2 Cellulitis

2
Erysipelas
3 Abscess

4 Boil
5 Hidiadenitis suppurativa

6 Carbuncle

7 Pyogenicgranuloma

8 GasGangrene

Madurafoot

10 Surgical site Infection

MADURA FOOT MyelomaPedis

Chronicprogressivegranulomatousinflammation condition

involving skin subcutaneoustissue deeperplanes

It is caused by Fungus
Bacteria

It causes multipledischargingsinuses

can involve the Madurafoot mostcommon 70.1

foot
Hand Madura hand 112.1
Demography
First Identified in Madurai TamilNadubyGILL

common in India Africa

Common in Tamil Nadu

Etiology
i Fungal Eumycotic Mycetoma

Madurellamycetomi
Madurella grisa

Blackgranules
crushed smear thick stoutfilaments 5µm

ii Bacterial Mycetoma
inferby
Metastatic

Nocardia mostcommon Tthmtain

Nocardiaasteroids
kidney
Actinomyces Aisraelii Abovis

Actinomadura Redgranules

Staphaures Botryomycosis rare

Yellow white red granules

Crushed smear thinfilaments Item
 Pathogenesis

Organismenters thio a frick in barefoot

Reachesdeeperplane inthe
foot

chronicgranulomatousinflammu

Pale painless
firmnodules

Vesicles

Burst Dischargingsinuses
1
Tropumulentdischarge
granules

Granules Black subcutaneousinfection

Yellow Red deeperplanesinvolved osteomyelitis

Muscles bonesinvolved

Tendons nerves late involvement

2 bacterialinfectionmay occur IN
mayinvolve then

clinical Features
1 Triad ofMycetoma Painlesssubcutaneous mass

multiple sinuses
seropurulent discharge
2 Painless diffuse swelling offoot
3 causes limb deformity disability

4 Pain bone involvement 2 infection

5 Local hyperhidrosis sympathetic activity

6 2 infection
Tiny shottyregionallymphnodes enlarged

Investigations
1 Microscopy discharge shows branching filamentousappearance
2 Culture Sabouroud's dextrose
agar medium
3 Gramstain Sunsayappeala gram
centre
gram clubs Actinomycosis
4 X lookforosteomyelitis
rayoffoot
5 MRI Dot in circle sign
6 FNAC Biopsy confirmation

7 USGof the area

8 ELISA Abtitreagainst the organism

Treatment

Medical

Ketoconazole
Eumycetoma upto 1year
Itraconazole

Voriconazole

Dapsone
Actinomycetoma 1stline Amikacin cotrimonazole 5weeks

2ⁿᵈline Amoxiclav Gentamycin Rifampicin Sulfonamides

Surgical
aftermedicaltherapy
Widesurgicalexcision
continue medicaltherapy

cases Amputation
Refractory

GAS GANGRENE
It is an infectivegangrene of the skeletalmuscle causing Edematousmyonecrosis by

clostridial organisms

clostridium welchii Anaerobic capsulated

Etiology gram
centralsporebearing non motile

Clostridium septicum

clostridium histiolyticum

coliforms

Variousstrains A B C D E CA'mc

Source Predisposingfactors

1 Soil contaminated manured cultivated

 2 Intestines Humans Animals through Fecal Flora

Crushwounds RTA

Amputations

Ischaemiclimb
helpinfect
Gunshot war wounds

Anaerobic environment initial infectionby Aerobicbacteria utiliseoxygen

Anaerobic environment Anaerobicbacteria

Pathogenesis
Spores enter through devitalised tissue

sporesgerminate

Releasedbacteriamultiply

Exotoxins are released

cause their effects

EXOTOXINS
12distincttoxinsidentified

Majorlethaltoxins α Alpha mc

β Beta
 r
toxin lecithinase Phospholipase C mostimp

hemolytic membranolytic extensivemyositis

µ toxin Hyaluronidase rapidspreadofgasgangrene

toxin Proteinase breakdown
of
tissues

toxin Phi Myocardialdepressant

K toxin destruction connective

Kappa of
tissue bloodvessels

Effects
a Myonecrosis extensivenecrosis muscle
of
Add
TRON The
Hydrogen

protein
Proteinase
AminoAcids
iii
further
multiplication
oforganisms

stains muscle Hydrogen Ammonium

Crepitus
sulphide

extends to insertion
fromorigin
involves muscles limb can alsoinvolvemuscles
of of thorax Abdomen
 b liver necrosis liver
Foaming frothy bloody

Clinical Features
Incubation period 1 2
days
1 Fever Tachycardia Pallor Toxemia
2 Khaki brown coloured limbs hemolysis
3 Wound is under tension
foulsmellingdischarge
decayingapple sicklysweety
4 Limb appears swollen
Crepitus can be
5
felt
6 Liver involvement Jaundice

kidney Oliguria

common sites Adductorregion

of lower limb
buttocks

subscapular region of upper limb

Abdominal wall
Appendix Gall Bladder CBD Intestine
uterus

clinical types
i Fulminant Liverfailure Renalfailure MODS ARDS
ii Massive one whole limb

iii Group group of muscles

iv Singlemuscle
v Subcutaneous species other than c wetchie

Investigations
1 Gramstaining oftissue gram bacilli
2 Robertson'scooked meat media meat pink sour smell
acid on

3 20.1 Human serum

growthplate c welchii
grown
Naegler's rxn AntiToxin NoAntitoxin

Tone opacity
of

4 X in muscleplane under skin

ray gas
5 LFT 75T ALT

6 RFT Blood urea Creatinine

7 CBC
8 PO PCO

Abdominal wound
9 CTscan of the part esp in chest
 Treatment

Medical
Penicillin 20L 4hourly
1 Inj Benzyl
Metronidazole 500mg 8hourly
Inj
normalbloodurea
Inf Aminoglycosides
2 Polyvalent Antiserum 25000U I 6hourly

aftertestdose
3 Freshbloodtransfusion

4 Hyperbaricoxygen

5 NS RL Rehydration
maintain urineoutput 0.5ml kg hr
6 Electrolyte
management

Surgical
1 Liberalincisionsgiven
deadtissues excised debridement till

healthytissuebleeds
2 Severe cases Amputation
lifesaving
stumpnotclosed Guilottineamputi

Ventilatorsupport mayberequired

Onceward 10T is used

for
a
pt withgasgangrene
 24 48hours to prevent the risk
Fumigation
for ofspreadofinfection

Prevention
ofGasGangrene
wounds
1 Properdebridementof devitalised crush
2 Devitalised wound should not be sutured

3 Adequatecleaning with NS 4202

4 Penicillin as prophylactic Antibiotic