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BOILS/CARBUNCLES/STAPHYLOCOCCAL CARRIAGE - Coggle Diagram
BOILS/CARBUNCLES/STAPHYLOCOCCAL CARRIAGE
Diagnosis
Firm, tender, erythematous nodules.
Duration/progression
Site of lesions. Boils occur in hair bearing sites e.g. face, neck, axilla or buttocks
Systemic symptoms e.g. fever
Examine Boil - Observe lesion; single or in groups size from pea sized to golf ball sized.
Examine - Assess for presence of discharging pus /fluctuance.
Lesions feels boggy and skin has shiny appearance
Boils may rupture spontaneously, draining pus or necrotic material - they heal to leave a permanent scar
Check for surrounding cellulitis
Check for person's temperature/pulse/blood pressure if clinically indicated
Clinical presentation of Carbuncle
Carbuncle- large/hard/red/dome-shaped/very painful lump increases in size over few days
Pus may drain from follicular orifices
Carbuncles developed a yellow-grey irregular crater centrally. necrosis of the intervening skin
Slowly heal often leaving a permanent scar
Duration and progression of symptoms. Site of lesion
Occurs usually at nape of neck/back and thighs
Presence of systemic symptoms/fever and malaise.
Examine - lesion /assess for presence of discharging pus/fluctuance
Check or surrounding cellulitis
Check person's temperature/pulse/blood pressure
Differential Diagnosis
Cystic Acne
Dental Abscess
Epidermoid Cyst
Folliculitis
Hidradenitis Supprativa
Anthrax
Atypical mycobacterial infection
Ecthyma
Kerion
Myiasis
Orf
Osteomyelitis
Management
Arrange for urgent same day incision and drainage for large/fluctuant boils .
For all Carbuncles
Incision and drainage in primary care if expertise /facilities available. Otherwise refer to surgical unit /emergency department
If incision /drainage in primary care consider swabs of pus from lesion /initiate antibiotic therapy.
Consider admission for IV antibiotics if systemically unwell. Has cellulitis.
Has infection in area where complications serious.
Is immunocompromised either underlying disease/medication ( diabetes /corticosteroids).
When to swab for Boil/Carbuncle - if not responding to treatment.
Persistent or recurrent/exclude atypical mycobacteria/staphylococcus aureus.
Person has multiple lesions.
Is immunocompromised.
Is colonised with MRSA.
Has diabetes.
Is a member of household/resides in institutional setting/recurrent outbreaks of skin /soft tissue infection.
If PVL-SA suspected, should mentioned specifically on laboratory form.
If admission /referral not required - advise apply moist heat three to four times per day to alleviate pain, localise the infection and hasten pus drainage.
advise small boil drain spontaneously.
Seek medical advise if lesion fluctuant.
Seek medical advice if systemically unwell /develop cellulitis.
Seek specialist advice if PVL-SA suspected particularly in people with severe /recurrent boils, who reside in a household or institutional setting where outbreaks of boils/carbuncles noted.
MRSA - suspect if person hospitalised within last year /chronic illness requiring healthcare visits/history of MRSA infection.
Prescribe course of oral antibiotics if fever/cellulitis/lesion.
Lesion is on face.
Pain or severe discomfort
Comorbidities (diabetes/immunosuppression)
Flucloxacillin is recommended first line (erythromycin in pregnancy/breastfeeding or clarithromycin for allergy to penicillin.
Give information /self-car advice - take paracetamol /ibuprofen for pain relief. Maintain good personal hygiene.
Wash hands carefully after contact with lesions. Wash clothes/bed linen/towels at high temperature daily.
Use separate face cloth/towel
Wear loose fitting clothing
Keep wound /grazes clean/uncovered with sterile gauze until healed. Not participate in contact sports/swimming pool /gym until boil cleared to avoid passing infection to others.
Recurrent Boils /Carbuncles - Exclude diabetes/anaemia or blood dyscrasias.
Obesity
Skin disease
Localised predisposing factors
Treatment with corticosteroids .immunosuppressive drugs.
Ask if close contact with infected person/family /through contact sports.
If family member works in hospital /healthcare setting
Swab the lesions.
IF PVL-SA infection is suspected specifically mention on labaoratory form.
If Staph infection confirmed check for carriage of S aureus.
If PVL-SA infection confirmed, management should be discussed with microbiology or local infection control team.
Reinforce self care advice.