Diagnosis Abscess NF Cellulitis DFU

H/O -boil like • Early : -recent history -Uncontrolled dm

swelling under • - localized abscess or of injury at site
skin which cellulitis with rapid (acute) -ulcers around
increasing in progression foot with purulent
size • -neglected discharge
progressively • - minimal swelling minor injuries
• that become -loss of
-history of fever• - no trauma or infected pain/sensation in
and chills discoloration ischemic patients
-comorbids
(dm, hiv) -gangrene in
• Late : severe cases
• - severe pain
•
• - high fever, chills and
rigors
•
• - tachycardia

C/E Hard/firm • - skin bullae Rubor, -erythema, pain,

swelling under • dolor, tumor, tenderness,
skin • - discoloration : calor warmth, or
o ischemic patches induration
Visible pus build
o cutaneous gangrene Skin breaks,
(white/yellow) • -foul odor, the
bullae or presence of
• - swelling, edema areas of necrosis, and
Pain/tenderness
• dermal induration and necrotic failure of wound
around area erythema tissue may healing despite
• be present optimal
• - subcutaneous in severe management
emphysema (gas cellulitis
producing organisms)

IX Wbc, esr, crp LRINEC Scoring system Dundee Physical exam :

(score of >6 has 92% classification •
Physical exam probability of NF) • - depth of ulcer
of abscess Class 1 – no (probe for
• CRP (mg/L) sepsis, no bone)
o ≥150: 4 points comorbidities•
o • - presence of
• Class 2 – one infection (look
• WBC count (×103/mm3) or more for cellulitis,
o <15: 0 points significant pus
o 15–25: 1 point comorbidities,o check for
o >25: 2 points no sepsis gangrene)
• •
• •
• Hemoglobin (g/dL) •
Class 3 – sepsis
o >13.5: 0 points but SEWS <4 • - assess
o 11–13.5: 1 point Achilles tendon
o <11: 2 points Class 4 – sepsis tightness
• and SEWS 4 or (silverskiold
• Sodium (mmol/L) more test - improved
o <135: 2 points ankle
• dorsiflexion
• Creatinine (umol/L) with knee
o >141: 2 points flexed =
• gastrocnemius
• Glucose (mmol/L) tightness,
o >10: 1 point equivalent
ankle
dorsiflexion
with knee
flexion and
extension =
Achilles
tightness)

Circulation
(asses dorsalis
pedis and
posterior tibialis
pulse)

• ABSI and
ischemic index
(index of >
0.45 and toe
pressure
>45mm Hg are
needed to heal
amputation and
>60mm Hg to
heal an ulcer)

Xray
(AP/Lateral,
oblique of foot
and ankle)

MRI (best for

differentiating
abscess from
soft tissue
swelling)
 Bone scan
(best to
differentiate
between soft
tissue infection,
osteomyelitis,
charcot
arthropathy)

Cultures –
scrapping of
base of ulcer,
needle
aspiration of
pus or tissue
fluid

RX Incision and • Abx : start empirically with Oral abx for Wound care
drainage penicillin, tazocin, non-severe
clindamycin, cases ABX : soft tissue
Oral abx metronidazole, and an infection (Mild -
aminoglycoside IV antibiotics dicloxacilin,
Pcm for pain for severe augmentin),
• definitive antibiotics : cases
o (moderate –
o penicillin G - for strep or Pcm/ibuprofen cefazolin, unasyn,
clostridium for pain rosephin),
o
o imipenem or doripenem or (severe –
vancomysin)
meropenem - for
polymicrobial
Surgical – wound
o
debridement,
o add vancomycin or
amputation
daptomycin - if MRSA
depending on
suspected
severity
Operative : emergency Glucose
radical debridement monitoring
with broad-spectrum IV
antibiotics

Amputation : when life

threatening