CARBUNCLE

Rizky Ardiana Vitasari (G99152080)

dr. Nugrohoaji Dharmawan, M.Kes,

Sp.KK, FINS DV
 Definition1,3
Carbuncle is a number coalesce of furuncles.
Carbuncle is a larger, more serious
inflammatory lesion with a deeper base,
characteristically occurring as an extremely
painful lesion at the nape of the neck, the
back, or thighs
 Epidemiology2
O Age of Onset
Children, adolescents, and young adults.
O Sex
More common in boys.
 Etiology1,4,5
O Staphylococcus aureus
O Gram positive cocci
O S. aureus permanently colonizes on anterior
nares.
O 60% of healthy individuals have carriage of S.
aureus.
 Pathogenesis4,5
O Trauma can provide a portal of entry.

cause damage to
S. aureus invade
the surrounding
hair follicle
tissues,

warmth, leads to an
erythema, and inflammatory
pain. response
 Pathogenesis6
O Three steps that important of S. aureus
infection
O adherence to host cells,
O invasion of tissue with evasion of host
defences, and
O elaboration of toxins.
 Pathogenesis6
Table.1 Examples of S. aureus specific virulence factors
Virulance factor Details
Clumping fator Allow adherence to host epithelial cell
Protein A Prevent antibody opsonization and
phagocytosis
Serine protease Digest desmosome proteins and cause
bullous disease
Digest skin fatty acids to invade through
Lipase
skin barrier
Membrane pore formation, especially in
Panton-Valentine neutrophils and skin tissues leading to cell
leukocidin lysis
 Clinical Features3,2
O Characterized by
multiple loculated
dermal and
subcutaneous
abscesses, superficial
pustules, necrotic plugs,
and sieve-like openings
draining pus.
O Fever and malaise are
common
Figure 1. Carbuncle on
dorsum of the foot.3
 Laboratory Test2,7
O Gram Stain
Gram-positive cocci within polymorphonuclear
(PMN) leukocytes.
O Bacterial Culture
Culture of pus isolates S. aureus . Sensitivities
to antimicrobial agents may determine
management.
 Gram Stain

Figure 2. Staphylococcus aureus

 Treatment8,9
O Surgery
O saucerization, and
O simple incision and drainage (I&D)
O Antibiotic
 Treatment7

Gambar 2. Management tratment

 Treatment7,10
O Preventing recurrences
O Apply mupirocin ointment daily to the inside
of nares and other sites of S. aureus carriage
 Prognosis9
O Most cases resolve with treatment
O Some individuals are subject to recurrent
carbuncle.
Case Report
 Patient Identity
O Name : Mrs. D
O Age : 60 years old
O Job : Housewife
O Address : Sukoharjo
O Date of examination : May 24th, 2017
O Reg numb : 013xxxxx
 Chief Complaint
Boils on the left cheek since 6 month ago
 Present illness

May 24th 2017

It didnt heal, so the
patient came to
2 weeks ago dermatovenerology
Boil was swelling, clinic Moewardi
painful, and patient hospital
6 month ago fever
Initially it was like Patient went to doctor
pimple, then enlarged and got oral medicine
into boil with pus. and oinment
Sometimes itchy and
painful
 Illnes History
O Past Illness
O Similar illness : denied
O Allergic : (+), cold urticaria
O Diabetes Mellitus : (+), for a year, treated with
insulin.
O Hypertension : (+), for a year, treated with
amlodipine and candesartan
O Family Illness
O Similar illness : denied
O Allergic : denied
 Phisical Examination
O General state : Compos mentis
O Vital sign
O BP : 140/100 mmHg
O HR : 88x/minute
O RR : 18x/minute
O T : 36,6 oC
O Pain score :3
O Weight : 44 kg
O Height : 153 cm
O BMI : 18.8 (normoweight)
 Phisical Examination
O Cephal : Dermatoloy stats
O Neck : Normal
O Thorax : Normal
O Abdomen : Normal
O Genital : Normal
O Upper limb : Normal
O Lower limb : Normal
 Dermatology status
O Face region seen
multiple pustular that
confluen on
erythematous base
Differential diagnosis
O Carbuncle
O Furunculosis
Laboratory test
Laboratory test
O Gram stain
O PMN: 50-70/HPF
O Bacil gram positive : 30-50/HPF
O Bacil gram negative : >100/HPF
Diagnosis
Carbuncle
 Treatment

Non-medical Medical
Avoid squeezing or Amoxicilin 500 mg 3 dd 1
irritating a boil PO

Before use ointment, Mupirocin oint 2 dd ue

compress with 0,9% Nacl
at least 15 minutes
Plan
O Culture of pus
O Antibiotic sensitivities
Prognosis
O Ad Vitam : Ad bonam
O Ad Sanam : Ad bonam
O Ad Fungsionam : Ad bonam
Thank You