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How Cellulitis develops in DM patient

Discuss the pathogenesis of cellulitis in patients with diabetes mellitus.

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How Cellulitis develops in DM patient

  1. 1. Pathogenesis of Cellulitis seen in patients with diabetes mellitus Presented by Cheng-Yi
  2. 2. –Harrison’s Manual of Medicine, 17th edition An acute inflammatory condition of the skin, is characterized by localized pain, erythema, swelling and heat.
  3. 3. Causes Infection.
  4. 4. Causes Non Infectious. Autoimmune Drug reaction
  5. 5. Risk Factors Neuropathy Peripheral vascular disease Poor glycemic control
  6. 6. Neuropathy Sensory Autonomic Motor
  7. 7. Sensory Autonomic Motor Diminish the perception of pain and temperature Diminish sweat secretion, resulting in dry & cracked skin Lead to foot deformities, which causes pressure- induced soft tissue damage
  8. 8. Pathogenesis 4 pathways Protein Kinase C Hexosamine PathwayPolyol Pathway Advanced Glycation End-products Hyperglycemia
  9. 9. Protein Kinase C Hexosamine PathwayPolyol Pathway Advanced Glycation End-products Excess formation of ROS
  10. 10. Excess formation of ROS Poly(ADP-ribose) Polymerase Pathway Promote inflammatory reactions & neuronal dysfunction
  11. 11. Edwards JL, Vincent AM, Cheng HT, Feldman EL., Diabetic neuropathy: mechanisms to management., Pharmacol Ther. 2008 Oct;120(1)
  12. 12. Risk Factors Neuropathy Peripheral vascular disease Poor glycemic control
  13. 13. Pathogenesis Impair blood flow necessary for healing ulcers & infections
  14. 14. D.M. Hyperglycemia Free Fatty Acid Insulin Resistance Oxidative Stress PKC Activation RAGE Activation Mark A. Creager, MD; Thomas F. Lüscher, MD, FRCP, Diabetes and Vascular Disease Pathophysiology, Clinical Consequences, and Medical Therapy: Part I, American Heart Association, Inc.
  15. 15. Oxidative Stress PKC Activation RAGE Activation ↓NO ↑ET-1 ↑AT II ↑AP-1 ↑NF-κB ↑TF ↑PAI-1 ↓NO Vasoconstriction Inflammation Thrombosis Mark A. Creager, MD; Thomas F. Lüscher, MD, FRCP, Diabetes and Vascular Disease Pathophysiology, Clinical Consequences, and Medical Therapy: Part I, American Heart Association, Inc.
  16. 16. Risk Factors Neuropathy Peripheral vascular disease Poor glycemic control
  17. 17. Pathogenesis Hyperglycemia Impairs neutrophil function & reduces host defense
  18. 18. Reference • Matthew E. Falagas, MD, MSc, and Paschalis I. Vergidis, MD, Narrative Review: Diseases That Masquerade as Infectious Cellulitis, Ann Intern Med. 2005;142:47-55. • Edwards JL, Vincent AM, Cheng HT, Feldman EL., Diabetic neuropathy: mechanisms to management., Pharmacol Ther. 2008 Oct;120(1) • Mark A. Creager, MD; Thomas F. Lüscher, MD, FRCP, Diabetes and Vascular Disease Pathophysiology, Clinical Consequences, and Medical Therapy: Part I, American Heart Association, Inc. • Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities In: UpToDate

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