This document summarizes various acute bacterial infections including cellulitis, Ludwig's angina, lymphangitis, abscesses, and tuberculous lymphadenitis. Cellulitis is a spreading skin infection caused by streptococci that leads to inflammation. Ludwig's angina involves cellulitis of the neck region accompanied by mouth swelling. Lymphangitis presents as red streaks along lymphatic vessels. Abscesses are localized pus collections that can be pyogenic, pyemic, or cold. Tuberculous lymphadenitis commonly affects cervical lymph nodes and progresses through stages of lymphadenitis, matting, cold abscess, and sinus formation. Other infections discussed include boils, carbuncles

1. ACUTE
INFECTIONS
B Y N G

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. 1.Precipitating factors
2.• 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
Cancer of the oral cavity
Calculi in the submandibular gland
Chemotherapy
Cachexia
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
• it 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
1. Stage of lymphadenitis
2. Stage of matting
3. Stage of cold abscess
4. Stage of collar stud abscess
5. 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.

28. 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.

29. 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.

31. 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.

32. 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

33. 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.

34. TREATMENT
• After confirming the diagnosis antituberculosis treatment is
given.

35. 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

36. • Complication of boils
Necrosis of the skin
Pyemic abscess and septicemia
Cavernous sinus thrombosis

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

38. 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

39. • 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)

40. • 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.

49. END