Infectious Disease Compendium

Carbuncles

Diagnosis

Great, big, tender, zits. There is a histologic difference between a carbuncle and a furuncle, and I do not care.

Epidemiologic Risks

Scratching yourself after picking your (but not anothers) nose (the anterior nares is where staph tends to be carried, except, perhaps, for the new strain of MRSA sweeping the nation).

Microbiology

S. aureus.

Empiric Therapy

I&D is the most effective therapy. Treat for S. aureus, usually for 10 days. And do not just suck out the pus with a needle, compared to an I&D, 74% of needle aspiration FAILED vrs 20% of open I&D (PubMed).

Pearls

Recurrent staph infections (cellulitis, folliculitis, carbuncles) can be treated with the following: 2 weeks po antistaph antibiotics PLUS mupirocin in the nose for 2 weeks PLUS hibiclens showers for 2 weeks PLUS terminal cleaning of the house: hot water bleach the sheets, towels and anything else that gets wet and reused. If the patient, their family or pet has any chronic skin conditions (atopic dermatitis, psoriasis, eczema) trying to get rid of staph will be as successful as getting democracy in Iraq (written in December 2005; a comment for which I was reported to the Chair of Medicine at one of my hospitals). Patients with those skin conditions are ALWAYS covered in S. aureus; I tend to think of them resembling Pig Pen, from the comic strip Peanuts.

Rants

I read somewhere recently (in other words I cannot find the reference) that if your pillow is 5 years old by weight it is 20% skin, mites and bacteria. More people have bought new pillows after I have told them that).

ICD9 Codes (Soon to be supplanted by ICD10)

Carbuncle 680.9; abdominal wall 680.2; ankle 680.6; anus 680.5; arm (any part, above wrist) 680.3; auditory canal, external 680.0; axilla 680.3; back (any part) 680.2; breast 680.2; buttock 680.5; chest wall 680.2; corpus cavernosum 607.2; ear (any part) (external) 680.0; eyelid 373.13; face (any part, except eye) 680.0; finger (any) 680.4; flank 680.2; foot (any part) 680.7; forearm 680.3; genital organ (male) 608.4; gluteal (region) 680.5; groin 680.2; hand (any part) 680.4; head (any part, except face) 680.8; heel 680.7; hip 680.6; kidney 590.2; knee 680.6; labia 616.4; ; leg, any part except foot 680.6; lower extremity, any part except foot 680.6; ; multiple sites 680.9; neck 680.1; nose 680.0; orbit 376.01; ; pectoral region 680.2; penis 607.2; perineum 680.2; pinna 680.0; scalp (any part) 680.8; scrotum 608.4; seminal vesicle 608.0; shoulder 680.3; skin NEC 680.9; ; spermatic cord 608.4; temple 680.0; testis 608.4; thigh 680.6; thumb 680.4; toe (any) 680.7; trunk 680.2; tunica vaginalis 608.4; umbilicus 680.2; upper arm 680.3; urethra 597.0; vas deferens 608.4; vulva 616.4; wrist 680.4.