What are the different types of purulent inflammations and why do they develop? Symptoms of the development of purulent diseases. Paronychia and felon

Purulent diseases and their development depend on following conditions: penetration of pyogenic microbes into the tissues of the body, the state of the body and environmental conditions. Therefore, all measures to prevent acute purulent diseases must take into account listed reasons, on which the appearance and development of these diseases depends.

Causes of purulent diseases. One of the main reasons for the occurrence of purulent diseases is, as said, the penetration of certain pyogenic microbes from outside into the tissues or blood of the body through various damage to the skin or mucous membranes. Therefore one of important ways prevention of many purulent diseases is the prevention of injuries both at work and at home.

In the presence of any open injury, the timely provision of rational first aid in compliance with the general rules of asepsis and antisepsis, as well as the immediate treatment of minor injuries by trained persons or through self- and mutual aid, is of particular importance.

For any damage to tissues and organs, no matter what they arise from (wounds, operations), it is very great importance has prevention purulent complications. It consists of a number of measures aimed at preventing the entry of purulent microbes into wounds and further development infections. In this regard, the organization and quality of the first and emergency care to all persons accidentally injured.

Purulent diseases prevention A. Prevention of wound infection (and, consequently, possible purulent complications) consists, first of all, in careful compliance with all modern rules surgical asepsis when providing medical care (when applying bandages, injections, dressings, etc.).

To prevent the penetration of pyogenic microbes into the wound, many methods have been proposed. The simplest of them is to lubricate minor damage to the skin with iodine tincture or an alcohol solution of brilliant green. Even better results are obtained by using N. N. Novikov’s liquid, which has the following composition: tannin - 1.0, brilliant green - 0.2, 96° alcohol - 0.2, castor oil - 0.5 and collodion - 20.0 . Using a pipette or glass rod, this liquid or BF-6 glue is applied directly to the damaged area of the skin and the surrounding skin surface. After 1-2 minutes, a dense elastic film forms over the damaged area of skin. For minor injuries, you can use another method: the wound and its circumference are wiped (washed) with a 3-5% soap solution or a 0.25 - 0.5% ammonia solution using gauze or cotton balls, dried, lubricated with iodine tincture, sprinkled a mixture of penicillin and streptocide and carefully sealed with an adhesive plaster. To prevent infection during microtrauma, a colloidal solution of furatsilin or brilliant green can also be used.

In the prevention of purulent diseases during wounds and operations, the prophylactic use of antibiotics or sulfonamide drugs is very important. Paramedic and nurse should be widely used when providing first aid for wounds. For this, they use, for example, sprinkling the wound with penicillin, streptocide, or even better - a mixture of them.

For large wounds, open fractures or burns, penicillin or bicillin should be administered intramuscularly. If injections are not possible, antibiotics are given orally in tablet form. After this, patients who have wounds that require primary surgical treatment are referred to a doctor. When a doctor treats fresh wounds, as well as when various operations(in before and postoperative period) also widely use general and local antibiotics.

The prophylactic use of antibiotics for various open injuries and operations promotes better wound healing, a significant reduction in purulent complications and their severity, and more. quick recovery and restoration of patients’ ability to work.

In preventing the further spread of acute purulent processes and the appearance of various complications, timely and rational treatment of primary inflammatory diseases, especially in the initial stages of their development, is of great importance. Thus, timely use of antibiotics and surgical intervention for a limited abscess can prevent its transition to a more common and severe disease - phlegmon, as well as the appearance of complications such as lymphangitis, lymphadenitis. Timely and rational treatment of one boil can prevent its transition to furunculosis, timely surgery for acute appendicitis or other acute purulent process in abdominal cavity prevents the development of general peritonitis, etc. The fight against pustular diseases (pyodermitis) at work and at home is also of great importance.

Speaking about the prevention of purulent diseases, it should be emphasized that all medical personnel must meticulously observe the rules of personal hygiene ( frequent washing hands, changing gloves and gowns), since dirty hands, dirty clothes contribute to the spread of pyogenic infection. In this regard, purulent diseases among medical personnel (boils, abscesses), as well as diseases such as tonsillitis and influenza, are of particular danger to surgical patients. The presence of these diseases among personnel can lead to infection of patients and their wounds and to the possible appearance of certain purulent diseases in them.

In addition to pyogenic infection, the occurrence and development of various purulent diseases largely depend on protective forces body. Therefore, in the prevention of any, including purulent diseases, activities that strengthen the human body are of great importance: regular physical education and sports, correct mode work and rest, wet wipes, air baths, etc. General strengthening and hardening the body increases its resistance to various infections and to one degree or another determines a more favorable course and outcome in the event of the development of a purulent disease.

In the prevention of many purulent diseases, the improvement of the external environment in which a person lives and works, that is, the improvement of working and living conditions, is of great importance. For example, in the prevention of a number of purulent diseases (furunculosis, pyodermatitis, etc.), general hygiene measures and skin care (especially hands) play an important role.

This includes proper sanitary-hygienic and sanitary-technical working conditions in industrial enterprises and agricultural work, combating dust and pollution in premises, rational and clean workwear, organization of showers, baths, laundries, measures to combat skin contamination ( various oils and liquids), as well as the struggle to improve everyday life (regular washing in the shower or bath, changing linen). To prevent diseases of the skin of the hands in some industries, it is advisable to use various protective ointments and methods of sanitation (health improvement) of the hands.

It should be remembered that continuous improvement of the culture of work and life is the main way to reduce morbidity in general and various purulent processes in particular.

Finally, in the prevention of many purulent diseases, sanitary and educational work among the population is of great importance. The role of sanitary educational work among the population (conversations, lectures, use of the press, radio, television) is especially great in the prevention of various microtraumas and pustular diseases (often the cause of more dangerous acute purulent processes), as well as complications acute diseases abdominal organs (appendicitis, cholecystitis, peritonitis). Purulent diseases, as a rule, require urgent hospitalization of patients and immediate surgical intervention.

Reasonable propaganda of the initial signs of purulent diseases and advice on the need early treatment behind medical care lead to a significant improvement in outcomes and a reduction in the number of various complications.

- This is damage to the skin and underlying tissues with the formation of a purulent focus. The pathology is manifested by significant swelling, hyperemia of surrounding tissues and intense pain syndrome. The pain can be tugging, bursting, and depriving you of sleep. Dead tissue and accumulations of pus are visible in the wound. General intoxication is observed, accompanied by fever, chills, headache, weakness and nausea. The treatment is complex and includes washing and draining wounds (if necessary, purulent leaks are opened), therapeutic dressings, antibiotic therapy, detoxification therapy, immunocorrective therapy and stimulation of recovery processes.

ICD-10

T79.3 Post-traumatic wound infection, not classified elsewhere

General information

A purulent wound is a tissue defect, the lumen of which contains purulent exudate, and signs of inflammation are detected along the edges. Purulent wounds are the most common complication of clean wounds, both accidental and surgical. According to various sources, despite strict adherence to sterility during operations, the number of suppurations in the postoperative period ranges from 2-3 to 30%. The causative agents of the purulent process in random and surgical wounds ah most often become so-called pyogenic microbes (staphylococci, streptococci, etc.). The treatment of previously untreated purulent wounds is carried out by surgeons; the treatment of accidental wounds that festered after PSO is carried out by orthopedic traumatologists. Treatment of festering surgical wounds is the responsibility of the specialists who performed the operation: surgeons, traumatologists, vascular surgeons, thoracic surgeons, neurosurgeons, etc.

Causes

Wounds in the head and neck area heal best. Suppuration occurs somewhat more often in wounds gluteal region, back, chest and abdomen, and even more often when the upper and lower extremities are damaged. Foot wounds heal the worst. Good immunity reduces the likelihood of developing purulent wounds with minor bacterial insemination. With significant insemination and a satisfactory state of the immune system, suppuration occurs more rapidly, but the process is usually localized and ends with recovery more quickly. Immune disorders cause more sluggish and prolonged healing of purulent wounds. The likelihood of infection spreading and complications developing increases.

Severe somatic diseases affect the general condition of the body and, as a result, the likelihood of suppuration and the speed of wound healing. However, diabetes mellitus has a particularly strong negative impact due to vascular and metabolic disorders. In patients suffering from this disease, purulent wounds can occur even with minor injuries and minor bacterial insemination. In such patients, poor healing and a pronounced tendency for the process to spread are observed. In healthy young people, on average, wounds fester less often than in older people, and in thin people - less often than in overweight people. The likelihood of a wound becoming suppurated increases in summer, especially in hot and humid weather, so elective surgeries recommended during the cold season.

Symptoms of purulent wounds

There are local and general symptoms pathology. Local symptoms include tissue defects with the presence of purulent exudate, as well as classic signs of inflammation: pain, local increase temperature, local hyperemia, swelling of surrounding tissues and dysfunction. Pain from a purulent wound can be pressing or bursting. When outflow is difficult (due to the formation of a crust, the formation of streaks, the spread of a purulent process), the accumulation of pus and increased pressure in the inflamed area, the pain becomes very intense, twitching and often deprives patients of sleep. The skin around the wound is hot. In the initial stages, during the formation of pus, redness of the skin is observed. If the wound persists for a long time, the redness may give way to a purple or purplish-bluish coloration of the skin.

Two types of edema can be distinguished at the site of the lesion. The edges of the wound are warm and inflammatory. Coincides with the zone of hyperemia, caused by impaired blood flow. Distal to the wound – cold reactive. There is no hyperemia in this area, and swelling of the soft tissues is caused by impaired lymph outflow due to compression of the lymph nodes in the area of inflammation. Dysfunction of the affected area is associated with swelling and pain, the severity of the disorder depends on the size and location purulent wound, as well as on the volume and phase of inflammation.

The main symptom of a purulent wound is pus - a liquid containing bacteria, tissue detritus, globulins, albumins, enzymes of leukocyte and microbial origin, fats, cholesterol, DNA admixtures and dead leukocytes. The color and consistency of pus depend on the type of pathogen. Staphylococcus is characterized by thick yellow or white pus, for streptococcus - liquid greenish or yellowish, for E. coli - liquid brown-yellow, for anaerobic microbes - brown, foul-smelling, for pseudomonas infection - yellowish, shimmering blue-green on the bandage (the pus acquires this shade upon contact with oxygen external environment). The amount of pus can vary significantly. Areas of necrotic tissue and granulation may be found underneath the pus.

Toxins enter the patient’s body from the wound, which causes the appearance of symptoms of general intoxication. Characterized by fever, loss of appetite, sweating, weakness, chills, headache. Blood tests reveal an acceleration of ESR and leukocytosis with a shift to the left. A urine test reveals protein. In severe cases, there may be an increase in the level of urea, creatinine and bilirubin in the blood, anemia, leukopenia, dysproteinemia and hypoproteinemia. Clinically, with severe intoxication, severe weakness and disturbances of consciousness, up to coma, can be observed.

Depending on the predominant process, the following stages of the purulent process are distinguished: formation of a purulent focus, cleansing and regeneration, healing. All purulent wounds heal by secondary intention.

Complications

With purulent wounds, a number of complications are possible. Lymphangitis (inflammation lymphatic vessels, located proximal to the wound) appears as red stripes directed from the wound to the regional lymph nodes. With lymphadenitis (inflammation of the lymph nodes), regional lymph nodes enlarge and become painful. Thrombophlebitis (inflammation of the veins) is accompanied by the appearance of painful red strands along the saphenous veins. With contact spread of pus, the development of purulent leaks, periostitis, osteomyelitis, purulent arthritis, abscess and phlegmon is possible. The most severe complication purulent wounds is sepsis.

If healing does not occur, the purulent wound may develop into chronic form. Foreign experts consider wounds without a tendency to heal within 4 weeks or more as chronic. Such wounds include bedsores, trophic ulcers, accidental or surgical long-term non-healing wounds.

Diagnostics

Due to the presence of obvious local signs, diagnosing purulent wounds is not difficult. To exclude the involvement of underlying anatomical structures, radiography, MRI or CT of the affected segment can be performed. IN general analysis blood signs of inflammation are determined. To determine the type and sensitivity of the pathogen, the discharge is inoculated onto nutrient media.

Treatment of purulent wounds

Treatment tactics depend on the phase of the wound process. At the stage of formation of a purulent focus, the main task of surgeons is to clean the wound, limit inflammation, fight pathogenic microorganisms and detoxify (if indicated). At the second stage, measures are taken to stimulate regeneration, it is possible to impose early secondary seams or skin grafting. At the stage of wound closure, epithelial formation is stimulated.

If pus is present, surgical treatment is performed, which includes dissecting the edges of the wound or skin over the lesion, removing pus, examining the wound to identify leaks and, if necessary, opening these leaks, removing necrotic tissue (necrectomy), stopping bleeding, washing and draining the wound. Sutures are not applied to purulent wounds; the application of rare sutures is allowed only when organizing flow-through drainage. Along with traditional methods treatments for purulent wounds are used modern techniques: vacuum therapy, local ozone therapy, hyperbaric oxygenation, laser treatment, ultrasound treatment, cryotherapy, treatment with a pulsating jet of antiseptic, introduction of sorbents into the wound, etc.

According to indications, detoxification is carried out: forced diuresis, infusion therapy, extracorporeal hemocorrection, etc. All of the above measures, both traditional and modern, are carried out against the background of rational antibiotic therapy and immunocorrection. Depending on the severity of the process, antibiotics may be prescribed orally, intramuscularly or intravenously. In the first days medications are used wide range actions. After determining the pathogen, the antibiotic is replaced taking into account the sensitivity of the microorganisms.

After cleansing the purulent wound, measures are taken to restore the anatomical relationships and close the wound (early and late secondary sutures, skin grafting). Secondary sutures are indicated in the absence of pus, necrotic tissue and severe inflammation of surrounding tissues. In this case, it is necessary that the edges of the wound can be compared without tension. If there is a tissue defect and it is impossible to compare the edges of the wound, skin grafting is performed using the island and brand methods, plastic with counter flaps, plastic with a free skin flap, or plastic with a skin flap on a vascular pedicle.

Purulent sore throat is a name that combines two purulent forms tonsillitis (acute tonsillitis) - follicular and lacunar. These forms of angina have a similar general and local course; one patient may experience signs of both forms of angina at the same time. Often the pathological process occurs in the palatine tonsils, in more in rare cases The lingual, nasopharyngeal and laryngeal tonsils are affected.

Most often, purulent tonsillitis is diagnosed in children of preschool and primary school age. In children under 5 years of age, as well as in adults, viruses are often the infectious agent; in the age group of 5–15 years, purulent tonsillitis of bacterial etiology is more often observed.

Bubbles of white or yellowish color on the surface of the tonsils - characteristic feature purulent sore throat

Causes of purulent sore throat and risk factors

Infectious agents are able to penetrate into the tissue of the tonsils exogenously (from a sick person by airborne droplets, household or nutritional routes) or endogenously (from carious teeth, in acute respiratory infections, other infectious processes in the body). In people with weakened immune systems, the disease can be caused by opportunistic microorganisms that are constantly present on the mucous membrane oral cavity or pharynx and under normal conditions do not provoke inflammation.

Risk factors for the development of purulent tonsillitis include:

hypothermia of both the body as a whole and the throat (for example, when eating ice cream, too cold water, etc.);
infectious processes in the body;
tonsil injury;
air pollution;
increased humidity in the room;
change in climatic conditions;
long-term exposure to solar radiation on the body;
food and other intoxications;
Not balanced diet;
bad habits;

Forms of the disease

In total, according to the nature of the inflammatory process, there are 4 forms of sore throat, one of which is purulent:

catarrhal (superficial lesion of the tonsils, no purulent plaque);
herpetic (on the tonsils there are subepithelial vesicles filled with serous exudate);
purulent (characterized by purulent plaque, which is easily removed without damaging the surface underneath);
necrotic (dense coating of green-gray-yellow color, after removal of which a bleeding surface is exposed).

A rare but dangerous complication of purulent tonsillitis can be severe swelling of the tonsils, up to the development of suffocation (including during sleep).

Purulent tonsillitis, in turn, can be follicular (mainly the follicles of the tonsils are affected; purulent islands are found on the tonsils, as well as purulent plaque on the mucous membrane of the tonsils, which is released from the follicles) and lacunar (characteristic is the accumulation of pus in the lacunae of the tonsils).

Depending on location pathological process Sore throat can be unilateral (rare, usually only at the beginning of the disease, later the process spreads to both sides) and bilateral.

The incubation period lasts from 12 hours to three days. The disease debuts acutely, with an increase in temperature to febrile levels - 39-40 ˚C, chills, headache, weakness, aches in the muscles and joints appear. Noted sharp pain in the throat, worse when swallowing and while talking, cervical The lymph nodes enlarged and painful on palpation. The palatine tonsils and adjacent tissues are hyperemic and swollen, in some cases the swelling is so significant that it makes breathing difficult.

A common sign of purulent tonsillitis in the follicular form are areas of purulent melting on the surface of the tonsils, which look like white or yellowish bubbles, which, in combination with a hyperemic tonsil, provides a characteristic “starry sky” symptom. At lacunar form pus is located at the mouths of the lacunae of the palatine tonsils, having the appearance of whitish-yellow films or stripes that may extend beyond the lacunae. In both lacunar and follicular forms, plaque is easily removed, without the appearance of a bleeding surface underneath - this symptom distinguishes purulent tonsillitis from other forms of the disease similar to it.

Features of the disease in children

Purulent tonsillitis in children has a rapid course. The disease begins with a sharp increase in temperature (up to 40 ˚C), the child becomes capricious and drowsy, due to soreness and severe pain sore throat refuses to eat or drink. Regional lymph nodes enlarge, and tachycardia often develops. In some cases, with purulent tonsillitis in children, there is such pronounced swelling of the tonsils that they begin to put pressure on eustachian tubes, causing ear congestion and noise in them, and sometimes the spread of the infectious process to the ear.

Diagnostics

To make a diagnosis of purulent tonsillitis, a patient's history and complaints are collected, as well as pharyngoscopy. As a rule, this is enough to make a diagnosis. If clarification is necessary, a general blood and urine test is performed, as well as bacteriological examination with an antibiogram of a throat smear. A general blood test shows an increase in the number of leukocytes with a shift in the leukocyte formula to the left. The erythrocyte sedimentation rate increases, reaching 40-50 mm/h (normal 1-15 mm/h). In some cases, identification of the infectious agent requires serological test blood, determination of pathogen DNA using polymerase chain reaction.

Required differential diagnosis with diphtheria, infectious mononucleosis.

Most often, purulent tonsillitis is diagnosed in children of preschool and primary school age.

Treatment of purulent sore throat

Treatment of purulent sore throat is usually carried out at home; hospitalization is indicated only in severe cases and in children under 3 years of age. The main method of treatment is antibacterial therapy; with the correct selection of the drug and dosage, the patient’s condition improves already on the second day from the start of treatment, however, the course of antibiotic therapy must be completely completed to avoid the development of antibiotic-resistant forms of microflora, as well as the occurrence of complications. Since there is a need for urgent treatment, broad-spectrum antibiotics are usually used.

If the temperature rises significantly, antipyretics are used (the need for them, as a rule, arises only in the first 1–3 days). General therapy supplemented by frequent gargling with antiseptic solutions and decoctions medicinal herbs, which make it possible to remove pus from the mucous membrane of the oral cavity and pharynx. In addition to rinsing, may be prescribed medications local action in the form of sprays (irrigation with sprays in the treatment of purulent tonsillitis replaced the lubricants used previously, as they are more convenient and less painful).

While the elevated body temperature persists, patients require strict bed rest. A gentle diet and plenty of fluids are recommended. During the period of the most acute manifestations, refusal to eat is acceptable, but intense drinking regime required.

Sometimes abundant liquid pus, localized at the mouths of the lacunae of the palatine tonsils, is difficult to remove by rinsing. In this case, washing the tonsils, which is performed by an otolaryngologist, can provide a positive effect.

Preparations for sore throat have proven themselves to be effective in the treatment of sore throat. local application- lozenges and lozenges, with complex preparations being more effective. For example, the drug Anti-Angin® Formula tablets/lozenges, which include vitamin C, as well as chlorhexidine, which has a bactericidal and bacteriostatic effect, and tetracaine, which has a local anesthetic effect. Due to its complex composition, Anti-Angin® has a triple effect: it helps fight bacteria, relieve pain and helps reduce inflammation and swelling (1,2).

Anti-Angin® is available in a wide range of dosage forms: compact spray, lozenges and lozenges (1,2,3).

Anti-Angin® is indicated for manifestations of tonsillitis, pharyngitis and the initial stage of sore throat; this may be irritation, tightness, dryness or sore throat (1,2,3).

Anti-Angin® tablets do not contain sugar (2).*, acute rheumatic fever, rheumatic joint damage, sepsis.

In case of frequent relapses of purulent tonsillitis, the inflammation becomes chronic and chronic tonsillitis develops. The constant presence of an infectious agent in the tonsils leads to its entry into the bloodstream, and through the bloodstream it spreads to other organs and systems. To prevent the development of complications, as well as in the absence of a positive effect from conservative therapy removal of pathologically altered tonsils is recommended. Surgery not indicated for patients with heart defects (grade 2 and 3), severe forms of diabetes mellitus, hemophilia.

Forecast

With timely diagnosis and adequate treatment the prognosis is favorable. If complications develop, as well as with frequently recurring purulent tonsillitis, the prognosis worsens.

Prevention of purulent sore throat

In order to prevent the development of purulent sore throat, the following are recommended:

timely diagnosis and treatment of helminthic infestations;
regular, at least twice a year, preventive examinations at the dentist;
strengthening common and local immunity(hardening the body, rational nutrition, avoiding hypothermia, etc.);
rejection of bad habits;
compliance with personal hygiene rules;
avoiding contact with patients with infectious respiratory diseases.

Video from YouTube on the topic of the article:

*With caution when diabetes mellitus, contains ascorbic acid.

Instructions for use medicine Anti-Angin® Formula in dosage form lozenges;
Instructions for use of the drug Anti-Angin® Formula in the dosage form of lozenges;
Instructions for use of the drug Anti-Angin® Formula in the dosage form of a dosed spray for topical use.

There are contraindications. You need to read the instructions or consult a specialist.

The most large organ human body is the skin, which is the barrier between the internal organs and the outside world. Except main function protecting the body from an unfavorable environment, mechanical damage and sunlight, the skin carries out thermoregulation, participates in excretory processes, as well as in the breathing process. It depends on the condition of the skin general health person, his immunity and well-being. Among the diseases that affect the skin, the most common are purulent skin diseases, accounting for more than 75% of all cases of skin diseases.

Causes of purulent skin diseases - pyoderma

Any skin diseases, accompanied by purulent inflammations, caused by pyogenic infections, are common name– pyoderma. The causative agents of pyoderma are mainly staphylococci, streptococci, less often E. coli or other opportunistic bacteria that are found in the atmosphere, soil, and also on the skin of a healthy person. Provided the body is functioning normally the immune system easily copes with the pathogenic microflora present on the skin; if the immune barrier is broken, the bacteria multiply, penetrating into the deeper layers of the epidermis and releasing toxins. The vital activity of pyogenic bacteria leads to the necrosis of areas of the skin and causes an increased presence of leukocytes - white blood cells, which, when fighting an infection, die and, accumulating in especially large quantities, form pus.

Preceded by pyoderma viral diseases, weakening the immune system, and with it the body’s resistance to pathogenic microbes, as well as mechanical damage, wounds, scratches, scratching, which provide easy access to the less protected layers of the dermis. In addition, insufficient hygiene and non-compliance with sanitary standards can become the basis for an increase in the population of bacteria, which can threaten purulent inflammation. Thus, every person in his life could observe acne with purulent discharge on the face or other areas of the skin, which are nothing more than the result of the activity of staphylococcus in conditions of increased secretion of the sebaceous glands.

From this we can conclude that conditionally pathogenic microflora is not an absolute guarantee of the occurrence of purulent skin diseases, and only a weakening of the body’s defenses or other of the above factors can serve as the beginning of the development of pyoderma.

Classification of pyoderma

Based on its location, pyoderma can be classified into the following groups of diseases:

Purulent inflammation of the epidermis, most often caused by streptococcus.

Pustular formations, in the deeper layers of the epidermis, localized in the skin appendages - lymph nodes, hair follicles ah, the causative agent of which in most cases is staphylococcus.

Diseases of the subcutaneous tissue - phlegmon.

Classification of pyoderma by infectious agents as follows:

Streptoderma (streptococcus):

Impetigo
Erysipelas
Vulgar ecthyma
Chronic diffuse streptoderma
Staphyloderma (staphylococcus):
Folliculitis
Sycosis
Ostiofolliculitis
Furuncle
Carbuncle
Hidradenitis

Based on the degree of penetration, pyoderma can be divided into superficial and deep, which in turn can be divided into acute, chronic and mild.

It should be noted that in medical practice there is no clear distinction between pyoderma, since almost all purulent skin diseases are accompanied by the presence of not one infection, but several simultaneously attacking a weakened body. These types of diseases are called strepto-staphylococcal pyoderma.

Superficial staphyloderma

Folliculitis is a superficial purulent inflammation of the skin caused by a staphylococcal infection and localized in the hair follicles. It is expressed as a purulent pustule followed by a scar or pigmentation at this place. Placed in groups or individually. In some cases, when other infections are associated with staphylococcus, baldness in areas of folliculitis is possible.

Ostiofolliculitis differs from folliculitis in the presence of hair in the center of purulent inflammation. It occurs mainly in places that can be subject to constant mechanical stress, friction during which the skin is broken and the infection gets inside.

Sycosis is a chronic purulent skin disease and differs from folliculitis in the area of the affected skin, as well as in the shimmering effect. Sycosis affects areas of the skin that are periodically irritated, with chronic rhinitis it is localized under the nose and spreads to its wings, manifested by skin irritation when shaving. The gestation period of a purulent pustule is short, so a dried crust forms on the skin, and sometimes a bluish tint appears on the skin.

Staphylococcal pemphigus in newborns is expressed in the appearance of blisters with pus on the surface of the skin. Weak immunity child and untimely treatment can lead to complications and sepsis. Bacteriophages are used for treatment.

Superficial staphyloderma occurs mainly on the skin of the face, less often on the body; the cause can be either mechanical damage to the skin or insufficient hygiene. Treatment is carried out locally and consists of wiping the inflamed area of skin with an antiseptic; UV lamps, ointments and antibiotics are used less frequently.

Deep staphyloderma

A furuncle is an acute inflammation of the hair follicle involving the adjacent sebaceous glands and skin necrosis. During the ripening of the boil, a rod forms inside, which can cause tugging pain because it affects nerve endings epidermis. The tissue around the tumor is inflamed and painful. To remove the boil, the patient is hospitalized and the infiltrate is removed under general anesthesia. A boil on the face poses a risk of spreading staphylococcal infection By blood vessels and lymph flows and threatens with meningitis inflammation of the brain.

Carbuncle is an acute inflammation of several hair follicles simultaneously with subsequent necrosis of the shafts and is accompanied by high temperature and pain. The cause is often a weakened immune system. After an abscess, a crater-shaped ulcer forms on the skin, which soon heals and a scar remains in its place.

Hidradenitis - acute purulent inflammation sweat glands without formation of a rod. Localized in the armpits, inguinal perineum, behind ears. At the site of infection, painful purulent infiltrates are formed that ooze pus. Danger of this disease is that the infection, penetrating through the apocrine glands, penetrates the skin and captures adipose tissue. Treatment of hidradenitis includes two stages - surgery to excise the sweat glands and anti-inflammatory treatment using radiation therapy.

For the treatment of deep staphyloderma, Vishnevsky ointments are used, ichthyol ointment, which contribute to the rapid withdrawal of the rod. Used to heal the inflamed area antibacterial ointments, which also disinfect the skin, preventing the infection from reappearing on the prepared soil.

Superficial streptoderma

Impetigo is a superficial skin lesion caused by streptococcal infections, most often found in childhood. The causes of impetigo can be microtraumas of the skin, poor hygiene, or previous viral infections with weakened general immunity, diabetes mellitus.

The infection manifests itself in the form of the formation of small blisters with a yellowish liquid on the skin, which soon burst and become covered with brown crusts. Larger blisters, when opened, are undisguised foci of infection; purulent ulcers form in their place. The infection can be transmitted through household healthy children, therefore the patient should be kept under strict quarantine.

Treatment of impetigo, a disease that was previously called streptoderma, without distinguishing it from other pyoderma with streptococcal pathogens, consists of ingesting antihistamines, immunomodulators, and bacteriophages. The surface of the skin is treated with antiseptics, which not only disinfect, but also dry the surface of the wounds, promoting rapid healing.

Diaper rash. In addition to impetigo, diaper rash is often caused in children by the causative agents of streptococci. In conditions of insufficient hygiene of infants, as well as taking into account the characteristics of the epidermis, in places where there is insufficient air supply, diaper rash occurs with further spread and suppuration of the skin. Putrefactive bacteria provoke inflammation in the folds of the skin, accompanied by unpleasant smell and causing pain to the baby. In addition to infants, diaper rash can also affect older people, whose skin regenerates slowly and wrinkles may occur, as well as fat people and bedridden patients. To prevent diaper rash in children and adults, you should take air baths, trying not to clog the surface of the skin in the folds, not to overheat the body and wash the skin folds weak solution potassium permanganate and calendula infusion.

Diaper rash is treated by drying out salicylic ointment, using baths with potassium permanganate, the skin is disinfected and wet diaper rash is dried.

Streptoderma is often accompanied by the addition of staphylococci living on the skin, then the situation is aggravated and the disease is more acute with the transition to more acute forms.

Deep streptoderma

Erysipelas is an infectious disease most often caused by streptococcus. It occurs both independently and against the background of other inflammatory processes on the skin. Erysipelas is expressed as the appearance of a red spot on the surface of the dermis and implies inflammation of all its layers. The surface of the source of infection is hot, there is a burning sensation, the edges are uneven, and sometimes there is throbbing pain. Symptoms of erysipelas manifest themselves acutely, the patient may feel dizziness, general weakness, and fever. Temperatures can rise to 40 degrees.

Erysipelas can be divided into three forms:

Erythematous erysipelas. It is characterized by uneven edges in the form of tongues, swelling of adjacent tissues.

Bullous erysipelas. A more serious course of this form is due to the detachment of the dermis and the appearance of blisters with escudate. After the blisters dry out, ulcers may appear in their place.

Bullous-hemorrhagic, in which the deep layers of the epidermis are affected and capillary ruptures are possible, followed by bleeding and bloody escudate blisters.

Treatment of erysipelas is carried out taking into account the form of the disease, general condition sick. Apply sulfa drugs, antibiotics for the bullous form are used to drain the blisters.

Ecthyma vulgaris is a deep form of streptoderma and is expressed in the occurrence of streptococcal ulcers, which are located on the surface of the lower leg, thighs, and lower back. The initial stage of ecthyma is manifested by the appearance of painful nodes in the deep layers of the epidermis, which gradually turn into pustules followed by tissue necrosis. The lesion increases over time, expanding its edges and deepening. An ulcer appears with characteristic brownish crusts from dried pustules.

Treatment of ecthyma is carried out locally by applying compresses, removing the crust and healing the ulcer. Use syntomycin, tetracycline, erythramecin ointments. In particularly advanced cases, antibiotics are used.

Deep streptoderma is characterized by special consequences for the general condition of the body, as well as the rapid development of the disease itself, for this reason self-medication is unacceptable.

Phlegmon

Cellulitis is an inflammation of the subcutaneous space without clear outlines with purulent manifestations. The causative agents of the disease are various microorganisms, in particular staphylococcus. The disease progresses rapidly, covering new areas, abscesses and blood poisoning are possible. Depending on the infection, purulent, serous and putrefactive phlegmon are distinguished.

The gateway to infection can be swollen lymph nodes, carious tooth canals, inflamed boils.

The disease manifests itself elevated temperature, swelling and hyperemia of the skin, infection may spread through the lymph and infection of internal organs.

Treatment of phlegmon involves draining infected organs, taking antibiotics and bacteriophages.

Complications of pyoderma can be divided into cosmetic - scars, frames, ulcers, and bacterial - lymphadenitis, abscesses, sepsis. The cause of complications can be called, first of all, a frivolous attitude towards neoplasms on the skin, because even a simple pimple, if left untreated, can develop into more serious illness with consequences for the whole organism. To prevent pyoderma, it is necessary to maintain immunity by taking immunomodulators, vitamins, playing sports and maintaining personal hygiene.

Purulent diseases, in which toxins and tissue breakdown products are absorbed into the blood, are accompanied by general painful phenomena: chills, fever, increased heart rate, lack of appetite, fatigue, etc. These phenomena are more pronounced when the infection spreads through the lymphatic and blood vessels (lymphangitis, lymphadenitis , thrombophlebitis). But to the greatest extent, general painful signs appear with further spread of the infection, i.e. with the so-called general purulent infection, which occurs after preliminary intermediate stages in the development of infection (lymphangitis, thrombophlebitis), but can occur without these diseases, directly after local purulent disease or infected wound.

A general purulent infection can develop from any purulent focus existing in the body, but in some cases this primary focus cannot be detected (cryptogenic general infection).

There are two types of general purulent infection. A general infection that is accompanied by the appearance of different areas the body of the patient has portable ulcers, called pyaemia; an infection that causes general infection organism without local abscesses - sepsis.

It is possible to divide a general purulent infection into a toxic form, which is characterized only by the phenomena of toxin poisoning; bacterial, in which there is in the blood great amount bacteria; embolic, in which bacteria are only transported by the blood and form new ulcers.

Clinically, it is difficult to distinguish between these forms, especially since pure forms are rare.

By clinical picture general purulent infection is also divided into two groups: a metastasizing form (septicopyemia), in which new purulent foci are formed, and a non-metastasizing form (septicemia).

General purulent infection without metastases(blood poisoning, sepsis, septicemia). With this type of general purulent infection, in some cases there are toxic waste products of bacteria in the blood, and in others, in addition, the bacteria themselves. The pathogens in sepsis are the same, most often streptococcus, and especially severe diseases are caused by hemolytic streptococcus, less often by staphylococcus, Escherichia coli, pneumococcus, and Pseudomonas aeruginosa. Pathoanatomical changes consist in the presence of a local focus of infection, often with a sluggish process, poor delineation, progressive purulent melting of tissue, hemorrhagic discharge, etc. If there are wounds, then the granulations in them are sluggish, pale, discharge from the wounds is scanty (dry wounds ).

From general changes note changes in the blood, the presence of bacteria in it (determined by blood culture), fragility vascular walls, enlargement and sagging of the spleen and degeneration of internal organs (kidneys, heart).

The gates of infection in sepsis can be very insignificant, hardly noticeable (for example, minor wounds), especially when a virulent infection enters them (wounds during autopsies, when working with pus, for example, in dressing rooms), and the source can be granulating wounds and local purulent diseases.

The onset of septicemia is usually accompanied by a high (up to 39-40°) temperature; Locally, an increase in pain, lymphangitis and lymphadenitis are often noted. Temperatures remain high for several days with fluctuations of up to a degree, but more are possible sharp fluctuations(fall in the morning, rise in the evening). The increase in temperature increased the pulse to 170 beats per minute and ended in the death of the patient on the 5th day. Intoxication of the body is reflected in increased heart rate, changes in the heart muscle and kidneys (protein and shaped elements in urine), side effects gastrointestinal tract(diarrhea). Hemorrhagic rashes may appear on the skin, hemorrhages are observed in internal organs and external bleeding (from wounds, nose). There is chills and heavy sweating, sometimes blackouts.

The prognosis is often poor. Death occurs due to symptoms of cardiac weakness.

Metastatic general purulent infection(septicopyemia). The most common causative agents of this type of general infection are staphylococci, less commonly streptococci, diplococci, E. coli or mixed infection. Very often, septicopyemia develops after carbuncles and even boils on the face and when infected, especially gunshot wounds. Septicopyemia is characterized by lesions of the veins (phlebitis), purulent melting and disintegration of blood clots, transfer of infected blood clots to various organs, (lungs, kidneys, brain, etc.) and the formation of metastatic abscesses, most often in subcutaneous tissue, in the lungs, pleura, kidneys, joints. With long-term septicopyemia, changes in the blood and general exhaustion of the body are noted.

A symptom characteristic of septicopyemia is the development of metastases from the primary purulent focus or the simultaneous development of multiple purulent foci.

The picture of the disease with septicopyemia is characterized by a high temperature of an unstable type with a temporary decrease almost to normal (for example, on the 4th day). Following the decrease, the temperature rises sharply when new abscesses appear (for example, on the 6th, 8th and 11th day).

Before the temperature rises, there is usually a tremendous chill, and when the temperature drops, there is drenching sweat. Sometimes the fever is remitting, hectic in nature with daily fluctuations of 2-3°; with chills of various durations observed either daily, or even several times a day.

Chills and fever correspond to the entry of new portions of infectious agents into the blood or the formation of a new focus. Chills, a rise in temperature and pouring sweat exhaust the patient, his pulse quickens and becomes weak, his breathing is frequent and shallow; the nervous system is depressed, the patient becomes indifferent, lethargic; When the temperature rises, delirium and loss of consciousness are observed. With long-term illness, jaundice appears due to the breakdown of red blood cells and liver damage, as well as a rash (exanthema). Transferable lesions give symptoms depending on the organ where they form. The disease lasts about two weeks (acute forms), but there are also chronic cases lasting several months. The diversity in the course of septicopyemia depends primarily on the state of the body, on its neuro-reflex responses to the invading infection. The very nature of the infection is also essential (with streptococcal infection - a more acute course of the disease, with staphylococcal infection - either acute or chronic), as well as the treatment used.

The prediction is always serious, the outcome is often fatal due to general exhaustion, metastases in the vital important organs(for example, in the brain) and degeneration of internal organs.

Treatment of general purulent infection and patient care. Treatment of a general purulent infection often gives unsatisfactory results. It is easier to take measures to prevent the development of infection than to fight it.

Most effective means For the treatment of general purulent infection, antibiotics are used: penicillin, streptomycin, syntomycin and biomycin (aureomycin). Penicillin is administered intramuscularly (200,000-400,000 units or more per day) or intravenously in the same doses by drip method along with saline solution. Streptomycin is administered subcutaneously at 500,000 units 2 times a day. Antibiotics are used either together or separately, depending on the severity of the disease and the nature of the pathogen. In addition to antibiotics, large doses of streptocide are used orally at the same time.

In case of general purulent infection, measures aimed at increasing reactivity and reducing the patient’s intoxication are of great importance. For this purpose, repeated blood transfusions are used, usually in small doses and by drip. Large amounts of fluid are administered daily in the form of heavy drinking (1-2 liters per day), drip enemas, subcutaneous and intravenous drip infusions of saline solution and 5% glucose (up to 2-3 or even more liters per day). Salt therapy aims to increase the amount of fluid in the vascular system, increase diuresis and eliminate toxins. Regular administration of 40% glucose intravenously and the use of cardiac drugs are necessary ( camphor oil, caffeine, digalene). Need to pay Special attention on nutrition of patients with general purulent infection. These patients often experience achylia, loss of appetite and diarrhea. Therefore, hydrochloric acid is prescribed; nutrition should be complete, easily digestible and tasty. Sometimes it is useful to give small doses of wine (port, Cahors), and vitamins are required. The role of the staff is to monitor the nutrition of the septic patient.

With a general purulent infection, patient care is very important. Need to take care of the condition nervous system sick. He must be placed in a room where absolute silence must be maintained, and bright lighting is undesirable. For pain, drugs are given. If you sweat profusely, you need to change your underwear, sometimes several times a day. Skin care and monitoring of urine (quantity, analysis), as well as bowel movements, are very important.

Of great importance for the outcome of the disease is taking measures in relation to primary focus and to metastatic foci. Both primary and metastatic lesions must be opened and good conditions for drainage of pus must be provided.

In some cases of severe local purulent process, in order to save the patient’s life, it is necessary to sacrifice the diseased organ, for example a limb, by resorting to its removal.

Preventive measures in relation to a general purulent disease are the same as in relation to a purulent infection in general, and consist of correct and timely assistance for injuries, protection of any wound from infection, careful, careful dressing of wounds to prevent the possibility of infection during dressings. In addition, a preventive measure is the correct treatment of local purulent infection with timely surgical intervention, since pus located inside the tissues under pressure can be absorbed into the blood, causing general infection.

Wound exhaustion. The long course of a severe injury, for example, a gunshot fracture and joint injuries, often leads to severe intoxication from a purulent focus. Without causing a septic process, the disease sometimes produces chills, fever, and deterioration of the general condition caused by the absorption of toxic products from the purulent focus. The most characteristic symptom of wound exhaustion is a progressive decrease in the amount of hemoglobin. Along with this, there is a decrease in the number of erythrocytes, an increase in ROE and a deterioration in the white blood count, a shift to the left (an increase in band forms of neutrophils, the disappearance of eosinophils).

The general condition of the wounded person worsens, the functioning of the digestive system is disrupted, diarrhea often appears, and the wounded person loses sleep. The condition of the wound also worsens, further granulation stops, the granulations are sluggish, sometimes watery, and dry.

The disease may end fatal with a picture of a sluggish general purulent infection.

With such a picture of the disease, it is necessary to immediately eliminate local reasons causing intoxication (retention of pus in the wound, leaks, foreign bodies, arthritis, new purulent foci).

To fight infection and increase the patient's resistance, they take the following measures: administration of penicillin, administration of sulfonamides, intravenous administration of 30 ml of 40% glucose solution.

Particular attention should be paid to nutrition. A dairy-vegetable diet and vitamin C are prescribed.

For diarrhea, 10 ml of a 10% solution is administered intravenously calcium chloride, give hydrochloric acid and sulfidine. At increased excitability and insomnia, luminal and bromine are prescribed.

If these measures do not produce an effect, then in the presence of a purulent focus on a limb, it is necessary to undergo radical surgery or amputation in a timely manner in order to save the patient’s life.