際際滷

際際滷Share a Scribd company logo

case study on cellulitis

Download as PPT, PDF
Y
Yamuna Srivalli

- Cellulitis is a bacterial skin infection that causes inflammation of the inner layers of skin and subcutaneous tissue. It commonly affects the legs and develops when bacteria enter through breaks in the skin. - A 60-year old male patient was admitted with swelling, pain and tenderness in his left foot and was diagnosed with cellulitis based on his symptoms, medical history of diabetes, and CT scan results. - He was started on a treatment regimen including antibiotics like metronidazole, tramadol for pain, and diclofenac gel to address the infection, symptoms, and prevent complications.

1 of 31
Downloaded 16 times
CASE PRESENTATIO N ON CELLULITIS PRESENTED BY: AKKI YAMUNASRIVALLI PHARM-D 3rd YR ROLL NO: 13 BROWNS COLLAGE OF PHARMACY
A 60 year old male patient admitted with the chief complaints of with swelling , heavy pain and tenderness in his left foot.
SUBJECTIVE INFORMATION
PATIENT NAME : XXXXX AGE : 60 yrs SEX : MALE IP NUMBER : 1698 DEPARTMENT :ORTHOPEDIC WEIGHT : 80 kgs
PAST MEDICAL HISTORY : NIL PAST MEDICATION HISTORY :NIL SOCIAL HISTORY SMOKER : NO ALCOHOL : YES MARITAL STATUS : MARRIED
OBJECTIVE INFORMATION
VITAL SIGNS: DURATION DAY 1 DAY 2 DAY 3 TEMERATURE 102 100 100 BP 110/80 110/70 120/60 PULSE 83 82 88
PROVISIONAL DIAGNOSIS It might be a case of CELLULITIS developed due to in-present diabetis.
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% BLOOD SUGAR: RBS 80-140 mg/dl 110mg/dl FBS 80-100mg/dl 90mg/dl PPBS 120-160mg/dl 140mg/dl
CT SCAN: A clear observation of the swelled portion of the foot due to cellulitis condition. The depth of infection can be observed.
DIAGNOSIS Based on CT-SCAN report and clinical manifestations, it is identified as cellulitis 11
PLAN S.no DRUGS FREQUENCY DOSE Day 1 Day 2 Day 3 Day 4 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 + + + +
PHARMACISTS INTERVENTION: Patients should be encouraged to inspect their feet daily and to apply water-based moisturizer. Elastic socks should be avoided, as they impair circulation . Do not take METROGYL if you are allergic to medicines containing metronidazole, any other nitroimidazole medicine. TRAMADOL should not be consumed if you have used alcohol, sedatives, tranquilizers, or narcotic medications within the past few hours. TRAMADOL can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never take tramadol in larger amounts, or for longer than prescribed .
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.
CELLULITIS Cellulitis is a bacterial infection involving Inflammation of subcutaneous connective tissue i.e. the inner layers of the skin. It specifically affects the dermis and 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
ETIOLOGY: Cellulitis is a condition caused by bacterial infection like Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes), or by a wide variety of exogenous bacteria. Bacteria enter into the body in many ways: Broken skin, burns, insect bites, surgical incisions and intravenous (IV) catheters are all potential pathways.
Many other bacteria causes cellulitis. Haemophilus influenza causes fascial cellulitis in young children. Pasteurella multocida leads to cellulitis associated with animal bites, mostly those of cats. Aeromonas hydrophila can cause an aggressive form of cellulitis in a laceration sustained in fresh water. Gram-negative bacillary (rod) cellulitis, like P. aeruginosa, is common among hospitalized, immunocompromised patients and may have multidrug resistance.
When bacteria enters the skin, it leads to redness and swelling around the site of the infection. If the bacteria gets into the bloodstream or into the deeper layers of the skin, complications can occur. Areas where the skin is dry and flaking, broken, or wounded are the most likely sites for bacteria to enter the body. Insect bites may also transmit bacteria that can cause a skin infection. The pathophysiology of cellulitis commonly starts out affecting the lower leg. The infected skin may be red, swollen, and painful to the touch. The red rash area may get worse or spread over time. PATHOPHYSIOLOGY
Any condition that causes chronic skin disruption, such as eczema, can increase a skin infection. The cellulitis can be made more severe by a weakened immune system caused by conditions such as diabetes or HIV. Chronic cellulitis can damage the lymphatic system and cause chronic swelling of the infected area. In rare cases, the bacteria can spread to the fascial lining, a deep layer of skin tissue. This is a very severe complication and a medical emergency.
INFECTED FOOT WITH CELLULITIS Chronic stage of cellulitis left untreated causing heavy damage in the foot
CELLULITIS EFFECTING EYE An open wound in the eye causing cellulitis
CELLULITIS IN HAND An open wound in the hand causing cellulites due bacterial infection
SIGNS AND SYMPTOMS: Pain and tenderness in the affected area. Redness or inflammation on your skin. Tight and swollen appearance of the skin. A feeling of warmth in the affected area. Fever.
RISK FACTORS: Injury. Any cut, fracture, burn gives bacteria an entry point. Weakened immune system. Conditions that weaken your immune system such as diabetes, leukemia and HIV/AIDS leave you more susceptible to infections. Certain medications, such as corticosteroids, also can weaken your immune system. Skin conditions. Skin disorders such as eczema, athlete's foot, chickenpox and shingles can cause breaks in the skin and give bacteria an entry point. Chronic swelling of your arms or legs (lymphedema). Swollen tissue may crack, leaving your skin vulnerable to bacterial infection.
HISTORY OF CELLULITIS: People who previously had cellulitis, especially of the lower leg, may be more prone to develop it again. INTRAVENOUS DRUG USE: People who inject illegal drugs have a higher risk of developing cellulitis. OBESITY: Being overweight or obese increases your risk of developing cellulitis and having recurring episodes.
COMPLICATIONS: Blood poisoning. Abscesses. Necrotising fasciitis. And also meningitis.
DIAGNOSIS: The condition of cellulitis is diagnosed by using computerized tomography (CT scan). CT scan: CT is used to accurately differentiate between superficial cellulitis and deep cellulitis(cellulitis associated with deep-seated infection). In uncomplicated cellulitis, CT demonstrates skin thickening, septation of the subcutaneous fat, and thickening of the underlying superficial fascia.
Goals of treatment: Generally the treatment of cellulitis is done based on the severity of infection. The treatment involves the following : When there is acute or early stage of cellulitis the patient is treated with the anti microbial therapy by giving a list of antibiotics and said to be used for one month and medication should be used until the prescribed medicines are finished. The IV and IM treatment is given in the following conditions , 1.If the infection is severe. 2. If the patient have other medical problems
3.If the effected person is very young or very old. 4.If the cellulitis involves areas close to important structures; for example, infection around the eye socket. DRUGS SPECIFICALLY USED: DICLOXACILLIN- 250 mg (OR) CEPHALEXIN- 500 mg is given orally T.I.D in the acute infections. Clindamycin or a macrolide (CLARITHROMYCIN OR AZITHROMYCIN) are reasonable alternatives in patients who are allergic to penicillin. Usually, cellulitis is presumed to be due to staphylococci or streptococci infection and may be treated with CEFAZOLIN, CEFUROXIME, CEFTRIAXONE, NAFCILLIN, OR OXACILLIN
STANDARD TREATMENT DRUGS GENERIC NAME DOSAGE FREQUENCY Cefuroxime Zinacef 250mg BD IV Clindamycin Cleocin 300mg/50ml OD Levofloxacin Levaquin 500mg OD IV Doripenem Doribax 500mg OD
Thank you..

More Related Content

case study on cellulitis

  • 2. A 60 year old male patient admitted with the chief complaints of with swelling , heavy pain and tenderness in his left foot.
  • 4. PATIENT NAME : XXXXX AGE : 60 yrs SEX : MALE IP NUMBER : 1698 DEPARTMENT :ORTHOPEDIC WEIGHT : 80 kgs
  • 5. PAST MEDICAL HISTORY : NIL PAST MEDICATION HISTORY :NIL SOCIAL HISTORY SMOKER : NO ALCOHOL : YES MARITAL STATUS : MARRIED
  • 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% BLOOD SUGAR: RBS 80-140 mg/dl 110mg/dl FBS 80-100mg/dl 90mg/dl PPBS 120-160mg/dl 140mg/dl
  • 10. CT SCAN: A clear observation of the swelled portion of the foot due to cellulitis condition. The depth of infection can be observed.
  • 11. DIAGNOSIS Based on CT-SCAN report and clinical manifestations, it is identified as cellulitis 11
  • 12. PLAN S.no DRUGS FREQUENCY DOSE Day 1 Day 2 Day 3 Day 4 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: Patients should be encouraged to inspect their feet daily and to apply water-based moisturizer. Elastic socks should be avoided, as they impair circulation . Do not take METROGYL if you are allergic to medicines containing metronidazole, any other nitroimidazole medicine. TRAMADOL should not be consumed if you have used alcohol, sedatives, tranquilizers, or narcotic medications within the past few hours. TRAMADOL can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never take tramadol in larger amounts, or for longer than prescribed .
  • 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 Cellulitis is a bacterial infection involving Inflammation of subcutaneous connective tissue i.e. the inner layers of the skin. It specifically affects the dermis and 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: Cellulitis is a condition caused by bacterial infection like Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes), or by a wide variety of exogenous bacteria. Bacteria enter into the body in many ways: Broken skin, burns, insect bites, surgical incisions and intravenous (IV) catheters are all potential pathways.
  • 17. Many other bacteria causes cellulitis. Haemophilus influenza causes fascial cellulitis in young children. Pasteurella multocida leads to cellulitis associated with animal bites, mostly those of cats. Aeromonas hydrophila can cause an aggressive form of cellulitis in a laceration sustained in fresh water. Gram-negative bacillary (rod) cellulitis, like P. aeruginosa, is common among hospitalized, immunocompromised patients and may have multidrug resistance.
  • 18. When bacteria enters the skin, it leads to redness and swelling around the site of the infection. If the bacteria gets into the bloodstream or into the deeper layers of the skin, complications can occur. Areas where the skin is dry and flaking, broken, or wounded are the most likely sites for bacteria to enter the body. Insect bites may also transmit bacteria that can cause a skin infection. The pathophysiology of cellulitis commonly starts out affecting the lower leg. The infected skin may be red, swollen, and painful to the touch. The red rash area may get worse or spread over time. PATHOPHYSIOLOGY
  • 19. Any condition that causes chronic skin disruption, such as eczema, can increase a skin infection. The cellulitis can be made more severe by a weakened immune system caused by conditions such as diabetes or HIV. Chronic cellulitis can damage the lymphatic system and cause chronic swelling of the infected area. In rare cases, the bacteria can spread to the fascial lining, a deep layer of skin tissue. This is a very severe complication and a medical emergency.
  • 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. Tight and swollen appearance of the skin. A feeling of warmth in the affected area. Fever.
  • 24. RISK FACTORS: Injury. Any cut, fracture, burn gives bacteria an entry point. Weakened immune system. Conditions that weaken your immune system such as diabetes, leukemia and HIV/AIDS leave you more susceptible to infections. Certain medications, such as corticosteroids, also can weaken your immune system. Skin conditions. Skin disorders such as eczema, athlete's foot, chickenpox and shingles can cause breaks in the skin and give bacteria an entry point. Chronic swelling of your arms or legs (lymphedema). Swollen tissue may crack, leaving your skin vulnerable to bacterial infection.
  • 25. HISTORY OF CELLULITIS: People who previously had cellulitis, especially of the lower leg, may be more prone to develop it again. INTRAVENOUS DRUG USE: People who inject illegal drugs have a higher risk of developing cellulitis. OBESITY: Being overweight or obese increases your risk of developing cellulitis and having recurring episodes.
  • 26. COMPLICATIONS: Blood poisoning. Abscesses. Necrotising fasciitis. And also meningitis.
  • 27. DIAGNOSIS: The condition of cellulitis is diagnosed by using computerized tomography (CT scan). CT scan: CT is used to accurately differentiate between superficial cellulitis and deep cellulitis(cellulitis associated with deep-seated infection). In uncomplicated cellulitis, CT demonstrates skin thickening, septation of the subcutaneous fat, and thickening of the underlying superficial fascia.
  • 28. Goals of treatment: Generally the treatment of cellulitis is done based on the severity of infection. The treatment involves the following : When there is acute or early stage of cellulitis the patient is treated with the anti microbial therapy by giving a list of antibiotics and said to be used for one month and medication should be used until the prescribed medicines are finished. The IV and IM treatment is given in the following conditions , 1.If the infection is severe. 2. If the patient have other medical problems
  • 29. 3.If the effected person is very young or very old. 4.If the cellulitis involves areas close to important structures; for example, infection around the eye socket. DRUGS SPECIFICALLY USED: DICLOXACILLIN- 250 mg (OR) CEPHALEXIN- 500 mg is given orally T.I.D in the acute infections. Clindamycin or a macrolide (CLARITHROMYCIN OR AZITHROMYCIN) are reasonable alternatives in patients who are allergic to penicillin. Usually, cellulitis is presumed to be due to staphylococci or streptococci infection and may be treated with CEFAZOLIN, CEFUROXIME, CEFTRIAXONE, NAFCILLIN, OR OXACILLIN
  • 30. STANDARD TREATMENT DRUGS GENERIC NAME DOSAGE FREQUENCY Cefuroxime Zinacef 250mg BD IV Clindamycin Cleocin 300mg/50ml OD Levofloxacin Levaquin 500mg OD IV Doripenem Doribax 500mg OD