Carbuncle

Introduction Carbunculus is a deep abscess disease formed by the fusion of multiple adjacent acute deep folliculitis and inflammation around the hair follicle. It is the most common follicular papillary and multi-atrial abscess, which occurs in the dense part of the subcutaneous tissue. With symptoms of systemic poisoning. Diffuse suppurative inflammation caused by hemolytic streptococcus or Staphylococcus aureus invading the subcutaneous, fascia or deep loose connective tissue. Inflammation can be caused by infection of skin or soft tissue, or by localized suppurative infection, or by lymphatic and blood flow. basic knowledge Proportion of disease: high incidence, about 30-50% Susceptible people: no special people Mode of infection: non-infectious Complications: premature beats pneumonia

Cause

Diabetes (20%):

The cause of infection in diabetic patients is related to the abnormality of systemic immune function caused by hyperglycemia. It is also closely related to the changes of local acid-base environment of infected lesions. Some studies have injected bacteria into the soft tissue of diabetic mice to establish a model of purulent infection, 3-6 After daytime, the pH value in the lesion was measured. The results showed that the pH of the lesion in the diabetic mouse model was significantly lower than that in the control group. The mechanism may be that hyperglycemia can produce more lactic acid than normal. Since there is no pyruvate carboxylase in leukocytes, lactic acid is here. Can not synthesize glycogen; because insulin is absolutely or relatively lacking in diabetes, lactic acid at the lesion can not be used into the tricarboxylic acid cycle, resulting in lactic acid accumulation and pH value in the lesion, the pH value change in the lesion can reduce cell repair The ability and antibiotic bactericidal effect, so diabetic patients are not only vulnerable to infection, and the infection is prolonged.

Low immunity (30%):

Patients with reduced body resistance, such as long-term use of corticosteroids, nephritis, diabetes, heart failure, malnutrition, hypogammaglobulinemia, pemphigus, exfoliative dermatitis, etc., most of which are developed by folliculitis The pathogen first invades the bottom of a single hair follicle to form an infection. Due to the thick and tough skin of the site, the infection then spreads to the subcutaneous deep fascia tissue along the fat column with less resistance in the deep part, and then spreads around the deep fascia, thus involving the surrounding area. The fat column and the hair follicle form a plurality of "pust head" sputum.

Pathogens (30%):

Mainly Staphylococcus aureus, followed by Streptococcus, anaerobic bacteria and Pseudomonas aeruginosa, skin is unclean, local abrasions, body resistance is an important cause of infection, which is more common in diabetic patients.

Prevention

(1) Adjust the diet, usually should eat less spicy and stimulating products, avoid drinking strong alcohol, in order to prevent the spicy products from damaging the spleen and stomach, causing the stomach to accumulate moisture and heat to induce the disease or aggravate the disease, should eat more fresh vegetables, fruits, Keep your stools open.

(2) Preventing moisture, especially in hot weather, hot weather, often due to poor working environment, or busy work and sweaty clothes, combined with changing underwear is not diligent, prone to this disease, therefore, should develop good habits, often replaced Underwear, shower, keep the skin clean, dry and hygienic.

(3) should actively treat primary diseases such as folliculitis, bloated, eczema and so on.

(4) To prevent scratching, whether it is neck, ankle, umbilical or other parts of the body, if the skin is damaged or has eczema, it should be treated with active symptomatic treatment, avoiding hard work and scratching, and it may be formed after secondary infection. Abscess.

Other life advice

1. Propaganda and education on the prevention and treatment of purulent skin diseases are widely carried out in units prone to pyoderma (such as certain factories, agricultural machinery stations, primary schools, etc.), and regular preventive inspections are carried out to eliminate all pathogenic factors as much as possible.

2. Pay attention to skin hygiene, strengthen physical exercise and increase skin resistance.

3. Maintain the integrity of skin function. For skin diseases, especially pruritic skin diseases, timely treatment should be carried out to prevent skin damage and avoid irritation such as scratching and skin friction.

4. Clothes, towels, basins, etc. are prohibited from public use to prevent contact with infection. The patient should be properly isolated. The dressings and contact materials used by the patient should be strictly disinfected or burned. During the illness, it is forbidden to use the liquid to clean the skin lesions. Wash the affected area with tap water to prevent extension.

5. When you are sick, you should ban alcohol or spicy food, and eat less food.

Complications Complications, premature beats, pneumonia

Not only local lesions are heavier than sputum, but also complicated with systemic suppurative infections. Lips and sputum easily cause intracranial spongy sinusitis, which is more dangerous.

If serious infections are not treated in time, pathogens and their toxins can cause damage to vital organs of the body.

1. Toxic myocarditis manifests as high fever, chest tightness, palpitations, pulse rate, irregular heart rhythm, frequent ventricular premature beats.

2. Pneumonia.

3. Sepsis suddenly chills, followed by high fever up to 40 ~ 41 ° C, or low temperature, abnormal mind, pulse speed, liver and spleen can be swollen, severe cases of jaundice or subcutaneous bleeding.

4. Patients with lip palsy have a risk of spongy sinus thrombosis.

Symptoms Common symptoms Dizziness, hyperthermia, chills, swollen lymph nodes, severe pain, hypoproteinemia

At the beginning, the local skin has a red, swollen, hot, painful inflammatory infiltrating flat lumps, dark red color, unclear state, gradually developing to the surrounding and deep tissues, about 1 to 2 weeks, the affected area is suppurative, necrotic , rupture, there are many ulceration on the surface, necrotic tissue and pus are discharged from the ulcer hole. In severe cases, the entire affected part is completely necrotic, the surface skin completely falls off, forming a deep huge ulcer, replaced by new granulation tissue, cured After the scar is formed, it occurs on the dorsal side of the neck. Secondly, the back can also occur in any part of the body. The total number of white blood cells and neutrophils can be significantly increased. The incidence of this disease is highest in men aged 60-70 years. Occurred in the elderly, prone to dangerous state, the prognosis is serious.

Purple red swelling: local redness and swelling at the beginning of the sputum, a flaky purple-red infiltrating area, the boundary is unclear, the lesion is slightly higher than the body surface, and multiple "pust heads" are visible on the surface.

Honeycomb rupture, pus and blood secretion: local inflammation develops rapidly, the central part of the lesion gradually necrosis, ulceration, the formation of rice granules of larger size or larger, the pus plug is ruptured and the sore mouth is honeycomb-shaped, with pus and bloody secretions. overflow.

Pain: Local infection due to inflammatory irritation and skin tension, and severe pain in the affected area.

Lymph node enlargement: The surrounding lymph nodes in the infected area can be swollen.

Symptoms of systemic poisoning: severe reactions, chills, high fever, fatigue, headache, dizziness and loss of appetite.

For patients whose condition has not healed, it is necessary to pay attention to whether there are diseases such as diabetes and hypoproteinemia, and the immune function is inhibited, and the corresponding examination is carried out.

Awkward inspection

Histopathology: sputum is a deep pyoderma with multiple ulcerations on the surface of the skin. There are diffuse cell infiltration under the microscope. There are many neutrophils and multiple atrial abscesses. These abscesses are separated by connective tissue, or Under the skin of fibrous tissue hyperplasia, the pus flows out of the pores of the skin.

Peripheral blood

(1) White blood cell count: The fever can have an increase in the total number of white blood cells.

(2) White blood cell classification and counting: When the total number of white blood cells is increased, neutrophils are often accompanied.

2. Diabetes related examination

(1) Fasting plasma glucose measurement: Both fasting blood glucose levels are measured twice, and the possibility of diabetes should be considered.

(2) Glycosylated serum protein: This test is not affected by clinical blood glucose fluctuations, and higher than normal to help diagnose diabetes.

(3) Glycated hemoglobin: Glycated hemoglobin is positively correlated with blood glucose concentration and is irreversible, and diabetes is often 2 to 3 times higher than normal.

3. Bacteriological examination

(1) Bacterial culture: For multiple infections and repeated infections, the pus can be directly extracted from the abscess for bacterial culture, and the positive result is helpful for the diagnosis of pathogenic bacteria.

(2) Drug sensitivity test: While the pus bacterial culture, the drug sensitivity test can provide a scientific basis for clinical drug treatment.

Electrocardiogram: The possibility of myocardial damage is ruled out.

Diagnostic diagnosis

1. Head papillary dermatitis: initially folliculitis, proliferative scars, no necrotic foci and obvious systemic symptoms.

2. : The inflammation is shallow, the infiltration is light, the cone is conical, the center has pus suppository, the systemic symptoms are mild, the necrotic tissue is not obvious, the suppurative center has pust plug, no honeycomb pus.

3. Purulent sputum: common in the scalp, no ulcers, less necrotic tissue, lesions are follicular pustules, broken spots in the affected area, can be found in fungi.

4. Actinomycosis: common in the unilateral jaw and cheeks, after a slow, pus thin, which can detect sulfur yellow particles.

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