A study of cellulitis and other soft tissue infections of the lower limb in non-diabetic patients

Mayilan, C (2013) A study of cellulitis and other soft tissue infections of the lower limb in non-diabetic patients. Masters thesis, Thanjavur Medical College, Thanjavur.

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Abstract

INTRODUCTION: Cellulitis is a condition which is characterized by inflammation of connective tissue of the skin with severe involvement of dermal and subcutaneous layers. It is principally a bacterial infection, the organism can be either the normal skin flora or an exogenous one. It involves mostly the skin which is more prone for the breaks, cracks, blisters, ulcerations, cuts, bite wounds or hospital related injuries like surgical wounds or the intravenous cannulae. Lower limbs are the most commonly involved sites as the skin over there is much susceptible for the injuries mentioned. As commonly known, diabetics are the most susceptible population for the lower limb cellulitis primarily because of the fact they have more incidence of foot ulcers (due to the neuropathy and vasculopathy which ensues in the form of sensory loss and poor distal circulation)and also because they are immunocompromised. Poor glycemic control aids the growth of the organism in the ulcers they develop and eventually results up in the cellulitis. Yet, there is a significant section of population who are nondiabetics, are also more prone for the development of lower limb cellulitis and its complications. This group is gaining attention now as the number of patients affected is in an increasing trend. The management part in this group differs from the diabetics in such a way that effect of altered body metabolism, glycemic control and sensory compromise is negotiated. Early cellulitis in the Non-diabetics can be managed in out-patient unit with oral antibiotics, analgesics and treating the primary cause. But cellulitis of higher grades, with its complications like blisters, myositis, fasciitis needs hospital admission, parenteral antibiotics and surgical management. AIM OF THE STUDY: In the study group of 100 cases of lower limb cellulitis in non-diabetic individuals, our aim is to 1. To Study the age and sex distribution of the patients with lower limb cellulitis. 2. To analyse various causes/risk factors for cellulits in the nondiabetics. 3. To study various grades of presentation of lower limb cellulitis. 4. To analyse the incidence of recurrent cellulitis. 5. To study the spectrum of infectious agents responsible and their sensitivity pattern. 6. To study the circulatory changes in the lower limb affected with cellulitis. 7. To study the underlying bone involvement,if any. 8. To analyse the various modes of treatment employed. 9. To study the outcome of the treatment in the study group. 10. To discuss the management of the resultant wound after treating the condition. MATERIALS AND METHODS: This study, principally an prospective case series study, includes 100 non-diabetic patients who got admitted for lower limb cellulitis and its complications, under all surgical units of Thanjavur Medical college, as the study group. PERIOD OF STUDY: The study period involves a span of one year and ten months between November 2010 and august 2012. MATERIALS: 1. Clinical evaluation: • Age incidence, • Sex incidence, • Limb involved, • Severity during presentation. 2. Investigations: • Complete blood count, • Swab/ wound biopsy culture from the wound, • Study of sensitivity pattern for the organisms, • Doppler study of the arterial and venous system of the involved limb, • Plain X-ray of the limb, • Blood culture and sensitivity for the organisms. 3. Management of cellulitis according to its severity. 4. Management of the sequelae. METHODOLOGY: All the 100 patients have been studied systematically which started with careful analytical history taking (Before bringing the patient into the study, he or she should be tested for blood sugar, confirming the fasting blood sugar < 110 mg/dl and the post prandial blood sugar < 140 mg/dl) 1. Categorizing the patients according to the age group, and in our study we have included individuals of age group 21-60 years as our study group, among these the incidence of the disease in each of four decades have been recorded. 2. Categorizing the patients according to the Gender, to study the incidence of the disease in each sex. 3. History regarding the presenting illness, pain, reddening of the region,swelling of the local part, any ulcerations, blister/ bleb formation. 4. whether he or she is aware of the cause for the cellulitis, 5. if he or she is not aware of the cause, eliciting history regarding any trivial trauma, unknown bites, history of bare foot walking is considered. 6. whether there is history of any such illness previously and if yes how it was managed then, principally to study the incidence of recurrent cellulitis. 7. whether the patient is a smoker or an user of tobacco in other forms. 8. Whether the patient is having any comorbid medical illness, (hypertension, epilepsy, cardiac illness, chronic kidney disease, chronic liver disease, bronchial asthma). In the clinical examination, general examination of the patient for the presence of the anemia and jaundice has been studied and the nutritional and hydration status of the patient has been recorded. CONCLUSION: 1. As the age increases, the incidence of Cellulitis increases, and the severity of the disease as well. 2. Females have the higher incidence of cellulitis compared to the males, (male to female ratio- 2:3) 3. As our study group is principally comprising of surgical inpatients, higher grades of cellulitis are more common in our study. 4. Recurrent cellulitis has been documented in 8% of the individuals. 5. In this study, web space infections/intertrigo has been the most common cause (overall) of the cellulitis in the non-diabetics, which supports the literature. The causes such as traumatic ulcers and post bite cellulitis are also responsible for significant number of cases. Web space infections/intertrigo is also the most common cause in the females whereas in the males, traumatic ulcers are the most common cause. Streptococcus sp. and the Staphylococcus sp. are the common organisms responsible for the cellulitis in the study group, which correlates with the literature. 6. Piperacillin-tazobactum and Imipenam are the most sensitive antibiotics in majority of cases, this shows the emerging resistance for the commonly used antibiotics,(ampicillin,cloxacillin and cephalosporins). 7. Circulatory changes in the form of altered arterial flow pattern has been noticed in 24% of the individuals and in around 8% of individuals venous reflux has been noticed. 8. No patient in the study,has had deep venous thrombosis. 9. Also no patient has shown underlying bone involvement. 10. 24% of Patients were managed conservatively. 72% patients in the study group required surgical debridement, 45 individuals in this group required fasciotomy..And 4% of individuals in the study group required amputation. 11. All the patients managed conservatively had an uneventful recovery, and, 66% of the patients had the residual wound that needed further attention, 3% of the patients remained with disability, and 6 patients of the study group expired because of the co-morbidities complicating the illness.

Item Type: Thesis (Masters)
Uncontrolled Keywords: cellulitis ; soft tissue infections ; lower limb ; non-diabetic patients.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 07 Jun 2018 02:45
Last Modified: 07 Jun 2018 02:45
URI: http://repository-tnmgrmu.ac.in/id/eprint/8273

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