A case report on Carbuncle

Mounika1*, Jaya Menon2, Lucy Grace3

1Staff Nurse, Kauvery Hospital, Tennur, Trichy

2Nursing Superintendent, Kauvery Hospital, Tennur, Trichy

3Nurse Educator, Kauvery Hospital, Tennur, Trichy

*Correspondence: M: 9659333344, Mail ID: Jaya [email protected]

Abstract

The word carbuncle is a term that evokes both medical concern and mythical wonder. In modern medicine, a carbuncle refers to a painful, deep skin infection, often caused by bacteria like Staphylococcus aureus, that results in large, swollen abscesses. It is a condition that can cause significant discomfort and requires prompt treatment to prevent complications.

In India, skin infections, including carbuncles, are relatively common, especially in urban areas with higher population densities and poor sanitation. Studies suggest that community-acquired skin infections caused by Staphylococcus aureus contribute significantly to hospital visits, with carbuncles being a major form of skin and soft tissue infections (SSTIs).

Globally, the incidence of carbuncles is difficult to pinpoint specifically, as they are classified under broader categories of skin and soft tissue infections (SSTIs). However, carbuncles are a major concern in both developed and developing countries.

Etiology

Carbuncles primarily involves bacterial infection, with Staphylococcus aureus being the most common causative agent. A carbuncle occurs when multiple boils (furuncles) coalesce to form a larger, deeper skin infection that affects both the hair follicles and the surrounding tissue. Occasionally, carbuncles can be caused by anaerobic bacteria, especially in cases that are recurrent and involve the anogenital region.

Staphylococcus aureus can normally be found on intact skin most commonly in intertriginous areas such as the groin, axilla, buttocks, and neck. It can also be present in the nares. Staphylococcus aureus can be transferred to other anatomical locations by scratching. When the skin barrier is broken down or disrupted, bacteria can inoculate the hair follicle. Once inoculated, the bacteria can proliferate and lead to folliculitis, furuncle, and/or carbuncle.

Case Report

A 61-years male presented with a painful, swollen mass on the back of his neck. He reported that the area had been red and tender for three days, with gradual worsening. Patient had a history of diabetes mellitus.

His vital signs were stable upon admission.

On examination, the affected area measured approximately 5*4cm in diameter, with multiple pus-filled heads visible on the skin surface. The surrounding tissue was erythematous, warm to touch and indurated. Tender lymph nodes were palpable in the cervical region.

Blood tests showed elevated white blood cell count (WBC), indicative of infection. Blood glucose levels were elevated. A sample of the pus was collected for bacterial culture to identify the causative organism and determine antibiotic sensitivity.

Based on clinical presentation and bacterial culture results, the patient was diagnosed with a carbuncle caused by Staphylococcus aureus and the doctor promptly started appropriate treatment.

Due to the size and severity, the carbuncle was incised and drained under local anaesthesia, which provided significant pain relief and reduced swelling. Approximately 20 ml of pus was drained during the procedure.

Analgesics were recommended to manage pain and reduce inflammation.

Intravenous antibiotics, Inj. Piptaz (Piperacillin + Tazobactum) 4.5 gm every 8 hours (1-1-1) were administered. The patient remained hemodynamically stable and the prescribed antibiotics were discussed with the patient including their benefits and potential side effects.

Follow-Up and Outcome

The patient was reviewed after seven days, showing marked improvement. Swelling had reduced, and the wound was healing well.

  • We educated the patient and their attendant on the proper technique for performing dressing changes at the surgical site to ensure effective wound care and minimize the risk of infection.
  • We explained the importance of a diabetic diet, focusing on a carbohydrate-restricted diet to help manage blood sugar levels effectively.
  • We emphasized the importance of eating a balanced diet, getting sufficient rest and managing stress to support a healthy immune system
  • We educated the patient on maintaining proper personal hygiene, emphasizing the importance of regular bathing and keeping the surgical site clean to prevent infection.

Conclusion

Early diagnosis and a comprehensive treatment approach were essential in this case of carbuncle management. Patient education and preventive measures can help reduce the risk of future infections. With proper treatment, including antibiotics and drainage when necessary, most patients recover well. Emphasizing good hygiene, proper wound care, and adopting healthy lifestyle habits like a balanced diet, sufficient rest, and stress management can significantly aid in both prevention and recovery.


Ms. Mounika
Staff Nurse


Ms. Jaya Menon
Nursing Superintendent


Ms. Lucy Grace
Nurse Educator

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