SURGICAL INFECTIONS-FUNGAL

4. FUNGAL INFECTIONS
These infections are due to Candidas Albicans and are met with in
hospital patients
- they occur on mucocutaneous surfaces (lips,mouth)
- and in the intestinal and respiratory tracts.
Those susceptible are:
* Those on steroids
* Diabetics
* Those on broad spectrum antibiotics
Treatment can be with Nystatin.
Fluconazole(150mg)oral
Ampliotericic B (350-500 mg). This drug has toxic effects.

Actinomyeous israeli is the causative organism of the human disease.
Most often the infection occurs from the patients own mouth or
GIT organisms.

Cervicofacial induration is seen and the infection is from oral
fungi in the tartar, or in caries teeth.
Soon multiple sinus appear in the indurate area, sulphur granules are discharged, and if examined under microscopic the fungus will be observed.

Similar indurations can occur in the chest or on the right iliac
fossa.

TREATMENT
Pencillin (5-20 million units daily) for weeks is required.
Surgical drainage may also be required.

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SURGICAL INFECTIONS

NECROTISING FASCITIS


B haemolytic Streptococci and Coagulase positive staphlococci
cause spreading life-threatening infection which involves
superficial fascia, with an extreme systemic toxicity.

Most soft tissue infections are caused by a mixed infection of
aneorobic (clostrodia) and gram positive bacteria.

These infection must be recognised early.
There is skin necrosis and bullae.
In early cases there is only cellulite mental confusion and toxicity
are indication for surgical treatment ofdebridment of all necrosed tissue.

A majority of cases have occured inside the hospital following
minor trauma or following abrasions, cuts or boils.
Chief diagnostic indicator is a superficial and widespread fascial
necrosis.
- Cellulitis and oedema are in evidence.
- The involved skin is pale-red without any distinct border,
there are blisters.
Diagnosis is made by observation of bacteria in the
serosanguinous exudate.
There is a marked increase in white cell count.


TREATMENT
1. Multiple linear incisions with debridement
2. Use of a combination of Clindamycin and Ampicillin

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SURGICAL INFECTIONS

STREPTOCOCCAL MYONECROSIS
Anaerobic Streptocci can cause gas formation.
The necrosis that occurs is very similar to that seen in
Clostroidial Gas Gangrene.
It occurs after an incubation period of 3-4 days
There is swelling and oedema,
There may also be a purulent exudate, pain develops
very rapidly,
Crepitus is felt and gas can be demonstrated in the
subcutaneous tissue or in the muscles (X RAY).

TREATMENT
Multiple incisions.
Drainage
Antibiotics

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SURGICAL INFECTIONS-ERYSIPELAS

ERYSIPELAS
This is a spreading Streptococcal Cellulitis with a raised
sharply defined irregular advancing border with accompanying
lymphangitis.
- There is a cutaneous erythema.
- Organisms(Beta Haemolytic Streptoccocus) gain entry into the skin
through a minor break in skin.
- There is a palpable raising of the skin at the border of the
lesion.
- The lesion is hot and tender and painful.
Systemic manifestations are those of an invasion of the blood-
stream through lymphatics and consist of
- rigours and
- swinging temperature,
- malaise and
- headache and
- severe tachycardia.
Some patients may be delirious.
Occurs in children, the aged with compromised immune system or impaired
Lymphatic drainage

TREATMENT
The organisms are extremely sensitive to Penicillin, and Erythromycin which soon controls the systemic symptoms.
Erythema may take some time to disappear.

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GAS GANGRENE 2

Gas Gangrene


Events
The established colonies of these organisms, leads to
production of toxins, which promote the further spread of the
infection, by invasion of uninjured tissue.
There is also a suppression of local immune defense and hemolytic action.

CLINICAL FEATURES
The incubation period is of 1-3 days
The patients present with history of injury, fever, and tachycardia.
- There is pain in the injured part and discharge of serous fluid
with a characteristic fishy adour.
- The skin shows change in color (pale to purple).
- Blebs appear on the surface.
- Crepitus under the skin or in the muscles is diagnostic.
The depth and extent of infection can be established by
X-ray examination and demonstration of gas in soft tissue
Death occurs with toxemia, septicemia.

TREATMENT
I)Early adequate surgical cleaning and debridement of all
contaminated wounds are the most effective means of prevention.
When in doubt of contamination, the wound can be left open(secondary suture)
ii)When diagnosed, multiple longitudinal incisions provide
decompression and exposure of the injured tissue to atmospheric
oxygen.
It also provides access to dead and damaged muscle which should
be excised.
iii)In late cases, amputation is required urgently.
iv) Antibiotic therapy with Penicillin or Tetracycline which is
effective.
v) Hyperbaric oxygenation can be used with success.
vi)In severe established cases giving of polyvalent gas gangerene
antitoxin may be considered.

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