VUYYURU, SRI KANTH

GROUP 12
3-D
PEDIATRICS CASE
PRESENTATION
INFORMANT: MOTHER
RELIABILIT: 90%
GENERAL DATA:

G.A, 12 years old, female, born on April 07 2005

at Ronda south province, cebu city, Filipino,
catholic, residing at Ronda, cebu city.
CHIEF COMPLAINT:
Swelling of the right leg
HISTORY OF PRESENT ILLNESS
1 MONTH PTA: The patient had onset of pain in the right leg by
walking and leg extension. The condition was tolerated. No history of
trauma. She noted the typness of skin in the right calf associated with
redness and tenderness which makes the patient inability to walk.
3 DAYS PTA: The patient had onset of red pruritic macular lesions initially
appearing on the face then spreading towards the trunk were noted. After
which she ate some food and felt allergic. Self medication with 10 mg
tablet of cetirizine provided temporary relief associated with epipgastric
discomfort occurring intermittently
2 DAYS PTA: The condition persisted and is associated with
fever. Self medication with paracetamol tablet provided relief
from fever. persistence of the condition prompted to consult
and seek admission in vsmmc.
PERSONAL HISTORY :

A)Gestational History: The mother was 30 years old with an OB score

of G3P2 (F2P0A0L2). She started her regular prenatal check-up on
3rd month of pregnancy which was attended by mid-wife at a local
health center located in Ronda, cebu city. The mother was healthy
during her pregnancy without any infections, she had no alcohol
and drug intake.
B) Birth History: The patient is 38 weeks term was
delivered via normal spontaneous vaginal delivery
attended by a mid wife at local health center Ronda city.
The patient had a birth weight of 3.50 Kg with a
length is unrecalled.
C) Neonatal History: The apgar score of the patient
was unrecalled by the mother. But she told that
the patient had active cry with no cyanosis, pallor
and no difficulty in breathing was noted
D) Feeding history: The patient was
exclusively breast fed 8 times per day with
30 minutes of duration
E) Past illnesses: The patient had no
previous illnesses like (-)measles, (-
)varicella, (-) mumps and (-) pertussis. No
allergic history.
IMMUNIZATION HISTORY:

The patient was immunized.

At birth: 1st dose 2nd dose 3rd dose

BCG 

DPT/ Dtap   

OPV/IPV   

Hib   

Hep B   

MMR 
FAMILY HISTORY: The mother of the patient is healthy
and has 5 children. Patients father died due to
hypertension when he was 51 years old. The mother is
working as house maid with a monthly salary of 1000
pesos.
Personal and Psycho-social HISTORY: The house is
made of wood with 1 room and 1 comfort room. They
live near the mountains. She has 4 children staying in
the same house. Birth rank of the patient is ¾. Patient
is grade 7 with above average school performance.
ENVIRONMENTAL HISTORY : no
one smokes cigarette. Their
garbage disposal is properly
disposed. Drinking water is mineral
and the dishwashing water is from
the small pools.
Review of system:

• General – no weight loss, no change in appetite

• Cutaneous – (+) rashes, (+) pigmentation, (+) pruritus
• Head – no lacrimation, no ear discharge, no epistaxis
• Cardiovascular – no fainting, no cyanosis
• Respiratory – no cough and fast breathing
• Gastrointestinal – no diarrhea
• Genitourinary – no discharge, no edema in hands and feet
• Endocrine – no breast discharges
• Nervous/behavioral – no convulsions, no weakness, no paralysis
• Musculoskeletal – no joint swelling, no limitation of movement
Physical Examination:

• General: patient on bed, active and not ill with good appetite.
• Vital sign: T: 38.4 C, HR:140 bpm, RR:28 cpm, Ht: 156 cm, Wt: 36.7
kg
• Skin: skin color is normal , good skin turgor and (+) rash noted.
• Head: hair is equally distributed and the anterior fontanel is soft and
not bulging.
• Face: no facial deformities noted
• Eyes: conjunctiva is pink, sclera is white and no discharges noted.
• Ear and mastoid: ear is symmetrical, not low set and no discharges
noted.
• Nose and paranasal sinuses: no alar flaring, no discharges
noted.
• Mouth and throat: lips are not dry, gums are pink, no dentition
noted.
• Chest and lungs: no chest retractions noted, fine crackles heard
in the lower lobe during auscultation.
• Heart and vascular system: no visible pulsation over various
parts of the chest and in the epigastrium.
• Extremities: no clubbing of both extremities and no cyanosis
present.
CELLULITIS

Vuyyuru Srikanth
Group 12
3-D
Cellulitis is a common infection of
the skin and the soft tissues
underneath. It happens when bacteria
enter a break in the skin and spread.
The result is infection, which may cause
swelling, redness, pain, or warmth.
Strep cellulitis – infection of the dermis.
Deeper infection, cannot palpate edge of the rash
 EPIDEMIOLOGY

• According to data collected from community hospitals in the

US in 2005, cellulitis was the 27th most common primary
diagnosis among adults at discharge.
• A population-based study in Minnesota limited to cellulitis
involving a lower extremity found an incidence of 199
episodes per 100,000 person-years.
• Gender did not affect this rate, but increasing age was
associated with a higher incidence.
• A similar incidence was recently reported from the
Netherlands in 2006.
• Among patients presenting to acute care facilities, men
outnumbered women and the lower extremity
predominated as the site of involvement.
• However, some forms of cellulitis are unique to women.
• Another study of US hospital data showed an increase in
visits for skin infection during the emergence of community-
associated MRSA;
• however, further analysis concluded this was mostly due to
abscesses rather than cellulitis.
 ETIOLOGY

• Cellulitis occurs when bacteria, most commonly

streptococcus and staphylococcus, enter through a
crack or break in your skin.
• The incidence of a more serious staphylococcus
infection called methicillin-resistant Staphylococcus
aureus (MRSA) is increasing.
• Although cellulitis can occur anywhere on your body,
the most common location is the lower leg.
• Bacteria is most likely to enter disrupted areas of
skin, such as where you've had recent surgery,
cuts, puncture wounds, an ulcer, athlete's foot or
dermatitis.
• Certain types of insect or spider bites also can
transmit the bacteria that start the infection.
• Bacteria can also enter through areas of dry,
flaky skin or swollen skin.
 PATHOPHYSIOLOGY
• Microorganisms gain initial access into the layers of the skin through the
discontinuities and cuts in the skin.
• The body responds to these microbes as foreign bodies and their
detection sets off an inflammatory response.
• The inflammatory response leads to redness, swelling, pain and itching of
the area involved. A local infection leads to inflammation of the area of
infection.
• With a competent immune system, the spread of the infection is limited.
• If the immune system fails to curb the initial infection, the infection may
become systemic by spreading into adjacent areas.
• If the infection spreads to the bloodstream, it is called Bacteremia.
• Group A streptococcus and staphylococcus [1] are the most common
causative agents of cellulitis.
• These bacteria are part of the normal flora living on the skin but they will
cause infection if the skin is broken.
• Predisposing conditions for cellulitis include insect bites, animal bites,
pruritic skin rash, recent surgery, athlete's foot, dry skin, eczema, burns
and boils.
• Another cause may be Hemophilus influenza, especially in cases of facial
infections.[2]
• In rare cases, the infection causing cellulitis can spread to the deep layer
of tissue called the fascial lining.
• Necrotizing fasciitis, also called "flesh-eating disease" by the media, is an
example of a deep-layer infection. It represents an extreme medical
emergency.
 RISK FACTORS
• The elderly and those with immunodeficiency (a weakened immune
system) are especially vulnerable to contracting cellulitis.
• Diabetics are more susceptible to cellulitis than the general
population because of impairment of the immune system; they are
especially prone to cellulitis in the feet because the disease causes
impairment of blood circulation in the legs leading to diabetic
foot/foot ulcers.
• Poor control of blood glucose levels allows bacteria to grow more
rapidly in the affected tissue and facilitates rapid progression if the
infection enters the bloodstream.
• Neural degeneration in diabetes means these ulcers may not be
painful and thus often become infected.
• Immunosuppressive drugs, and other illnesses or infections that
weaken the immune system are also factors that make infection
more likely.
• Chickenpox and shingles often result in blisters that break open,
providing a gap in the skin through which bacteria can enter.
Lymphedema, which causes swelling on the arms and/or legs,
can also put an individual at risk.
• Diseases that affect blood circulation in the legs and feet, such
as chronic venous insufficiency and varicose veins, are also risk
factors for cellulitis.
• Cellulitis is also extremely prevalent among dense populations
sharing hygiene facilities and common living quarters, such as
military installations, college dormitories, and homeless shelters.
 SIGNS and SYMPTOMS
• pain and tenderness in the affected area
• redness or inflammation of your skin
• a skin sore or rash that appears and grows quickly
• a tight, glossy, swollen appearance of the skin
• a feeling of warmth in the affected area
• a central area that has an abscess with pus
formation
• a fever
• Some common symptoms of a more serious cellulitis infection are:
• shaking
• chills
• a feeling of illness
• fatigue
• dizziness
• lightheadedness
• muscle aches
• warm skin
• sweating
 DIFFERENTIAL DIAGNOSIS
• Burn Wound Infections
• Dermatologic Manifestations of Nocardiosis
• Emergent Treatment of Gas Gangrene
• Erysipeloid
• Erythema Multiforme
• Impetigo
• Insect Bites
• Leukemia Cutis
• Pyoderma Gangrenosum
• Stevens-Johnson Syndrome
• Wells Syndrome
 PATIENT FINDINGS
• redness
• swelling
• pain
• tightness of skin
• fever
• pruritis
 PATIENT FINDINGS
• redness
• swelling
• pain
• tightness of skin
• fever
• pruritis
 TREATMENT
• Treatment consists of resting the affected limb or area, cleaning the wound
site if present (with debridement of dead tissue if necessary) and treatment
with oral antibiotics, except in severe cases, which may require admission and
intravenous (IV) therapy.
• Flucloxacillin monotherapy (to cover staphylococcal infection) is often
sufficient in mild cellulitis, but in more moderate cases or where streptococcal
infection is suspected then usually combined with oral
phenoxymethylpenicillin or intravenous benzylpenicillin, or
ampicillin/amoxicillin (e.g. co-amoxiclav in the UK).
• Pain relief is also often prescribed, but excessive pain should always be
considered relevant, as it is a symptom of necrotising fasciitis, which requires
emergency surgical attention.
• As in other maladies characterized by wounds or tissue destruction,
hyperbaric oxygen treatment can be a valuable adjunctive therapy, but is not
widely available.