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Carbuncle

Carbuncles are skin infections, which are larger than furuncles with more than one opening draining pus. It is mainly caused due to bacteria such as Staphylococcus aureus or Streptococcus pyogenes.


Presentation

Typical appearance of carbuncle can be described as development of red lump right beneath the skin. The affected area gets irritated and is extremely painful to touch. The lump is filled with pus and is of the size of a lentil. The area undergoes swelling and the neighboring areas can also swell and become red. The lump has several pus-filled openings, which may ooze and the skin develops crustiness. Carbuncles usually grow very fast and enlarge. In many cases, individuals also experience fever and malaise, along with fatigue [9].

Weakness
  • If the patient is very weak or has diabetes, the carbuncle is likely to develop more rapidly, is more serious and has a longer course.[what-when-how.com]
  • Any sign that the body feels weak and tired should be taken into consideration, as in some cases the bacteria can leave the area of the carbuncle and spread to other parts of the body.[brainreference.com]
  • People at higher risk for boils are those with diabetes or a weak immune system. Drug users who use needles are also more likely to get them. Symptoms of carbuncles A carbuncle starts as a small painful bump. But it can grow quickly.[saintlukeshealthsystem.org]
  • In many cases, affected individuals also suffer from fever, fatigue and general weakness. Diagnosis: A physical examination is enough for diagnosing carbuncle.[symptoma.com]
Papule
  • A 1 cm soft, pink, stalked papule revealed multiple, closed,, comedo-like spots on its surface (Fig. 1). The lesion was mildly tender and freely mobile on a broad-based stalk.[ncbi.nlm.nih.gov]
  • ‘Common skin infections include cellulitis, erysipelas, impetigo, folliculitis, and furuncles and carbuncles.’ boil , blister, sore, abscess, pustule, pimple, spot, wart, papule, wen, whitlow, canker View synonyms 2 A bright red gem, in particular a garnet[en.oxforddictionaries.com]
  • […] innoculated, bacteria cause a boil, which runs its usual infectious course in about 10 days Clinical features Painful localized bacterial infection of skin and subcutis, usually with several openings through which pus is discharged Tender, swollen red papules[pathologyoutlines.com]
  • A week earlier, she first noticed a grainsized papule. It gradually increased in size and became painful. The pain extended to the shoulders and upper back, and neck movement became difficult.[what-when-how.com]
Eruptions
  • Copyright HarperCollins Publishers noun 1. an extensive skin eruption, similar to but larger than a boil , with several openings: caused by staphylococcal infection 3. a dark reddish-greyish-brown colour Collins English Dictionary .[collinsdictionary.com]
  • All rights reserved. carbuncular ( carˈbuncular ) ( kɑrˈbʌŋkjulər ; kärbuŋˈky o ̅o lər ) adjective ME OFr L carbunculus , a little coal, gem carbo : see carbon noun 1. an extensive skin eruption, similar to but larger than a boil , with several openings[collinsdictionary.com]
Facial Scar
  • Management of these rare sites is urgent because of the potential intracranial complications and the surgical outcome is often unsatisfactory due to associated facial scarring.[ncbi.nlm.nih.gov]

Workup

A preliminary physical examination is often enough to diagnose carbuncles. However, the pus samples may also be tested for presence of bacteria to confirm the diagnosis. The bacterial culture test helps in determining the appropriate course of treatment.

In conditions when individuals develop carbuncles recurrently, various other tests are done to determine underlying health conditions such as diabetes. Urine and blood tests are conducted to evaluate the overall health of the affected individuals [10].

Treatment

In many conditions carbuncles heal by themselves in less than 2 weeks. In the initial stages, individuals can help drain pus by providing warm treatment by means of warm cloth that needs to be placed over the affected area. This needs to be done several times during the day. Individuals are advised against pricking or piercing the boils to prevent spread of infection [11].

In situations, when the carbuncles have persisted over 2 weeks, medical treatment is required. Antibiotics are the preferred treatment regime which are given orally and also through topical application of antibacterial ointments. Antibacterial soaps are also given to locally disinfect the affected area.

Surgery is the method of choice in cases when the lesions are deep and large. The carbuncle is then drained with the help of needle or a scalpel [12].

Prognosis

In majority of the cases, carbuncles can heal by themselves, seldom requiring any treatment. In cases, when they do not, treatment may be required. However, carbuncles have a high recurrence rate if appropriate precautionary and preventive measures are not adopted.

Etiology

Carbuncles are a result of bacterial infection, mostly caused due to bacteria residing on the skin surfaces. The bacteria responsible for causing such skin infections are Staphylococcus aureus and Streptococcus pyogenes. Small injury or insect bite gives the bacteria the access to enter the skin and cause an infection. Various body parts which are moist, are more prone to develop carbuncles. These areas include the groin region, armpit, nose, thighs and mouth [2]. Individuals with weakened immune system, poor nutrition and poor hygienic practices are at an increased risk of developing carbuncles.

Epidemiology

The exact incidence of carbuncles is unknown. It is a common occurrence amongst the adolescent group and in early adulthood years. Boys are more prone to develop carbuncles than girls. Children are less likely to develop such a type of skin abscess [3]. There has been a rise in the incidence of methicillin-resistant staphylococcus aureus infections in the past 20 years [4] [5].

Sex distribution
Age distribution

Pathophysiology

For a bacterium to cause an infection, it must first gain entry into the skin. Individuals with skin rashes such as folliculitis, or cuts during practices such as shaving and friction due to clothing can also cause the skin to break. In such situations, bacteria such as Staphylococcus aureus can gain entry into the skin causing an infection [6].

A carbuncle has several openings and is pus filled. Individuals with diabetes or compromised immune systems are more prone to contract carbuncles [7]. Carbuncles more commonly develop on moist areas of the body which is apt for the growth and development of the bacteria. Body areas such as groin, mouth, thighs, nose and armpits are the common regions for development of carbuncles [8].

Prevention

Practicing good personal hygiene is the basis for prevention of carbuncle and its recurrence. Individuals are advised to wash hands after using the bathroom and before eating. Regular bathing also keeps the skin free from bacteria. Individuals should also avoid squeezing boils in order to prevent spread of infection. It is also advised that clothes and towels should be regularly washed in hot water. In cases, when chances of developing carbuncles repeatedly are high, then antibiotics may be prescribed as a preventive regime.

Summary

Carbuncles are infectious and may spread by contact. Family members can develop carbuncles at almost the same time. Some individuals develop more than one carbuncle, such a condition is termed as carbuinculosis. Carbuncles appear to be larger than furuncles and are filled with pus. The infection is deep rooted in the skin and includes hair follicles as well. Such a type of condition can turn painful and can be accompanied by fever [1].

Patient Information

  • Definition: Carbuncle is a skin abscess which is larger than a boil, having multiple pus filled openings. It is a contagious condition which can spread to other individuals. Carbuncle consists of multiple boils which are filled with dead tissues and pus.
  • Cause: Bacterial infections are the major cause for development of carbuncles. Staphylococcus aureus and Streptococcus pyogenes are the bacteria that favor the development of boils and carbuncles. Individuals with poor immunity, poor personal hygiene and underlying disease conditions such as diabetes are at an increased risk of developing carbuncle.
  • Symptoms: A carbuncle develops as a large lump which is filled with pus and the affected area becomes swollen and turns red. In many cases, the neighboring area also becomes red and swollen. The lump is very painful to touch and can also itch. In many cases, affected individuals also suffer from fever, fatigue and general weakness.
  • Diagnosis: A physical examination is enough for diagnosing carbuncle. In order to determine the causative organism, bacteria culture by testing the pus is also required. Urine and blood tests would also be needed in order to diagnose other underlying heath conditions that would be causing carbuncle.
  • Treatment: Antibiotics are the treatment of choice for carbuncles. In cases, when the skin abscess turns large and deep, surgical intervention is required to drain the pus.

References

Article

  1. Zimakoff J, Rosdahl VT, Petersen W, Scheibel J. Recurrent staphylococcal furunculosis in families. Scand J Infect Dis 1988; 20:403.
  2. Gordon RJ, Lowy FD. Bacterial infections in drug users. N Engl J Med 2005; 353:1945.
  3. Sosin DM, Gunn RA, Ford WL, Skaggs JW. An outbreak of furunculosis among high school athletes. Am J Sports Med 1989; 17:828.
  4. van Belkum A, Verkaik NJ, de Vogel CP, Boelens HA, Verveer J, Nouwen JL. Reclassification of Staphylococcus aureus Nasal Carriage Types. J Infect Dis. Jun 15 2009;199(12):1820-6.
  5. BARBER M. Methicillin-resistant staphylococci. J Clin Pathol 1961; 14:385.
  6. Otto M. How Staphylococcus aureus Breaches Our Skin to Cause Infection. J Infect Dis. May 2012;205(10):1483-5. 
  7. Brook I, Frazier EH. Aerobic and anaerobic bacteriology of wounds and cutaneous abscesses. Arch Surg 1990; 125:1445.
  8. Stollery N. Skin infections. Practitioner. Apr 2014;258(1770):32-3. 
  9. Weedon D, Strutton G. Skin Pathology. 2nd ed. New York, NY: Churchill Livingstone; 2002:459-66.
  10. Long CB, Madan RP, Herold BC. Diagnosis and management of community-associated MRSA infections in children. Expert Rev Anti Infect Ther. Feb 2010;8(2):183-95.
  11. Thwaites GE, Edgeworth JD, Gkrania-Klotsas E, Kirby A, Tilley R, Török ME. Clinical management of Staphylococcus aureus bacteraemia. Lancet Infect Dis. Mar 2011;11(3):208-222.
  12. Derkson, DJ. Incision and drainage of an abscess. In: Procedures for primary care physicians, 1st ed, Pfenninger, J, Fowler, GC (Eds), Mosby, St. Louis 1994. p.50.

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Last updated: 2017-08-09 18:00