cellulitis

entry kali ni,aku nak cerita pasal satu kes yang sangat2 'common' di India, dan mungkin di M'sia juga. kalau dekat india ni,boleh kate bersepah penyakit cellulitis ni,tambah lagi di kawasan ceruk2 kampung yang mane anda dihantar sebagai duty intern di klinik desa-contohnya di ullal/moobidri/dll..Kalau dekat kampung2,camp2 yang aku pergi,cellulitis memang on spot diagnosis tapi further evaluation nye lebih manis kalau kite bincangkan dari kes2 yang kene admit di hospital..

case: Mr Banoveenture,78 y old male ,k/c/o DM type 2 ,not on regular treatment

came with

- pain and swelling of right leg x 2weeks

fever x 1 week ,wound over right leg x 3 days

on examination: Pallor +, pedal edema+(rt) rt mature cataract+

vitals-stable CVS-Pansystolic murmur Gr 4 + in mitral area

local examination; swelling + up to mid calf - rt leg ,tenderness +, Increase temperature +, redness visible,poorly defined,wound (2x2cm) over right great toe (dorsal aspect)pus visible +,

peripheral pulse-felt.ROM-WNL.examination on left leg-normal

Impression-> Uncontrolled DM type 2 with cellulitis with osteomyelitis?.To R/O MR?

investigations sent:CBC.RBS,PPBS,FBS,glycoHB

blood c/s-no growth after 48h

wound swabs c/s: shows Gram + cocci -streptoccoci

sensitive to ampicillin/chloramphenicol/clotrimoxazole/

vancomycin and resistant to gentamicin/amikacin

so management for this patient?

Inj Bacirom 1g iv BD-(cefpirome-4th generations of cephalosporin against G-ve,+ve and pseudomonas)> antibiotic

inj Ampicillin iv q6h ( BSA,Penicilline group against Gram+ve cocci)-antibiotic

Cap Ocid 0-1-0 (omeprazole)-PPI

Tab Ultrazet 0-1-0 (Tramadol + paracetamol)-painkillers

Tab z.cal 1-0-0 -ca

duration of treatment biasenye 7-10 hari for inj,followed by tab,tapi depends lah kat keadaan patient..macam pakcik ni,kene control DM die,kene wat ECG and ECHO utk rule out cardiac problem juga..so ape lagi.. REFER to MED..=)

nak tau lebih details,boleh klik kat bawah ni=)

http://www.patient.co.uk/health/Cellulitis.htm