Boils & carbuncles dnbid 2
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Boils & carbuncles dnbid 2

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physiotherapy notes

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Boils & carbuncles dnbid 2 Boils & carbuncles dnbid 2 Document Transcript

  • BoilA boil, also called a furuncle, is a deep folliculitis, infection of the hairfollicle. It is almost always caused by infection by the bacteriumStaphylococcus aureus, resulting in a painful swollen area on the skincaused by an accumulation of pus and dead tissue. Individual boilsclustered together are called carbuncles. Staphylococcus is a genus ofbacteria that is characterized by being round (coccus or spheroidshaped), Gram-positive, and found as either single cells, in pairs, ormore frequently, in clusters that resemble a bunch of grapes. Thegenus name Staphylococcus is derived from Greek terms "staphyleand kokkos" that mean "a bunch of grapes", which is how the bacteriaoften appears microscopically (after Gram staining).In 1884, German physician Ottomar Rosenbach first described andnamed the bacteria. Two major divisions of the genus Staphylococcusare separated by the bacterias ability to produce coagulase, anenzyme that can clot blood. Most human infections are caused bycoagulase-positive S. aureus strains. Almost any organ system can beinfected by S. aureus.Signs and symptomsBoils are bumpy red, pus-filled lumps around a hair follicle that aretender, warm, and very painful. They range from pea-sized to golfball-sized. A yellow or white point at the center of the lump can beseen when the boil is ready to drain or discharge pus. In a severeinfection, an individual may experience fever, swollen lymph nodes,and fatigue. A recurring boil is called chronic furunculosis.[1][3][4][5] Skininfections tend to be recurrent in many patients and often spread toother family members. Systemic factors that lower resistancecommonly are detectable, including: diabetes, obesity, andhematologic disorders.[6]
  • CausesUsually, the cause is bacteria such as staphylococci that are present onthe skin. Bacterial colonization begins in the hair follicles and cancause local cellulitis and inflammation.[1][5][4] Additionally, myiasiscaused by the Tumbu fly in Africa usually presents with cutaneousfuruncles.[7] Risk factors for furunculosis include bacterial carriage inthe nostrils, diabetes mellitus, obesity, lymphoproliferative neoplasms,malnutrition, and use of immunosuppressive drugs.[8] Patients withrecurrent boils are as well more likely to have a positive family history,take antibiotics, and to have been hospitalized, anemic, or diabetic;they are also more likely to have associated skin diseases and multiplelesions.[9]ComplicationsThe most common complications of boils are scarring and infection orabscess of the skin, spinal cord, brain, kidneys, or other organs.Infections may also spread to the bloodstream (sepsis) and becomelife-threatening. S. aureus strains first infect the skin and its structures(for example, sebaceous glands, hair follicles) or invades damagedskin (cuts, abrasions). Sometimes the infections are relatively limited(such as a stye, boil, furuncle, or carbuncle), but other times they mayspread to other skin areas (causing cellulitis, folliculitis, or impetigo).Unfortunately, these bacteria can reach the bloodstream (bacteremia)and end up in many different body sites, causing infections (woundinfections, abscesses, osteomyelitis, endocarditis, pneumonia)[10] thatmay severely harm or kill the infected person. S. aureus strains alsoproduce enzymes and exotoxins (both secreted by staph) that likelycause or increase the severity of certain diseases. Such diseasesinclude food poisoning, septic shock, toxic shock syndrome, andscalded skin syndrome.[11] Almost any organ system can be infected byS. aureus.TreatmentIn contrast to common belief, boils do not need to be drained in orderto heal; in fact opening the affected skin area can cause furtherinfections.[12] In some instance however, draining can be encouragedby application of a cloth soaked in warm salt water. Washing andcovering the furuncle with antibiotic cream or antiseptic tea tree oil[13]
  • and a bandage also promotes healing. Furuncles should never besqueezed or lanced without the oversight of a medical practitionerbecause it may spread the infection.[1][5]Furuncles at risk of leading to serious complications should be incisedand drained by a medical practitioner. These include furuncles that areunusually large, last longer than two weeks, or are located in themiddle of the face or near the spine.[1][5]Antibiotic therapy is advisable for large or recurrent boils or those thatoccur in sensitive areas (such as around or in the nostrils or in theear). Staphylococcus aureus has the ability to acquire antimicrobialresistance easily, making treatment difficult. Knowledge of theantimicrobial resistance of S. aureus is important in the selection ofantimicrobials for treatment. Poor personal hygiene being common,the role of nasal S. aureus carrier may differ from communities withgood hygienic practices. Staphylococcus aureus re-infection may resultfrom contact with infected family members, contaminated fomites, orfrom other extra-nasal sites. This raises a suggestion to treathousehold contacts and close contacts if recurrence persists, becauseit is likely that one or more contacts are asymptomatic carriers of S.aureus. In addition to the increase in the cost of treatment in poorcountries, the possibility of developing drug resistance must beconsidered. The most important independent predictor of recurrence isa positive family history. Boils are spread among individuals bytouching or bursting a boil.Furunculosis is a common disease, particularly with deficient hygiene.A large number of S. aureus organisms are frequently present on thesheets and underclothing of patients with furunculosis and may causere-infection of patients and infection of other members of the family[9]The role of iron deficiency anemia in recurrent furunculosis wasdemonstrated, all patients were free from recurrence during the sixmonths follow-up period after iron supplementation.[15] A variety ofhost factors, such as abnormal neutrophil chemotaxis, deficient intra-cellular killing, and immuno-deficient states are of importance in aminority of patients with recurrent furunculosis[16] Health educationabout sound personal hygiene and correction of anemia should bemandatory in management of furunculosis.[9] It was found thatrecurrence was significantly associated with poor personal hygiene.[17]
  • A previous study reported that MRSA infection was significantlyassociated with poor personal hygiene. It was reported that frequenthand and body washing with water and antimicrobial soap solutiondecreases staphylococcus skin colonization. Previous use of antibioticsis associated with a high risk of recurrence. This may be due to thedevelopment of resistance to the antibiotics used.[18] An associatedskin disease favors recurrence. This may be attributed to thepersistent colonization of abnormal skin with S. aureus strains, such asis the case in patients with atopic dermatitis.[18] ***************************CarbuncleA carbuncle is an abscess larger than a boil, usually with one or moreopenings draining pus onto the skin. It is usually caused by bacterialinfection, most commonly Staphylococcus aureus. The infection iscontagious and may spread to other areas of the body or other people.Men get carbuncles more often than women. Because the condition iscontagious, family members may develop carbuncles at the sametime.CausesOften, the direct cause of a carbuncle cannot be determined. Thingsthat make carbuncle infections more likely include friction fromclothing or shaving, generally poor hygiene and weakening ofimmunity. For example, persons with diabetes and immune systemdiseases are more likely to develop staphylococcal infections.PresentationA carbuncle is made up of several skin boils. The infected mass is filledwith fluid, pus, and dead tissue. Fluid may drain out of the carbuncle,but sometimes the mass is so deep that it cannot drain on its own.Carbuncles may develop anywhere, but they are most common on theback and the nape of the neck.The carbuncle may be the size of a pea or as large as a golf ball. Itmay be red and irritated, and might hurt when touched. It may also
  • grow very fast and have a white or yellow center. It may crust orspread to other skin areas. Sometimes, other symptoms may occur,such as fatigue, fever and a general discomfort or sick feeling. Itchingmay occur before the carbuncle develops.EtymologyThe word is believed to have originated from the Latin: carbunculus,originally a small coal; diminutive of carbon-, carbo: charcoal orember, but also a carbuncle stone, "precious stones of a red or fierycolour", usually garnets.[1]TreatmentCarbuncles usually must drain before they will heal. This most oftenoccurs on its own in less than two weeks. Placing a warm moist clothon the carbuncle and soaking the affected area several times each dayhelps it to drain, which speeds healing. Squeezing the carbuncle, orcutting it open without medical supervision can spread and worsen theinfection.Treatment is needed if the carbuncle lasts longer than two weeks,returns frequently, is located on the spine or the middle of the face, oroccurs along with a fever or other symptoms. Treatment helps reducecomplications related to an infection. A doctor may prescribeantibacterial soaps and antibiotics applied to the skin or taken bymouth. Deep or large lesions may need to be drained by a healthprofessional. Proper excision, by cruciate incision, under strict asepticconditions will treat the condition effectively.Proper hygiene is very important to prevent the spread of infection.Hands should always be washed thoroughly, preferably withantibacterial soap, after touching a carbuncle. Washcloths and towelsshould not be shared or reused. Clothing, washcloths, towels, andsheets or other items that contact infected areas should be washed invery hot (preferably boiling) water. Bandages should be changedfrequently and thrown away in a tightly-closed bag. If boils/carbunclesrecur frequently, daily use of an antibacterial soap or cleansercontaining triclosan, triclocarban or chlorhexidine, can suppress staphbacteria on the skin.
  • ************
  • Skin Boil or Furuncle DefinitionDetailed checkup of this infection discovers that the boil is centered ona hair follicle. Skin boils (or Furuncles) is local infection of hair folliclesdeep in the skin. Boils are presented as red tender spots, lumps orpustules. After some time infected region of tissue becomes firm, hard,and tender. Finally, the center of the boil softens and gets filled withfighting white blood cells from the bloodstream to eliminate theinfection. Previously mentioned mixture of white blood cells, bacteria,and proteins is defined as pus. After some time, the pus define a peak,which can be surgically opened or spontaneously drain out through thesurface of the skin. This collection of white blood cells,proteins andbacteria which is usually enclosed within tissue is defined as abscess.CausesIn most cases individuals with skin boils are in good health conditionand have good personal hygiene. But they carry Staphylococcusaureus bacteria on the surface of their skin. Reason of this iscommonly not identified, but it is estimated that every fifth personcarry SA bacteria. This germ of Staphylococcus bacteria is mostusually found in the nostrils, armpits, between the legs and in the cleftbetween the buttocks. Sometimes it may be transferred to other sitesfrom the nostrils via the finger nails. Boils are also in some casesrelated to diabetes, immune deficiency, anaemia, or iron seficiencytroubles.Types of BoilsFuruncle presents collection of pus (also called boil) with other name.This is an abscess in the skin caused by the bacterium Staphylococcusaureus. A furuncle can have one or more openings onto the skin andmay be related with a chills or fever.Cystic Acne is defined as a type of abscess that is formed when oilducts become clogged and infected. This type of boils generallyinvolves deeper skin tissue than the more superficial inflammationfrom common acne. Appearance of cystic acne is usually on the facearea and mostly occurs in the teenage years.
  • Carbuncle is a term related for an abscess that affects a group of hairfollicles. Terms like furunculosis or carbunculosis may be defined ascases of chronic and recurring boils.Hidradenitis Suppurativa is an condition in which there are multipleabscesses that form under the armpits and mostly in the groin region.These regions presents answer of local inflammation of the sweatglands. It is hard to treat with antibiotics and mostly requires asurgical process to remove affected sweat glands in order to stopinflammation of skin tissue.Pilonidal Cyst is a unique kind of abscess that happens in the crease ofthe buttocks. This type of boils often start as tiny areas of infection inthe base of the region of skin tissue from which hair grows (alsoknown as the hair follicle). With irritation from direct pressure, overtime the inflamed area expands to become a painful, firm, and tendernodule that makes it hard to sit without discomfort. Pilonidal cyst oftenoccur after long travels that require long-term sitting.Treatment and Prevention Tips: • Sometimes boils can be related with serious infection and it would be useful to visit your doctor if there is any suspicions. • People with weight issues should work on their eating habits and take regular exercise as much they can. • Eating balanced healthy food with combination of meat and plenty of vegetables and fruit - try to avoid fast food habits!! • Personal hygiene is very important factor - it is strongly recommended to wash whole body once a day with soap and water • It is not recommended sharing towels with your sport colleagues or other family members • It would be good to maintain a clean handkerchief and dont pick your nose! • Changing underclothes and night attire regularly helps too. • Try to avoid leisure activities for some time which cause sweating and friction from clothing, such as squash and jogging. • In case of having iron deficiency, a course of iron tablets may help reduce infection.
  • • If there is any possibility of taking 1000 mg of vitamin C each day has also been advocated. dnbid