Download - Erysipelas Fk 260215
8 MONTHS OLD MALE WITH ERYSIPELAS
Supervised byNugrohoadji Dharmawan, dr., Sp.KK, M.Kes
Faris Khairuddin SyahG99141114
INTRODUCTION
Erysipelas
•Infection involving superficial dermal structures•Erysipelas was known as St. Anthony’s Fire•Distinguished with cellulitis by well demarcated raised borders
Erythematous patch
•Tenderness•Edematous•Indurated•Shiny•Well-defined•Well-demarcated
The Infectious Disease Society of America (IDSA)
•Streptococcus pyogenes•Group B Streptococcus•Group C Streptococcus•Group G Streptococcus
ETIOLOGY
Streptococcus is the most common etiology of erysipelas
• Group A Streptococcus
Face
• Non-Group A Streptococcus
Lower extremity
Toxemia rather than bacteremia
Port d’ entry becomes bacterial inoculation site
EPIDEMIOLOGY
Lower incidence
• Antibiotic era• Growing sanitary• Lower virulence
Face Lower Extremities
No race dependencies
Adult Female > Adult Male
Male Children > Female Children
Highest rate on 60-80
aged
PATHOGENESIS
Port d’ entry
Bacteria
Tissue
• Polysacaride wall• Fibrin barrier• Cell membrane Trauma Anaerobic bacteria
Low count organism Cytokine reaction and bacteria superantigen
CLINICAL MANIFESTATIONProdrome of fever, chills, and general malaise on incubation period
Fever
Pain and tenderness on port d’ entry Small erythematous patch
• Bright red• Edematous• Indurated• Shiny• Well-defined• Slightly raised borders• Well-demarcated
Bulging dan tenderness regional lymphatic tissue
CLINICAL MANIFESTATION
Adult•Lower extremity•Interdigitalis regional•Hand•Trunk•Face
Children •Face•Extremities
CLINICAL EXAMINATIONPHYSICAL EXAMINATION
Prodrome of fever, chills, and general malaise on incubation
period
Fever
Pain and tenderness on port d’ entry Small erythematous patch• Bright red• Edematous• Indurated• Shiny• Well-defined• Slightly raised
borders• Well-demarcated
Bulging dan tenderness
regional lymphatic
tissue
IMAGING AND LABORATORY EXAMINATION
Blood count Leucocytosis
Biopsy Bacteria Culture
Blood Culture Suspect on sepsis
MRI
CT
CLINICAL MANIFESTATION
DIFFERENTIAL DIAGNOSIS
Insect bite
Cellulits
Ecthyma gangrenosum
Allergic Contact Dermatitis
Urtikaria
Erysipeloyd
Herpes
Zooster
Necrotizing
Fascitis
TREATMENT
DRUGS
Antibiotics (5-14 days)
• Penicillin• Cephalosphorin• Macrolide
Analgetics
• Corticosteroid Prednisone• AINS Ibuprofen
Hygiene Betadine or Hibiclens wash
Wound management
Elevation
Inpatient treatment indicated for children or immunocompromised
COMPLICATION AND PROGNOSIS
Further infection
Heart valve bacteria inoculation
Erysipelas recurrent
Permanent lymphedema
PATIENT STATUS
Identity
• Name : An. KBP• Sex : Male• Age : 8 mo• Religion: Islam• Occupation : -• Address: Kalijambe, Sragen• Status : Single• MR : 01 28 82 91
RECENT MEDICAL HISTORY
Patient came to the hospital accompanied by his mother with a chief complaint swelling in his right hand and right leg since two weeks before the examination.
The patient was referred by pediatric department.
Complained swelling in his right hand and right leg two weeks before the examination after an IV needle insertion while being treated in hospital Assalam Sragen with complaints of high fever and was diagnosed with dengue fever.
Swelling has been treated with ointment and compress (no drugs information).
Complaint was slightly reduced but the pain and heat still disturbing.
MEDICAL HISTORY
Similar disease history : (-)
Drug allergy : (-)
Food allergy : (-)
Atopic history : (-)
Inpatient history : dengue fever on Februari 2015
FAMILY MEDICAL HISTORY
Similar disease history
: (-)
Drug allergy
: (-)
Food allergy
: (-)
Atopic history
: (-)
PHYSICAL EXAMINATION
General Examination
• Compos mentis• GCS : E4V5M6• Height : 70 cm• Weight : 10 kg
Dermatological Examination
• Erythematous plaque, well-bordered and brown crust were observed on regio cruris dextra and manus dextra