Anthrax is an acute purulent-necrotic inflammation of several adjacent sebaceous glands and hair follicles with the formation of infiltration and extensive necrosis of the skin and subcutaneous tissue. Pathogens (Staphylococcus or stafilo-streptococcal infection, less Streptococcus) penetrate the hair follicles.
Development of carbuncle contribute to malnutrition, vitamin deficiencies, heavy common diseases (diseases of the blood system and others), diseases of metabolism (obesity, diabetes). Carbuncle more likely to develop on the back of the neck, in the interscapular region, on the lower back, buttocks, sometimes on the limbs, face.
Initially, there is a small inflammatory infiltrate with surface pustules rapidly increasing in size. Notes voltage tissues, acute pain, aggravated by palpation. In subsequent infiltration increases in size, skin this area gets a bluish tint, tense, edema, pain intensifies, the temperature rises up to 38-40 degrees. Thinning of the epidermis over the hearth of necrosis in several places breaks from holes ("SITA") pus. Through the holes are visible necrotic tissue (Fig. 6 and 7). With the beginning of exclusion necrotic masses General condition of the patient begins to improve, pain gets better. The wound is cleansed and healed scar. Complications of carbuncle: lymphangitis (see), lymphadenitis (see), throm (see), sepsis (see). Especially hard [and may be complicated meningitis (see)] is the carbuncle person.
Differential diagnosis is performed between the ordinary and anthrax anthrax (see anthrax).
Forecast of carbuncle generally favorable, with the exception of patients with severe diabetes, and carbuncle persons complicated thrombophlebitis. In these cases can be fatal.
Treatment. The risk of complications patient requires hospitalization to the surgical Department. First used around the hearth penicillin (200 000-450 000 IU) in solution novokaina daily for 2-3 days. Intramuscularly prescribed injections of antibiotics, inside sulfa drugs, quartz, UHF , or x-ray treatments. On the surface of carbuncle impose sterile dressing. Patient prescribe bed rest; carbuncle persons forbidden to talk. Shows excessive drinking, lacto-vegetarian diet (food only liquid). Patients suffering from diabetes, conduct insulin.
The failure of conservative treatment and the growing intoxication are an indication for surgical treatment. The operation is performed under General anesthesia cruciform incision through the entire thickness of necrosis viable tissues. Skin flaps usepreview, necrotic tissue is excised, purulent leakages opened. In wound pads are introduced with hypertonic solution of sodium chloride. After 2 to 3 days tampons removed and a gaping cavity loosely perform a fresh ointment tampons. Dressings should be rare. Carbuncle persons spend only conservative treatment.