Infectious Disease Compendium

Furuncles

Diagnosis

Big painful boils.

Epidemiologic Risks

Scratching when colonized with S. aureus.

Microbiology

S. aureus.

Empiric Therapy

I&D, plus oral antibiotics. Given the MRSA sweeping the nation, in Portland trimethoprim/sulfamethoxazole 2-3 ds po tid or doxycycline are the only reliable and affordable oral agents; let local susceptibilities by your guide. I&D may be all you need.

For MRSA boils, I&D plus trimethoprim/sulfamethoxazole was equal to I&D plus placebo for cure of acute disease, although the antibiotic group had less recurrence (PubMed). 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).

For recurrent disease: 2 weeks of po antibiotics PLUS 2 weeks of mupirocin to nose and open lesions PLUS 2 weeks of Hibiclens baths PLUS hot water/bleach all reused clothes and sheets (wet cottons that you reuse can be a source for recurrent re-inoculation of S. aureus, AND no scratching after picking your nose usually aborts recurrent disease. For women (and some men) new make-up. New razor blades. Flip the mattress and new pillows. It is usually not necessary to treat family members or pets, although who could argue with tossing the cat in the washer/dryer?

Pearls

One bid of tmp/sulfa is the dose for a UTI, for a cutaneous S. aureus infection it is probably homeopathic.

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Furuncle 680.9; abdominal wall 680.2; ankle 680.6; anus 680.5; arm 680.3; auditory canal, external 680.0; axilla 680.3; back 680.2; breast 680.2; buttock 680.5; chest wall 680.2; corpus cavernosum 607.2; ear (any part) 680.0; eyelid 373.13; face (any part, except eye) 680.0; finger (any) 680.4; flank 680.2; foot 680.7; forearm 680.3; 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; labium 616.4; leg, 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; specified site NEC 680.8; spermatic cord 608.4; temple (region) 680.0; testis 604.90; thigh 680.6; thumb 680.4; toe (any) 680.7; trunk 680.2; tunica vaginalis 608.4; umbilicus 680.2; upper arm 680.3; vas deferens 608.4; vulva 616.4; wrist 680.4