of pus which is composed of dead leukocytes, bacteria and necrotic tissue. The area around the abscess is encircled by fibrin products and it is infiltrated with leukocytes and bacteria. It is called pyogenic membrane.

16. CLINICAL FEATURES Throbbing pain Fever Rigors Chill(may also be absent )

17. SIGNS Calor Rubor Loss of function Dolor Tumor Flactuation (may nor be elicited in deep seated abscess)

18. TREATMENT Incision and drainage under general anaesthasia Use of antiseptics Treatment of the causative Differential diagnosis Rupture aneursym Soft tissue sarcoma

19. Pyemic abscess This is due to pus-producing organisms in the circulation (pyemia). It is the systemic effect of sepsis. It commonly occurs in diabetics and patients receiving chemotherapy and radiotherapy. Pyemic abscess is characterized by following features: • They are multiple • They are deep-seated • Tenderness is minimal • Local rise of temperature is not present Since pyemic abscess doesn’t not cause rise temperature it is called nonreactive abscess to differentiate it from pyogenic abscess.

20. TREATMENT This is treated by multiple incisions over the abscess site and drainage (like a pyogenic abscess) with antibiotic cover.

21. Cold abscess Is abscess with absence of signs of inflammation Usually is due to chronic disease mostly tuberculosis other chronic diseases such as leprosy, actino­mycosis and madura foot also produce abscesses which are 'cold'

22. Cervical tuberculous lymphadenitis Lymph node tuberculosis constitutes 20-40% of extrapulmonary tuberculosis The disease may be caused by Mycobacterium tuberculosis, atypical mycobacteria and Mycobacterium bovis. PATHOGENESIS In 80% of the cases, mycobacteria pass through tonsillar crypts and affect tonsillar node or jugulodigastric group of nodes, in the anterior triangle of the neck. In 20% of the cases, lymph nodes in the posterior triangle Other lymph nodes in the neck such as preauricular, submandibular can also be affected.

23. CLINICAL FEATURES Tuberculous lymphadenitis presents as a gradually increasing painless swelling of one or more lymph nodes of a few weeks to a few months duration. Multiple sites may be involved. SYSTEMIC SYMPTOMS Fever Night sweat Weight loss Fatigue

24. STAGES OF TUBERCULOUS LYMPHADENITIS Stage of lymphadenitis Stage of matting Stage of cold abscess Stage of collar stud abscess Stage of sinus

25. Stage of lymphadenitis Upper anterior deep cervical nodes are enlarged. Lymph nodes are Nontender discrete mobile firm palpable.

26. STAGE OF MATTING Results due to involvement of capsule Nodes move together Firm, nontender Matting is pathognomonic of tuberculosis. Other rare causes of matting are chronic lymphadenitis and anaplastic variety of lymphoma.

27. STAGE OF COLD ABSCESS Occurs due to caseating necrosis of lymph nodes Clinical features of cold abscess in the neck No local rise in temperature No tenderness No redness Soft cystic and fluctuating swelling Transillumination is negative On stemocleidomastoid contraction test, it becomes less prominent indicating that it is deep to the deep fascia.

28. Stage of collar stud abscess It results when a cold abscess which is deep to the deep fascia ruptures through the deep fascia and forms another swelling in the subcutaneous plane which is fluctuant. Cross fluctuation test may be positive. It is treated like a cold abscess.

29. STAGE OF SINUS Sinus is a blind tract leading from the surface down into the tissues. It occurs when collar stud abscess ruptures through the skin.

30. PATHOLOGICAL TYPES OF TUBERCULAR LYMPHADENITIS Caseating type : Most common type seen in young adults. Hyperplastic type : Lymph nodes show marked degree of lymphoid hyperplasia. Least caseation is seen in patients with good body resistance. Atrophic type: Seen in elderly patients. Lymphoid tissue undergoes degeneration. Glands are small with early caseation

31. INVESTIGATION IN TUBERCULOUS LYMPHADENITIS Complete blood picture may reveal low Hb%. ESR is elevated in majority of cases. Chest X-ray is usually negative, also sputum for AFB (acid­ fast baciIi). FNAC (fine needle aspiration cytology) can give a diagnosis in about 75% of cases.

32. TREATMENT After confirming the diagnosis antituberculosis treatment is given.

33. OTHER ACUTE INFECTION BOILS This is also called furuncle. It is a hair follicle infection caused by Staphylococcus aureus or secondary infection of a sebaceous cyst It starts with a painful indurated swelling with surrounding oedema. After about 1-2 days, softening occurs in the center and a pustule develops which bursts spontaneously discharging pus. Necrosis of subcutaneous tissues produces a greenish slough. Skin overlying the boil also undergoes necrosis. Hence, boil is included under acute infective gangrene. Furuncle of the external auditory meatus is a very painful condition because of the rich nerve supply of the skin

34. Complication of boils Necrosis of the skin Pyemic abscess and septicemia Cavernous sinus thrombosis

35. TREATMENT OF BOILS Incision and drainage with excision of slough. Antibiotic cloxacillin is given. Diabetes, if present, is treated

36. CARBUNCLE This is an infective gangrene of the subcutaneous tissue caused by Staphylococcus aureus It commonly occurs in diabetic patients. Patients with poor immunity, or undergoing radiotherapy can also develop Back of neck is the commonest site followed by back and shoulder region. Skin of these sites is coarse and has poor vascularity

37. CLINICAL FEATURES OF CARBUNCLES Typically, the patient is a diabetic. Severe pain and swelling in the nape of the neck Constitutional symptoms such as fever with chills and rigors are severe. Surface is red, angry looking like red hot coal. Surrounding area is indurated(thickened)

38. COMPLICATIONS OF CURBUNCLE Worsening of the diabetic status resulting in diabetic ketoacidosis. Extensive necrosis of skin overlying carbuncle. Hence, it is included under acute infective gangrene. Septicaemia toxaemia .

39. END