case study on cellulitis

Pharm.D case presentations

1. CASE
PRESENTATIO
N
ON
CELLULITIS
PRESENTED BY:
AKKI YAMUNASRIVALLI
PHARM-D 3
rd
YR
ROLL NO: 13
BROWNS COLLAGE OF PHARMACY

2. •A 60 year old male patient admitted
with the chief complaints of with
swelling , heavy pain and tenderness
in his left foot.

3. SUBJECTIVE
INFORMATION

4. •PATIENTNAME:XXXXX
•AGE :60yrs
•SEX :MALE
•IPNUMBER :1698
•DEPARTMENT :ORTHOPEDIC
•WEIGHT :80kgs

5. •PAST MEDICAL HISTORY : NIL
PAST MEDICATION HISTORY :NIL
•SOCIAL HISTORY
SMOKER : NO
ALCOHOL : YES
MARITAL STATUS : MARRIED

6. OBJECTIVE
INFORMATION

7. VITAL SIGNS:
DURATION DAY 1 DAY 2 DAY 3
TEMERATURE
102 100 100
BP 110/80 110/70 120/60
PULSE 83 82 88

8. PROVISIONAL
DIAGNOSIS
It might be a case of
“CELLULITIS” developed
due to in-present diabetis.

9. LAB INVESTIGATIONS
PARAMETERS NORMAL VALUES OBSERVEDVALUES
Haemoglobin M:14-16,F:13-15 11.2gm
WBC COUNT 4000-11000cells/cmm 17,300cell/cmm
DC: NEUTROPHILS 40-80% 82%
ESINOPHILS 1-6% 7%
BASOPHILS 1-2% 3%
LYMPHOCYTES 20-40% 45%
MONOCYTES 2-10% 15%
BLOODSUGAR: RBS80-140mg/dl 110mg/dl
FBS 80-100mg/dl 90mg/dl
PPBS 120-160mg/dl 140mg/dl

10. CT SCAN:
Aclearobservationoftheswelledportionofthefootdueto
cellulitiscondition.Thedepthofinfectioncanbeobserved.

11. DIAGNOSIS
Based on CT-SCAN report and
clinical manifestations, it is identified
as “cellulitis”
11

12. PLAN
S.noDRUGS FREQUENCY DOSE Day1Day 2Day 3Day4
1.Metrogyl
(metranidazole)
BD 500mg
++++
2.Tramadol
(ultram)
BD 50mg
++++
3.Voveran(diclofe
nac sodium)
BD 100gm
++++
4.Taxim
(cefataxime)
BD 250mg
++++
5.Rantac
(rantidine)
BD 150mg
++++
6.Dicloxacillin BD
250mg
+−++
7.Ampicillin
(omnipen)
BD 500 ml
++++

13. PHARMACISTS
INTERVENTION:
•Patientsshouldbeencouragedtoinspecttheirfeetdailyand
toapplywater-basedmoisturizer.
•Elasticsocksshouldbeavoided,astheyimpaircirculation.
•Do not take METROGYL if you are allergic to medicines
containing metronidazole, any other nitroimidazole medicine.
•TRAMADOL shouldnotbeconsumedifyouhaveused
alcohol,sedatives,tranquilizers,ornarcoticmedications
withinthepastfewhours.TRAMADOLcansloworstopyour
breathing,especiallywhenyoustartusingthismedicineor
wheneveryourdoseischanged.Nevertaketramadolin
largeramounts,orforlongerthanprescribed.

14. •Before taking AMPICILLIN, tell your doctor or
pharmacist if you are allergic to it; or to PENICILLIN or
CEPHALOSPORIN ANTIBIOTICS; or if you have any
other allergies. This product may contain inactive
ingredients, which can cause allergic reactions.

15. CELLULITIS
•Cellulitisis abacterial infectioninvolving
Inflammation of subcutaneous connective
tissue i.e. the inner layers of theskin. It
specifically affects thedermisand the
subcutaneous fat.
•The legs and face are the most common
sites involved, though cellulitis can occur
on any part of the body.
•The leg is typically affected following a
break in the skin

16. ETIOLOGY:
Cellulitisisaconditioncausedbybacterialinfectionlike
Staphylococcusaureus(S.aureus)andStreptococcus
pyogenes(S.pyogenes),orbyawidevarietyofexogenous
bacteria.
Bacteriaenterintothebodyinmanyways:Broken
skin,burns,insectbites,surgicalincisionsand
intravenous(IV)cathetersareallpotentialpathways.

17. Manyotherbacteriacausescellulitis.
Haemophilusinfluenzacausesfascialcellulitisinyoung
children.
Pasteurellamultocidaleadstocellulitisassociatedwith
animalbites,mostlythoseofcats.
Aeromonashydrophilacancauseanaggressiveformof
cellulitisinalacerationsustainedinfreshwater.
Gram-negativebacillary(rod)cellulitis,likeP.
aeruginosa,iscommon among hospitalized,
immunocompromisedpatientsandmayhavemultidrug
resistance.

18. Whenbacteriaenterstheskin,itleadstorednessand
swellingaroundthesiteoftheinfection.Ifthebacteriagets
intothebloodstreamorintothedeeperlayersoftheskin,
complicationscanoccur.
Areaswheretheskinisdryandflaking,broken,or
woundedarethemostlikelysitesforbacteriatoenterthe
body.
Insectbitesmayalsotransmitbacteriathatcancauseaskin
infection.
Thepathophysiologyofcellulitiscommonlystartsout
affectingthelowerleg.Theinfectedskinmaybered,swollen,
andpainfultothetouch.Theredrashareamaygetworseor
spreadovertime.
PATHOPHYSIOLOGY

19. •Anyconditionthatcauseschronicskindisruption,suchas
eczema,canincreaseaskininfection.
•Thecellulitiscanbemademoreseverebyaweakened
immunesystemcausedbyconditionssuchasdiabetes
orHIV.
Chroniccellulitiscandamagethelymphaticsystemand
causechronicswellingoftheinfectedarea.
•Inrarecases,thebacteriacanspreadtothefasciallining,a
deeplayerofskintissue.Thisisaveryseverecomplication
andamedicalemergency.

20. INFECTED FOOT WITH CELLULITIS
•Chronic stage of cellulitis left untreated causing heavy
damage in the foot

21. CELLULITIS EFFECTING EYE
An open wound in the eye causing cellulitis

22. CELLULITIS
IN
HAND
An open wound in the
hand causing cellulites
due bacterial infection

23. SIGNS AND
SYMPTOMS:
Pain and tenderness in the affected area.
Redness or inflammation on your skin.
Tightandswollenappearanceoftheskin.
Afeelingofwarmthintheaffectedarea.
Fever.

24. RISK FACTORS:
Injury.Anycut,fracture,burngivesbacteriaanentrypoint.
Weakenedimmunesystem.Conditionsthatweakenyour
immunesystem—suchasdiabetes,leukemiaandHIV/AIDS—
leaveyoumoresusceptibletoinfections.Certainmedications,
suchascorticosteroids,alsocanweakenyourimmunesystem.
Skinconditions.Skindisorders—suchaseczema,athlete's
foot,chickenpoxandshingles—cancausebreaksintheskin
andgivebacteriaanentrypoint.
Chronicswellingofyourarmsorlegs(lymphedema).
Swollentissuemaycrack,leavingyourskinvulnerableto
bacterialinfection.

25. HISTORYOFCELLULITIS:
Peoplewhopreviouslyhadcellulitis,
especiallyofthelowerleg,maybemorepronetodevelop
itagain.
•INTRAVENOUSDRUGUSE:
Peoplewhoinjectillegaldrugshaveahigher
riskofdevelopingcellulitis.
•OBESITY:
Beingoverweightorobeseincreasesyour
riskofdevelopingcellulitisandhavingrecurring
episodes.

26. COMPLICATIONS:
Blood poisoning.
Abscesses.
Necrotising fasciitis.
And also meningitis.

27. DIAGNOSIS:
•Theconditionofcellulitisisdiagnosedbyusing
computerizedtomography(CTscan).
•CTscan:
CTisusedtoaccuratelydifferentiatebetween
superficialcellulitisanddeepcellulitis(cellulitis
associatedwithdeep-seatedinfection).
•Inuncomplicatedcellulitis,CTdemonstratesskin
thickening,septationofthesubcutaneousfat,and
thickeningoftheunderlyingsuperficialfascia.

28. Goals of treatment:
Generallythetreatmentofcellulitisisdonebasedon
theseverityofinfection.Thetreatmentinvolvesthe
following:
Whenthereisacuteorearlystageofcellulitisthe
patientistreatedwiththeantimicrobialtherapybygiving
alistofantibioticsandsaidtobeusedforonemonthand
medicationshouldbeuseduntiltheprescribedmedicines
arefinished.
TheIVandIMtreatmentisgiveninthefollowing
conditions,
1.Iftheinfectionissevere.
2.Ifthepatienthaveothermedicalproblems

29. 3.Iftheeffectedpersonisveryyoungorveryold.
4.Ifthecellulitisinvolvesareasclosetoimportant
structures;forexample,infectionaroundtheeyesocket.
DRUGSSPECIFICALLYUSED:
DICLOXACILLIN-250mg(OR)CEPHALEXIN-500mg
isgivenorallyT.I.Dintheacuteinfections.
Clindamycinoramacrolide(CLARITHROMYCINOR
AZITHROMYCIN)arereasonablealternativesinpatients
whoareallergictopenicillin.
Usually,cellulitisispresumedtobedueto
staphylococciorstreptococciinfectionandmaybe
treatedwithCEFAZOLIN,CEFUROXIME,CEFTRIAXONE,
NAFCILLIN,OROXACILLIN

30. STANDARD
TREATMENT
DRUGS GENERIC NAME DOSAGE FREQUENCY
Cefuroxime Zinacef 250mg BD
IVClindamycin Cleocin 300mg/50ml OD
Levofloxacin Levaquin 500mg OD
IV Doripenem Doribax 500mg OD

31. Thank you……..