selulitis

NAMA

NAMA

Selulitis

DEFINISI

Selulitis adalah infeksi pada lapisan kulit yang lebih dalam.

PENYEBAB

Bakteri streptokokus atau stafilokokus atau bakteri lainnya.

Dalam keadaan normal kulit memiliki berbagai jenis bakteri, tetapi kulit yang utuh merupakan penghalang yang efektif untuk mencegah masuknya bakteri dan mencegah pertumbuhan bakteri di dalam tubuh. Jika kulit robek, bakteri bisa masuk dan berkembangbiak, menyebabkan infeksi dan peradangan.

Faktor resiko terjadinya selulitis:

Gigitan dan sengatan serangga, gigitan hewan, gigitan manusia

Luka di kulit

Riwayat penyakit pembuluh darah perifer, diabetes

Baru menjalani prosedur jantung, paru-paru atau gigi

Pemakaian obat imunosupresan atau kortikosteroid.

GEJALA

Infeksi paling sering ditemukan di tungkai dan seringkali berawal dari: - kerusakan kulit akibat cedera ringan - luka terbuka di kulit - infeksi jamur diantara jari-jari kaki.

Selulitis menyebabkan kemerahan atau peradangan yang terlokalisasi. Kulit tampak merah, bengkak, licin disertai nyeri tekan dan teraba hangat.

Ruam kulit muncul secara tiba-tiba dan memiliki batas yang tegas. Bisa disertai memar dan lepuhan-lepuhan kecil.

Gejala lainnya adalah: - demam - menggigil - sakit kepala - nyeri otot - tidak enak badan.

DIAGNOSA

Diagnosis ditegakkan berdasarkan gejala-gejalanya. ntuk menentukan penyebabnya, dilakukan pembiakan terhadap contoh darah atau jaringan kulit yang terinfeksi.

PENGOBATAN

Pengobatan yang tepat dapat mencegah penyebaran infeksi ke darah dan organ lainnya.

Diberikan penicillin atau obat sejenis penicillin (misalnya cloxacillin). Jika infeksinya ringa, diberikan sediaan per-oral (ditelan). Biasanya sebelum diberikan sediaan per-oral, terlebih dahulu diberikan suntikan antibiotik jika: - penderita berusia lanjut - selulitis menyebar dengan segera ke bagian tubuh lainnya - demam tinggi.

Jika selulitis menyerang tungkai, sebaiknya tungkai dibiarkan dalam posisi terangkat dan dikompres dingin untuk mengurangi nyeri dan pembengkakan.

PENCEGAHAN

Hindari kerusakan kulit pada saat bekerja atau berolah raga dengan menggunakan perlengkapan yang tepat.

Bersihkan setiap luka di kulit.

Menjaga kesehatan tubuh dan mengendalikan penyakit menahun. Tubuh yang sehat lebih mudah melawan bakteri sebelum mereka berkembangbiak dan menyebabkan infeksi.

http://www.medicastore.com/med/detail_pyk.php?idktg=14&iddtl=345&UID=20041006185014202.155.60.14Cellulitis

Last Updated: June 7, 2004

Background: The word cellulitis literally means inflammation of the cells. It generally indicates an acute spreading infection of the dermis and subcutaneous tissues resulting in pain, erythema, edema, and warmth.

Pathophysiology: Skin and subcutaneous tissues are involved when microorganisms invade disrupted skin.

Frequency: In the US: Cellulitis is a common infection.

Mortality/Morbidity: Cellulitis may progress to serious illness by uncontrolled spread contiguously or via the lymphatic or circulatory systems.

Race: No predilection exists.

Age: No predilection for age is known except as noted for facial cellulitis and perianal cellulitis.

Facial cellulitis occurs more commonly in adults older than 50 years and in children aged 6 months to 3 years.

Perianal cellulitis occurs predominantly in children. (This is somewhat of a misnomer, and the term perianal disease is preferred by some authors.)

History: Patient may have a history of trauma or surgery, causing a break in the skin, or may have no discernible dermal injury. The infection typically develops over a period of several days.

Among those with peripheral vascular disease or diabetes, minor injuries or cracked skin in the feet or toes can serve as a source for infection.

Foreign bodies passing through skin, such as intravenous catheters or orthopedic pins, can provide a portal of entry to infection.

In those with prior surgery involving lymph node dissection, such as mastectomy, no evidence of recent injury may be observed. However, these patients are prone to recurrent cellulitis in these areas.

Physical: Hallmarks of cellulitis include the following:

Warmth, erythema, edema, and tenderness of affected area are present.

Associated red streaking visible in skin proximal to the area of cellulitis is characteristic of ascending lymphangitis. In lymphangitis the infection is carried through the lymphatic system.

Regional lymphadenopathy may be present.

The margin of cellulitis will not be palpable.

Fever may be present.

Cellulitis characterized by violaceous color and bullae suggests infection with Streptococcus pneumoniae (pneumococcus).

Causes: Bacterial and fungal infections

In individuals with normal host defenses, the most common causative organisms are group A streptococci and Staphylococcus aureus.

Cellulitis in infants may present as sepsis, most commonly caused by group B streptococci.

In immunocompromised hosts, gram-negative rods or fungi may cause cellulitis, though fungal cellulitis is rare.

Wounds occurring after exposure to fresh water may be caused by Aeromonas hydrophila, a gram-negative rod.

Pneumococcus may cause a particularly malignant form of cellulitis, typically in an immunocompromised host, and frequently is associated with tissue necrosis, suppuration, and blood stream invasion.

Patients with the following conditions are at increased risk of developing serious or rapidly spreading cellulitis:

Diabetes

Immunodeficiency

Other systemic illness

Varicella

Impaired peripheral circulation (arterial insufficiency or venous stasis)

Lymphadenectomy following tumor excision, such as mastectomy

Postvenectomy status following saphenous vein stripping

Chronic steroid use increases the risk of cellulitis.

Cellulitis may complicate varicella.

Cellulitis may be identified by a margin of erythema surrounding the vesicles.

Though varicella is a viral illness and does not respond to antibiotics, the development of cellulitis complicating varicella mandates antibiotic treatment and careful clinical follow-up. Untreated cellulitis in association with varicella may progress to severe disfiguring gangrene of the dermal structures requiring skin grafting. Deaths have been reported.

Angioedema Burns, Chemical Dermatitis, Atopic Dermatitis, Contact Dermatitis, Exfoliative Erysipelas Erythema Multiforme Gas Gangrene Impetigo Plant Poisoning, Toxicodendron Stevens-Johnson Syndrome Toxic Epidermal Necrolysis Lab Studies: No workup is required in uncomplicated cases that meet the following criteria:

Small area of involvement

Minimal pain

No systemic signs of illness (eg, fever, chills, dehydration, altered mental status, tachypnea, tachycardia, hypotension)

No risk factors for serious illness (eg, extremes of age, general debility, immunocompromise)

Consider the following tests in more serious cases, such as those in which systemic signs are present, the patient is at high risk of complicated cellulitis, or any of the risk factors listed in Causes section are associated with the diagnosis.

Complete blood count

BUN

Creatinine

Blood cultures

Aspiration of the wound

Culture and Gram stain are of limited use.

Yield is positive approximately one third of the time.

Areas of abscess or bullae formation

Culture and Gram stain of fluid may be helpful.

Yield is positive approximately 90% of the time.

Immunofluorescence: Direct immunofluorescence is technically possible and may lead to a definitive diagnosis in culture-negative cellulitis, but this is rarely necessary.

Imaging Studies: Plain radiographs are unnecessary in uncomplicated cases.

In more severe clinical cases, particularly with crepitus, radiographs may show gas in the tissues. If gas is seen, the differential diagnosis then includes fasciitis and gangrene, which generally are considered surgical emergencies.

TREATMENT

Emergency Department Care: Mild cellulitis

May be treated on an outpatient basis with a regimen of oral antibiotics.

Some clinicians prefer an initial dose of parenteral antibiotic with a long half-life, followed by an oral agent.

Reevaluate within 24-48 hours. Patients who have not improved should be considered for admission.

Complicated cellulitis - Patients with an underlying illness or signs of systemic toxicity require admission to the hospital for intravenous antibiotics.

Consultations: Patients with crepitus, extensive bullae formation, or necrosis of the skin require surgical consultation.

Deep and rapidly spreading infections may develop into life-threatening emergencies. In such cases, patients require intensive monitoring, fluid and vasopressor support, broad-spectrum antibiotic coverage, and consideration for surgical debridement in the operating room.

MEDICATION

The goals of therapy are to eradicate the infection and prevent complications.

Drug Category: Antibiotics -- Empiric coverage for group A streptococci and S aureus should be provided. Acceptable outpatient regimens include penicillinase-resistant synthetic penicillin or a first-generation cephalosporin. Alternatively, long-acting parenteral cephalosporin may be administered.

Drug NameDicloxacillin (Dycill, Dynapen) -- Bactericidal antibiotic that inhibits cell wall synthesis and is used to treat infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when staphylococcal infection suspected.

Adult Dose500 mg PO q6h

Pediatric Dose50 mg/kg/d PO divided q6h

ContraindicationsDocumented hypersensitivity

Interactions Decreases efficacy of oral contraceptives; increases effects of anticoagulants; probenecid and disulfiram may increase levels

PregnancyB - Usually safe but benefits must outweigh the risks.

PrecautionsMonitor PT in patients taking anticoagulant medications; toxicity may increase in renal impairment

Drug NameCephalexin (Keflex, Biocef) -- First-generation cephalosporin that inhibits bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal and effective against rapidly growing organisms forming cell walls.Primarily active against skin flora. Typically used for skin structure coverage and as prophylaxis in minor procedures.

Adult Dose500 mg PO q6h

Pediatric Dose50 mg/kg/d PO divided q6h


InteractionsCoadministration with aminoglycosides increases nephrotoxic potential; may increase toxicity of anticoagulants


PrecautionsAdjust dose in renal impairment because toxicity may increase; monitor PT in patients taking anticoagulant medications

Drug NameCeftriaxone (Rocephin) -- Third-generation cephalosporin that has broad-spectrum activity against gram-negative organisms, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms than earlier generation cephalosporins. By binding to 1 or more penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial growth.

Adult Dose1-2 g IV/IM qd or divided bid, depending on type and severity of infection; not to exceed 4 g/d

Pediatric DoseNeonates >7 days: 25-50 mg/kg/d IV/IM divided bid; not to exceed 125 mg/dInfants and children: 50-75 mg/kg/d IV/IM divided bid; not to exceed 2 g/d


InteractionsProbenecid may increase levels; coadministration with ethacrynic acid, furosemide, or aminoglycosides may increase nephrotoxicity


PrecautionsAdjust dose in renal impairment; caution in breastfeeding women and allergy to penicillin

Drug NameNafcillin (Unipen) -- Treats infections caused by penicillinase-producing staphylococci. Used to initiate therapy in patients who may have penicillin G-resistant staphylococcal infection. Do not use to treat penicillin Gsusceptible staphylococcal infections.Use parenteral therapy initially in severe infections. More severe infections may require very high doses. Change to oral therapy as condition improves.Thrombophlebitis, associated with parenteral route, occurs occasionally, particularly in elderly. Thus, administer parenterally only for short term (24-48 h), and change to oral route if clinically possible.

Adult Dose2 g IV/IM q4h

Pediatric Dose150 mg/kg/d IV/IM, divided q6h


InteractionsAssociated with warfarin resistance when administered concurrently; bacteriostatic action of tetracycline derivatives may decrease effects


PrecautionsTo optimize therapy, determine causative organisms and susceptibility; treat >10 d to eliminate infection and prevent sequelae (eg, endocarditis, rheumatic fever); take cultures after treatment to confirm that infection eradicated

Drug NameCefazolin (Ancef, Kefzol, Zolicef) -- First-generation semisynthetic cephalosporin that binds to 1 or more penicillin-binding proteins, arrests bacterial cell wall synthesis, and inhibits bacterial growth. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin-structure coverage.Total daily dosages are same for IV and IM administrations.

Adult Dose1 g IV/IM q8h

Pediatric Dose20 mg/kg IV/IM q8h


InteractionsProbenecid prolongs effect; coadministration with aminoglycosides may increase renal toxicity; may yield false-positive urine-dip test for glucose


PrecautionsAdjust dose in renal impairment; superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy

Drug NameImipenem and cilastatin (Primaxin) -- Used for severe disease. Used to treat multiple organism infections in which other agents do not have broad-spectrum coverage or are contraindicated because of their potential for toxicity.

Adult Dose500 mg IV q6h

Pediatric Dose3 mo>12 years: 50 mg/kg/d IV divided q6h; not to exceed 4 g/d


InteractionsCyclosporine may increase adverse CNS effects of both agents; ganciclovir may result in generalized seizures

PregnancyC - Safety for use during pregnancy has not been established.

PrecautionsAdjust dose in renal insufficiency; avoid use in children 2 wk of therapy (monitor platelet counts); unnecessary use may lead to development of resistance to drug

Drug NameErtapenem (Invanz) -- Bactericidal activity results from inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin-binding proteins. Stable against hydrolysis by a variety of beta-lactamases including penicillinases, cephalosporinases, and extended spectrum beta-lactamases. Hydrolyzed by metallo-beta-lactamases.

Adult Dose1 g qd for 14 d if IV and 7 d if IM; infuse over 30 min if IV

Pediatric DoseNot established


InteractionsProbenecid may reduce renal clearance of ertapenem and increase half-life, but benefit is minimal and does not justify coadministration


PrecautionsPseudomembranous colitis may occur; seizures and CNS adverse reactions may occur; when using with lidocaine to administer intramuscularly, avoid inadvertent injection into blood vessel

Further Inpatient Care: Some patients may require admission for intravenous antibiotic therapy.

Early discharge utilizing parenteral antibiotics on an outpatient basis has been shown to achieve cure of infection and improved patient satisfaction.

Further Outpatient Care: Prophylaxis for recurrent cellulitis may be achieved by treatment with oral penicillin or erythromycin twice daily or intramuscular benzathine penicillin monthly.

Complications: Bacteremia

Local abscess

Superinfection with gram-negative organisms

Lymphangitis

Thrombophlebitis

Facial cellulitis in children - Causes meningitis in 8%

Gas-forming cellulitis (gangrene) - May require amputation (25% mortality rate)

Prognosis: Prognosis with uncomplicated cellulitis is good. Antibiotic regimens are effective in more than 90% of patients.

Patient Education: Patients should be advised to seek medical care for worsening symptoms, including increasing pain, redness, and swelling; erythematous streaking proximal to the affected area; fever and chills.

For excellent patient education resources, see eMedicine's Diabetes Center. Also, visit eMedicine's patient education article, Cellulitis.

Medical/Legal Pitfalls: Failure to diagnose gas gangrene may have devastating consequences.

Failure to admit patients with risk factors for developing severe cellulitis for intravenous antibiotic administration and observation may result in rapid disease progression.

Special Concerns: Scar cellulitis is common in areas of previous burns, particularly those that required treatment with grafts.

Escherichia coli cellulitis may develop in presence of nephrotic syndrome.

Cellulitis of the lower extremities is more likely to develop into thrombophlebitis in geriatric patients.

Pseudomonads may cause cellulitis in immunocompromised children.

Caption: Picture 1. Severe cellulitis of the leg in a woman aged 80 years. The cellulitis developed beneath a cast and was painful and warm to the touch. Significant erythema is evident. Margins are irregular but not raised. An ulcerated area is visible in the center of the photograph.

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Caption: Picture 2. Severe cellulitis of the leg in a woman aged 80 years. This photograph shows intense erythema in a patchy distribution. An eroded area is visible near the center of the photograph.



Picture Type: Photo

Caption: Picture 3. Cellulitis complicating burns. Larger lesion is a second-degree burn and the smaller lesion is a first-degree burn, each with an expanding zone of erythema consistent with cellulitis.



Picture Type: Photo

Caption: Picture 4. Mild cellulitis with a fine lace-like pattern of erythema. This lesion was only slightly warm and caused minimal pain. This is typical for the initial presentation of mild cellulitis.



Picture Type: Photo

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selulitis