Cellulitis, Red Lymphangitis Streaks, Kple Ŋutilã me Ʋuʋudedi ƒe Kaka Kpata¶

Dɔlékuiwo ƒe ŋutigbalẽ kple lãkusi falɛfalɛwo ƒe dɔlékui sesẽwo (SSTI) tso ʋuʋudedi siwo ƒoa ƒu ɖe teƒe ɖeka (ŋutilã me ʋuʋudedi, abi, kple carbuncles) dzi va ɖo ŋutigbalẽ kple ŋutigbalẽ te dɔlékui siwo kaka kabakaba (erysipelas, cellulitis, kple acute ascending lymphangitis) dzi. Togbɔ be ŋutigbalẽdɔléle siwo mesẽ o geɖe wɔa nu ɖe dɔlékuiwutike siwo wozãna le kɔdzi alo tsi si woɖena le kɔdzi bɔbɔe ŋu hã la, ŋutigbalẽdɔléle si kakana kabakaba gaƒoƒo ɖesiaɖe, si naa fli dzĩwo yia alɔ alo afɔ ɖeka dzi yia abɔta alo akɔta, dzea mo alo ŋku ƒe titina, alo hea dzoxɔxɔ si nɔa anyi ɖaa, vuvɔ, tɔtɔ, alo gbɔgbɔ kabakaba vɛ le gaƒoƒo ʋɛ aɖewo ko me va zua ʋu si ate ŋu ade ame ƒe agbe afɔku me dɔlékuiwo xɔxɔ ( .sepsis kple septic shock ƒe ʋuʋu) alo lãɖuɖu necrotizing fasciitis ƒe dɔléle si nye necrotizing fasciitis. Ne afɔku ƒe dzesi siawo dometɔ aɖe dze la, ƒo ka na miaƒe nutoa me tɔwo xexlẽdzesi siwo wozãna kpata alo yi kɔdzi ƒe dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ si te ɖe ŋuwò enumake. Dzro míaƒe mɔfiame siwo ku ɖe... orbital cellulitis kple mo ƒe afɔku-dzogoe etɔ̃ ƒe dɔlékuiwo kple ʋuka me ʋu ƒe sisi goglo (DVT) ..

Wò nuwɔna enumake le aƒemee nye be tsɔ nuŋlɔti akpɔ dzodzroa ƒe gotagome liƒo tututu eye nàŋlɔ gaƒoɖokui ƒe ɣeyiɣi ɖe ŋutigbalẽa dzi, akɔ abɔ si vuvu la ɖe dzi wu dzi ƒe seƒe be wòaɖe dɔdzẽ ƒe ʋuʋu dzi akpɔtɔ, mègamimi, aƒo, alo atsɔ aŋe aƒo ƒoƒo alo abi le aƒeme gbeɖe o, eye nàdi dɔlékuiwutike siwo wodo ɖe ʋuka me enumake le kɔdzi ne ʋuka dzĩ ƒe ʋukawo le ʋuʋum alo dɔlékuiwutikewo ƒe dɔlékuiwutikewo ƒe dzesiwo dona.

Wɔ esia fifia¶

1. Kpɔ enumake be Sepsis alo Necrotizing Fasciitis ƒe aflaga dzĩ siwo ate ŋu ade ame ƒe agbe afɔku me le asiwò eye nàƒo ka na wò nutoa me xexlẽdzesi kpata ne ele afima. Ƒo ka na 911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia, alo nàlé ŋku ɖe míaƒe nyatakakadzraɖoƒe si nye xexlẽdzesi siwo wozãna kpata ne amea xɔ vevesese si mesɔ kple alesi ŋutigbalẽa le o, ʋuʋudedi siwo ƒe amadede nye aŋutiɖiɖi-yibɔ (bullae), ŋutigbalẽ si se le eɖokui me be yevuvu abe bubble wrap (crepitus) alo eƒe lãme ʋuʋu keŋkeŋ, tɔtɔ alo alɔ̃dɔdɔ, gbɔgbɔ kabakaba (gbɔgbɔ 22 kple edzivɔ le miniti ɖeka me), vuvɔ ʋuʋu (sesẽ), alo ʋu ƒe sisi si bɔbɔ.
2. Zã ballpoint pen alo amekoko ƒe dzesidenu nàtsɔ akpɔ ŋutigbalẽ dzĩ la ƒe gotagome gotagome tututu eye nàŋlɔ gaƒoɖokui ƒe ɣeyiɣi si tututu wòde fli la xa. Ta fli si wotsɔ fli ƒokpli alo fli sesẽ la blewuu ɖe axadzi tututu le afisi ŋutigbalẽ dzĩ si me dzo le do go ŋutigbalẽ si sɔ le, eye nàŋlɔ ɣeyiɣia (le kpɔɖeŋu me, 14:30). Ne wò alo atikewɔla si kpɔa nu kpatawo gbɔ gbugbɔ lé ŋku ɖe ŋutigbalẽa ŋu le gaƒoƒo 1 va ɖo 2 megbe la, dzodzro ɖesiaɖe si yi ŋgɔ to wò nuŋlɔtsi ƒe ka ŋu la ɖo kpe edzi be dɔlékuia le kakam vevie eye wòkpena ɖe ame ŋu wòdzidzea alesi wòle zɔzɔm kabakabae.
3. Kpɔe ɖa be fli dzĩwo (lymphangitis streaks) le mɔ zɔm yi dzi le abɔta eye nàse le ɖokuiwò me be ʋuka siwo vuvu, siwo le ƒoƒom le abɔta, abɔta ƒe ʋuʋudedi, alo akɔta hã. Lé ŋku ɖe abɔta, abɔta, nyivi, kple ata ememetɔ ƒe akpa si le eme ŋu nyuie be fli dzĩ tsɛ, siwo me kɔ alo esiwo le keklẽm tso abi la gbɔ ɖo ta akɔta hã. Lãmetsiŋusẽ si le dzi yim fia be dɔlékui vɔ̃ɖiwo (zi geɖe la, Streptococcus pyogenes) ge ɖe ʋuka siwo me ʋu sina tona me eye wole du dzi yina titina ʋukawo me; esia bia be woada atikewo kpɔ kpata eye zi geɖe la, wodoa dɔlékuiwutikewo ɖe ʋuka me.
4. MÈgazi aŋe alo lãgbalẽŋudɔwɔnu ɖe ƒoƒoe, ʋuʋudedi, alo ŋutigbalẽ ƒe ʋuʋudedi me GBEÐE o. Ʋuʋudedi aɖe mimi hea mɔ̃ ƒe nyaƒoɖeamenu gã aɖe vɛ ɖe dɔdzẽ ƒe gli si mebɔbɔ o (pyogenic membrane) si ƒo xlã ʋuʋudedi ƒe kotokua dzi, si wɔnɛ be ʋuʋudedia yi megbe eye wògoglo wu wòzua ami si le ŋutigbalẽ te, ʋukawo, kple ʋumenugbagbeviɣiwo, siwo ate ŋu aƒã Staphylococcus aureus (MRSA) si te ŋu nɔa te ɖe methicillin nu tẽ ɖe ʋukawo me (dɔlékuiwo, dzitodzito me dɔléle, alo cavernous sinus thrombosis).
5. Do abɔ kple afɔ si ŋu cellulitis si mesẽ o le ɖe dzi wu dzia ƒe seƒe (negbe ɖe wosusu be ʋukawo me dɔléle alo compartment syndrome le eŋu ko hafi). Ne ètsɔ afɔ alo alɔ si me cellulitis le la ɖo dzi ɖe akɔtaɖonuwo dzi wu dzi ƒe seƒe la, wozãa nuheŋusẽ tsɔ ɖea interstitial inflammatory fluid (edema) ɖa, si ɖea ŋutigbalẽ ƒe keke si me vevesese le dzi kpɔtɔna eye wòkpena ɖe dɔlékuiwutikewo ŋu be woage ɖe lãmenugbagbeviwo ƒe aba me.
6. Mitsɔ atike si me tsi le dzadzɛ si me dzo le la de dzo si wotu ɖe teƒea (alo avɔ fafɛ si me tsi le la ɖe erysipelas/cellulitis dzodzoe dzi) eye nàɖe asigɛwo, gaƒoɖokuiwo, kple afɔkpa siwo le sesẽm la katã ɖa. Ðe asigɛ ɖesiaɖe si le asi alo afɔbidɛ si vuvu la ŋu enumake hafi vuvua nalé ga la eye wòaƒo xexlẽdzesia. Le dzoxɔxɔ si le teƒe ɖeka, si wotu ɖe gli ŋu si me ɖoɖowɔɖi ƒe dɔléle aɖeke mele o gome la, avɔ dzodzoe dzadzɛ aɖe ɖiɖi ɖe ʋuƒoa dzi aɖabaƒoƒo 15 zi gbɔ zi 3 va ɖo 4 gbesiagbe nana ʋu si sina le teƒea dzina ɖe edzi vaseɖe esime atikewɔla nate ŋu awɔ lãɖeɖe kple tsiɖeɖe (I&D) si me dɔlékui mele o.

Nyametsotsoti: ŋutigbalẽ ƒe dzodzro sesẽ, fli dzĩwo, kple ʋuʋudedi ƒe ʋuʋudediwo dodokpɔ¶

flowchart TD
    Start["Dzĩ Dzĩ, Dzoxɔxɔ, Vuvu, Alo Vevesese le Ŋutilã ƒe Abi (Dzĩ Siwo Kaka, Dzĩ Siwo Kɔkɔ, Dzĩ Ƒe Ʋuʋu, alo Pus Boil) ."] --> CheckDeadly{"Afɔɖeɖe 1: Kpɔ Amekoko & Sepsis Red Flags: Vevesese sesẽ si mesɔ gbɔ o, ʋuʋudedi/yibɔ, ʋuʋudedi, crepitus, tɔtɔ, gbɔgbɔ kabakaba, vuvɔ, alo ŋku/kɔ/akɔta ƒe vuvu?"}

    CheckDeadly -->|"Ẽ na Aflaga Dzĩ ANYE"| Emergency911["NYA KPƆKPƆ KPƆKPƆ KPƆKPƆ KPLE AGBE ALOO Afɔkpodzi ƑE AVƆ: Ƒo ka na 911 / 112 / 999 alo Yi Kɔdzi Kpata Dɔwɔƒe Enumake (Wosusu be Necrotizing Fasciitis, Sepsis, alo Orbital Cellulitis)"]

    CheckDeadly -->|"AO: Ŋudzɔnɔnɔ, vitals li ke, amadede pink/dzẽ si sɔ"| PenMark["Afɔɖeɖe 2: Ta Ink Pen Border Ðe Dzĩ ƒe Gome Nugbɔ eye Nàŋlɔ Gaƒoɖokui ƒe Ɣeyiɣi ƒe Dzesi Tɔxɛ Ðe Ŋutilã Dzi; Ðe Kplɔ̃wo Kple Gaƒoɖokuiwo Katã ɖa"]

    PenMark --> Classify{"Afɔɖeɖe 3: Ŋutilãmedɔléle Ƒomevi Kae Le Ame Ŋu?"}

    Classify -->|"Fli dzĩwo (streaks) siwo zɔa mɔ yia dzi alo afɔ yia abɔta alo akɔta ƒe ʋuka siwo fa miamiamia gbɔ"| Lymphangitis["ƲUƲU ƑE ƲUƲU ƑE ƲUƲU KPƆKPƆ KPƆKPƆ: Yi Dɔwɔƒe si Kpɔa Dɔléle Kpatawo Gbɔ alo Dɔnɔdzikpɔƒe Kpata le gaƒoƒo aɖewo me hena dɔlékuiwutike siwo wozãna kabakaba le ɖoɖo nu (zi geɖe la, IV) hafi dɔlékuiwo naxɔ ame"]

    Classify -->|"Kpe dzĩ dzodzoe si kaka ɖe gbadzaa alo esi kɔ ɖe dzi (Cellulitis alo Erysipelas - No pus pocket) ."| Cellulitis["CELLULITIS ALOO ERYSIPELAS: Do abɔ kple afɔ ɖe dzi wu dzi, lé ŋku ɖe afɔbidɛwo dome be fungi ƒe gbagbã hã, di atikewɔlawo ƒe dodokpɔ gbemagbe ke; yi ED enumake ne dzodzroa tso pen line kabakaba alo dzoxɔxɔ dze egɔme"]

    Classify -->|"Kotoku si me ʋuʋudedi le si le abe dome ene alo esi le tɔtrɔm (Cutaneous Abscess, Furuncle, alo Carbuncle) ."| Abscess["CUTANEOUS ABSCESS / BOIL: MÈGAMIMI, aƒoe, alo atsɔ aŋe aƒoe le aƒeme GBEÐE o; de atike si me dzo le dzadzɛ eye nàkpɔ atikewɔla hena dɔlékuiwutike siwo me dɔlékui mele o ƒe Incision and Drainage (I&D) kpe ɖe MRSA dɔlékuiwutikewo ŋu"]

Dɔdaƒewo ƒe hatsotsowo: cellulitis kple erysipelas vs. lymphangitis vs. cutaneous abscess¶

Le Infectious Diseases Society of America (IDSA) kple UK National Institute for Health and Care Excellence (NICE) ƒe mɔfiame siwo ku ɖe ŋutigbalẽ kple lãmeka falɛfalɛwo ƒe dɔlékuiwo ŋu nu la, atikewɔwɔ kpata nɔ te ɖe nenye be dɔlékuia nye non-purulent (kaka dɔdzẽ si kaka to ŋutigbalẽ alo ʋukawo me evɔ kotoku si me tsi le si me ʋuʋudedi mele o, si zi geɖe la, etsona beta-hemolytic Streptococcus) alo purulent (si nye ʋuʋudedi si woƒo ƒu ɖe gli ŋu le ŋutigbalẽa me alo ami si le ŋutigbalẽ te, si ƒe akpa gãtɔ tso Staphylococcus aureus gbɔ, si me MRSA si wokpɔ le nutoa me hã le).

Alesi woawɔ kple nusita woawɔ "Pen Border and Timestamp" mɔnu¶

Ne dɔnɔ alo ƒometɔ aɖe lé ŋku ɖe afɔ alo alɔ si biã si vuvu ŋu la, amegbetɔ ƒe ŋkuɖoɖonudzi mate ŋu adrɔ̃ ʋɔnu kakaɖedzitɔe nenye be dzodzroa keke ta sentimeta 1 alo sentimeta 5 le gaƒoƒo etɔ̃ siwo va yi me o, vevietɔ le xɔ si me woɖɔlia awu le ƒe akaɖi te. Atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ, dɔnɔdzikpɔlawo, kple ŋutigbalẽŋutinunyalawo zãa Ink Pen Demarcation Method le xexeame katã:

1. Zã ballpoint pen si wozãna ɖaa, fine-tip permanent marker, alo surgical skin pen: Klɔ asi kple adzalẽ kple tsi gbã. Ta fli kpui siwo kplɔ wo nɔewo ɖo blewuu alo fli si metso o ɖe gotatɔ kekeake si le dzodzro si wokpɔna (erythema) la ŋu tututu. Ne ʋuka dzĩwo ƒe fli dzĩwo le du dzi yi alɔ alo afɔ dzi la, ke fli kpui aɖe si wotsɔ atitsoga wɔe le fli dzĩ la ƒe nugbɔ kɔkɔtɔ kekeake.
2. Ŋlɔ gaƒoɖokui ƒe gaƒoƒo (kple ŋkeke) tututu ɖe ŋutigbalẽ si le lãmesẽ me si le fli la xa la dzi: Le kpɔɖeŋu me, ŋlɔ 10:00 AM alo 10:00.
3. Alesi woaɖe tɔtrɔwo gɔme le nuŋlɔti ƒe fli dzi:
4. Keke kabakaba HAFI nàdze dɔlékuiwutikewo zazã gɔme: Ne dzodzroa yi ŋgɔ wu sentimeta 1 va ɖo 2 le gaƒoƒo ɖeka me to wò nuŋlɔtsi ƒe fli ŋu, alo ne ʋuka dzĩ aɖe lia sentimeta geɖe yi alɔ alo ata dzi le gaƒoƒo 1 va ɖo 2 me la, dɔlékui ƒe agba alo aɖi ƒe wɔwɔme le zɔzɔm kabakaba; yi kɔdzi ƒe dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake.
5. "First 24-to-48-Hour Antibiotic Paradox" (Jarisch-Herxheimer-like inflammatory flare): Le IDSA kple NICE ƒe mɔfiamewo nu la, ne dɔnɔa nya dze dɔlékuiwutike nyuitɔ nono alo esi wodona ɖe ʋuka me gɔme na cellulitis ko la, dzodzroa kple vuvua enuenu tsoa nuŋlɔti ƒe fli gbãtɔa vie le 24 va ɖo 36 gbãtɔa me gaƒoƒo. Esia dzɔna elabena esi dɔlékuiwutikea le Streptococcal dɔlékui miliɔn geɖe wum le ŋutigbalẽa me la, dɔlékui ƒe lãmenugbagbeviwo ƒe gli siwo le gbagbãm la ɖea aɖi siwo naa dɔdzẽ kple dɔlékuiwutike siwo xɔa ʋumenugbagbevi ɣi kple tsi geɖe ɖe abi la ƒe go kemɛ dzi hena ɣeyiɣi aɖe. Zi alesi dɔnɔa se le eɖokui me be yeƒe ɖoɖoa li ke (dzudzɔ yeye si nu sẽ, vuvɔ, alo vevesese deto sesẽ aɖeke meli o), liƒo ƒe kekeɖenudɔ sue aɖe le gaƒoƒo 24 gbãtɔwo me mefia le eɖokui si be dɔlékuiwutikea do kpo nu o; ke hã, ne dzodzro yi edzi le kekem ɖe enu le gaƒoƒo 48 va ɖo 72 siwo va yi le dɔlékuiwutikewo zazã me, alo ne ɖoɖowɔɖi ƒe dzesiwo nu sẽ ɖe edzi ɣesiaɣi la, ele be woagbugbɔ ŋku alé ɖe kɔdzi kpata.

Lãmetsiŋusẽ ƒe dɔléle sesẽ: nusita "red streaking" yi abɔta alo akɔta nye atikewɔwɔ kpata¶

Le blemakɔnu xɔŋkɔwo me la, zi geɖe la, woyɔa fli dzĩ si ƒoa xlã alɔ alo afɔ tso lãɖeɖe si me dɔlékui le me be "ʋu ƒe aɖi." Le ŋutilã ƒe wɔwɔme nu la, fli dzĩ ma nye acute ascending lymphangitis: dɔlékui ƒe amedzidzedze si le dɔ wɔm ɖe ʋumenugbagbeviɣimɔ̃wo si ɖea lãmenugbagbeviwo me tsi tso ŋutigbalẽa me trɔna yia dzia me.

Alesi dɔlékuiwo zɔna tso ŋutigbalẽ sue aɖe me gbãna yia ʋukawo me¶

1. Agbo si dzi woato age ɖe eme: Zi geɖe la, abi si wodze egɔme tsoe la nɔa sue ɖedzesi aɖe: avu ƒe ƒoƒo alo ƒoƒo ɖe asi ŋu, rose ŋù ƒe ƒoƒo, ʋuʋudedi le afɔkpodzi, ɖa si ŋu dɔlékui le (paronychia), nudzodzoe alo akpɔkplɔ ƒe ɖuɖu si wotsɔ asibidɛwo ƒo, alo ŋutigbalẽ si me gbagbã le afɔbidɛwo dome tso kamedefefewɔla ƒe afɔ gbɔ (tinea pedis).
2. Lymphatic capillaries ƒe amedzidzedze: Dɔlékui vɔ̃ɖiwo (siwo xɔ ŋkɔ wu Ƒuƒoƒo A Streptococcus pyogenes, si ɖea enzymes-dissolving enzymes abe hyaluronidase kple streptokinase, alo Pasteurella multocida le gaƒoƒo 12 va ɖo 24 me tso esime avu ɖui) gena ɖe microscopic lymphatic capillaries me le dermis me.
3. Ʋeʋẽ dzĩ siwo wokpɔna le ʋukawo ŋu: Ne dɔlékuiwo le dzidzim ɖe edzi eye wole ʋuʋum yi dzi le ʋuka siwo le etame siwo le sisim le abɔta alo afɔ te ƒe ʋukawo xa me la, ʋukawo ƒe gliwo va xɔa abi vevie eye wokekea ŋutigbalẽ ƒe ʋuka siwo le wo dzi la ɖe enu, si wɔnɛ be zi ɖeka alo esi wu nenema si le dzo dam, si le dzo dam streaks yi abɔ kple afɔ la dzi.
4. Nutome ʋukawo ƒe mɔxenu (Lymphadenitis): Lãmetsiʋuwo tsɔa dɔlékuiawo yia nutome ƒe ʋuʋudedi teƒewo: epitrochlear node le abɔta ememetɔ kple axillary nodes le abɔta (na asi/abɔ ƒe dɔlékuiwo), alo popliteal node le klo megbe kple inguinal nodes le akɔta ƒe ʋuʋudedi me (na afɔ/afɔ ƒe dɔlékuiwo). Lãmetsiŋusẽ siawo vuvuna zua ƒunukpeƒetetedɔ siwo me vevesese le esime dɔlélenutsiŋutete ƒe lãmenugbagbeviwo le avu wɔm be yewoalé dɔlékuiawo.
5. Breakthrough into the thoracic duct and vena cava (Bacteremia and Sepsis): Ne dɔlélea ɖu nutome ʋukawo dzi dɔlékuiwutike aɖeke manɔmee la, ʋuka si ŋu dɔlélea le la sina yia akɔta ƒe ʋuka (alo ɖusime ʋuka) me tẽ eye wòkɔna tẽ yia subclavian vein si le dzia tame tututu, eye wòtsɔa dɔlékui gbagbewo yɔa ʋu si le ɖoɖoa me la me (bacteremia) eye wòhea septic shock vɛ le gaƒoƒo aɖewo me.

Lãgbalẽ me ʋuʋudedi kple MRSA ƒe ƒoƒoewo: nusitae afɔku le nutete alo aƒeme lancing me¶

lãgbalẽ ƒe ʋuʋudedi nye ʋuʋudedi (ʋumenugbagbevi ɣi kukuwo, lãkusi ƒe gbeɖuɖɔ siwo zu tsi, kple dɔlékui gbagbewo) ƒe do si le teƒe ɖeka si fibrin si xɔ dzo kple granulation tissue ƒe gli si me ʋukawo le ƒo xlãe. furuncle (boil) nye ʋuʋudedi si dzɔna tso ɖa ƒe ƒuƒoƒo me, gake carbuncle nye ɖa siwo do ƒome kple wo nɔewo ƒe ƒuƒoƒo si me goglo, si me xɔ geɖe le, si wɔa ƒuƒoƒo gã aɖe si sesẽ abe ʋuƒo ene, si ƒe amadede nye aŋutiɖiɖi (zi geɖe la, le kɔ ƒe akɔta, akɔta ƒe akpa si le etame, alo ata dzi le ame tsitsiwo alo amesiwo ŋu suklidɔ le gome).

Nusita MELE be nàmimi alo atsɔ aŋe aƒoe le aƒeme GBEÐE o¶

Ne ƒoƒoe aɖe vuvu sesĩe eye wòle veve sem la, dɔnɔwo dzea agbagba enuenu be yewoaƒoe ahaƒoe ɖe yewoƒe asibidɛwo dome abe aklã ƒe ʋuʋudedi ene, alo atsɔ avɔlɔlɔ̃ ƒe aŋe si me dzo le alo modzakaɖehɛ aƒoe.

Alesi atikewɔlawo daa abi dedie: sterile Incision and Drainage (I&D) .¶

Dɔlékuiwutikewo ɖeɖe mate ŋu ada abi si tsi nyuie o elabena ʋuka aɖeke mele ʋuka siwo me ʋu sina tona si le acidic pus me si atsɔ atikea ayi eme o, eye pH si bɔbɔ la nana dɔlékuiwutike geɖe megawɔa dɔ o. Le dɔnɔdzikpɔƒe si wokpɔa dɔnɔwo gbɔ kpata alo dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ la, atikewɔla wɔa Incision and Drainage (I&D) kabakaba: - Ne ɖɔktaa kɔ ŋutigbalẽa ŋu eye wòtsɔ lidocaine na dome la me mekɔ o (eye zi geɖe la, etsɔa abadzivɔ ƒe ultrasound léa ŋku ɖe kotokua ŋu be yeakpɔe ɖa be tsi ƒe ʋuʋudedi tsɔ wu be wòanye ʋuka sesẽ aɖe alo pseudoaneurysm si le ʋuka aɖe dzi) vɔ la, ɖɔktaa tsɔa lãgbalẽŋudɔwɔnu si me dɔlékui mele o lãa dome si le tɔtrɔm la ɖe fli me ale be ʋuʋudedi sina yia gota faa nyaƒoɖeamenu manɔmee. - Ðɔktaa kplɔa ʋuka si me dɔlékui mele o alo ʋu si me dɔlékui mele o le doa me blewuu be wòagbã kotoku siwo me ka le (loculations) siwo me ʋuʋudedi ɣla ɖo, tsɔa saline si me dɔlékui mele o klɔa doa me nyuie, eye wòdea wick alo loop drain si mesẽ o ne ehiã ale be ŋutigbalẽa ƒe goawo nagatre nu kaba o. - Le IDSA ƒe mɔfiamewo nu la, ne wotsɔ MRSA-active antibiotic (abe trimethoprim-sulfamethoxazole [Bactrim/Septra] alo doxycycline) si woano kpe ɖe I&D ŋu ŋkeke 5 va ɖo 10 kpe ɖe I&D ŋu la, enaa dɔyɔyɔ ƒe agbɔsɔsɔ nyona ɖe edzi ŋutɔ eye wòɖea abi siwo gbugbɔna dzi kpɔtɔna, eye wònye sedziwɔwɔ ɣesiaɣi si abi la lolo wu sentimeta 2, si ƒo xlãe cellulitis, si le mo/asi/vidzinuwo dzi, alo edzɔna le dɔnɔ si ŋu asrã, suklidɔ, alo dɔlélenutsiŋutete ƒe nutete le ŋu.

Vovototodedeameme veviwo didi: nɔnɔme siwo le abe cellulitis ene (alo woɣla wo ɖokui ɖe ete) .¶

Gbesiagbe le atikewɔwɔ kpata me la, mɔ̃ eve siwo tsi tre ɖe wo nɔewo ŋu tsɔ dea dzesi dɔlélewo dzɔna: wogbea amekoko ƒe nɔnɔme kpata si wua ame (necrotizing fasciitis alo dep vein thrombosis) be enye "cellulitis bɔbɔe," alo afɔ ƒe nɔnɔme si nɔa anyi didi si mexɔa dɔlékui o (venous stasis dermatitis, si nyea "bilateral leg cellulitis" ƒe alafa memama 30. misdiagnoses) la, wotsɔa dɔlékuiwutikewo zazã enuenu daa dɔe madzemadzee.

Agbo tɔxɛ siwo dzi afɔku le ŋutɔ si dzi woato age ɖe eme: lãwo ƒe ɖuɖu, tsi ƒe dodo, kple afɔ ƒe gbagbã¶

Ɣesiaɣi si nèdi atikewɔlawo ƒe kpekpeɖeŋu le cellulitis alo abi aɖe ta la, gblɔ alesi tututu ŋutigbalẽa gbã kple nuto si ka abi la na ɖɔkta ɣesiaɣi, elabena dɔlékui siwo mebɔ o siwo te ŋu nɔa te ɖe cellulitis dɔlékuiwutike siwo wozãna ɖaa (abe cephalexin alo penicillin ene) nu keŋkeŋ le nusiwo woɖena fiana me la le:

1. Avu kple Avũ ƒe ɖuɖu (Pasteurella multocida kple Capnocytophaga): Avũ ƒe aɖuwo wɔa dɔ abe aŋe siwo le lãkusi me ene siwo doa Pasteurella multocida ɖe asi ƒe lãkusiwo kple ƒunukpeƒewo goglo, si hea cellulitis si wóna kple ʋumenugbagbeviɣidɔ vɛ le gaƒoƒo 12 va ɖo 24 me (kpɔ lãwo ƒe ɖuɖu). Ebia amoxicillin-clavulanate (Augmentin) tsɔ wu cephalexin. Capnocytophaga canimorsus si tso avu ƒe aɖuɖɔ me ateŋu ahe fulminant sepsis vɛ na dɔnɔ siwo si aɖuɖɔtoe mele o (ƒunukpeƒetetedɔ ƒe gbagbã kple asplenia) alo kple aklãdɔ.
2. **Dzetsi, Tsi Dzĩ (Mexico-ƒuta / Ƒuta Tɔsisiwo), alo Tɔmelã Siwo Mekɔ O ( (Gulf of Mexico)Vibrio vulnificus). ʋumenugbagbeviɣidɔ, alo suklidɔ. Ebia be woana kɔdzi IV ƒe dzidzime etɔ̃lia ƒe cephalosporin (ceftazidime/ceftriaxone) kple doxycycline enumake. (Gulf of Mexico)
3. Tsi Nyui Tawo, Tɔsisiwo, Tawo, alo Tsitsetsewo (Aeromonas hydrophila): Tsi nyui ƒe tsitawo alo tɔsisiwo me ƒe ʋuʋu hea cellulitis kabakaba tso Aeromonas hydrophila gbɔ, si hiã be woatsɔ fluoroquinolone (ciprofloxacin) alo trimethoprim-sulfamethoxazole akpe ɖe nusiwo wotsɔ tsyɔa nu dzi si wozãna ɖaa ŋu.
4. Tsi Dzodzoewo, Nail Salons, alo Sneaker Pucture To Rubber Afɔkpodzi (Pseudomonas aeruginosa): Afɔɖeɖe ɖe ɖa si xɔ dzo dzi to tenisfɔkpa ƒe foam rababa ƒe afɔkpodzi dzi doa Pseudomonas aeruginosa ɖe afɔƒua me, gake tsi dzodzoe siwo me klorin mele nyuie o ya hea Pseudomonas folliculitis vɛ.
5. Ŋutilã si Gã le Afɔbidɛwo Dome (Kamedefefewɔla ƒe Afɔ / Tinea Pedis): Le afɔkpodzi ƒe cellulitis ƒe dɔléle siwo wu 50 le alafa me me la, dɔlékuiawo gena ɖe eme to nusuekpɔmɔ̃, macerated fungal cracks le afɔbidɛ enelia kple atɔ̃lia dome. Ne wotsɔ atike si wotsɔna tsia fungi ƒe afɔbidɛ ƒe lãkusi me dɔlékui la dada ne cellulitis la haya vɔ la xea mɔ na afɔdzidɔ si gbugbɔna dzɔna.

Sepsis progression checklist: ne ŋutigbalẽ ƒe dɔléle va zu ŋutilã bliboa ƒe kuxi¶

Le Surviving Sepsis Campaign kple UK Sepsis Trust ƒe nya nu la, ele be woatsɔ amesiame si ŋu cellulitis, erysipelas, lymphangitis, alo ŋutigbalẽ me ʋuʋudedi le la ayi kɔdzi ƒe dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake ne TIME / Red Flag Sepsis ƒe dzesi aɖewo dze edzi:

• T - Dzoxɔxɔ ƒe masɔmasɔ: Dzoxɔxɔ si nu sẽ wu 38.3 degree Celsius (101 degrees Fahrenheit), aɖuwo ƒe vuvɔ sesẽ (** sesẽ**), alo ŋutilã ƒe dzoxɔxɔ si le titina si bɔbɔ le mɔ si mesɔ o nu si mede 36.0 degree Celsius (96.8 degrees Fahrenheit).
• I - Dɔlékui ƒe dzesi siwo le dzidzim ɖe edzi kabakaba: Dzoxɔxɔ si kekena wu wò nuŋlɔti ƒe dzesi si wu sentimeta 1 va ɖo 2 le gaƒoƒo ɖeka me, ʋumenugbagbevi dzĩwo ƒe fli dzĩ siwo le abɔta lialia, alo ʋuʋudedi yeye siwo ƒe amadede nye aŋutiɖiɖi/yibɔ.
• M - Susu ƒe ɖiɖi: Tɔtɔ yeye ɖesiaɖe, nuƒoƒo si me mekɔ o, susu ƒe tɔtɔ, alɔ̃dɔdɔ si meɖe dzesi o, alo nyɔnyrɔ̃ sesẽ.
• E - Dɔléle vevie / Dzitodzito ƒe teteɖeanyi: Gbɔgbɔ kabakaba (gbɔgbɔ 22 alo esi wu nenema le miniti ɖeka me), dzi ƒe tsotso le gbɔɖeme me wu 100 va ɖo 110 le miniti ɖeka me, taɖuame ne wole tsitre (ʋu ƒe sisi le ʋuka me le 100 mmHg teƒe), ŋutigbalẽ si le ɣie/si me ʋuʋudedi le alo fa miamiamia, alo to aɖuɖɔ aɖeke manɔmee hena 12+ gaƒoƒo.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

• United States kple Canada: Ƒo ka na 911 na ŋutigbalẽdɔléle ɖesiaɖe si kpe ɖe sepsis ƒe dzesiwo, necrotizing fasciitis red flags, alo mo/orbital swelling ŋu. Ne èdi be yeakpɔ abi siwo mesẽ o alo cellulitis kaba si me ɖoɖowɔɖi ƒe dzesi aɖeke mele o la, yi dɔnɔdzikpɔƒe kpata alo kɔdzi ƒe dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ gbemagbe ke (wokpɔa edzi le IDSA Skin and Soft Tissue Infection Guidelines te).
• United Kingdom: Ƒo ka na 999 alo yi A&E enumake hena NICE NG153 / UK Sepsis Trust Red Flag ƒe dzesi ɖesiaɖe, orbital/facial cellulitis, alo lymphangitis si kaka kabakaba. Ƒo ka na NHS 111 hena ŋkeke ɖeka dzi GP alo Out-of-Hours ƒe dodokpɔ kpata le cellulitis alo abi siwo le teƒea ŋu.
• European Union: Ƒo ka na 112 le EU dukɔwo katã me hena septic alo necrotizing nɔnɔme kpatawo.
• Australia kple New Zealand: Ƒo 000 le Australia alo 111 le New Zealand. Wokpɔa edzi le Atikewɔwɔ ƒe Mɔfiamewo: Dɔlékuiwutike (Australia) kple ANZCOR dɔlékuiwutikewo ƒe dɔlékuiwutikewo ƒe ɖoɖowo te.
• India kple Asia-Pacific: Ƒo 112 (alo 108 le India), 995 le Singapore, 119 le Japan kple South Korea, alo 999 le Malaysia kple Hong Kong. Yi kɔdzi si me amekoko kple dɔlékuiwutikewo dodo ƒe ŋutete le gaƒoƒo 24 me.

Nya siwo wobiaa amewo enuenu¶

Nukatae wòle be matsɔ nuŋlɔti ƒe fli aƒo xlã ŋutigbalẽ me dɔlékui dzĩ aɖe?¶

Ne ètsɔ bɔlƒomɔ̃ alo dzesidenu ta fli ɖe ŋutigbalẽa ƒe gotagome liƒo tututu dzi eye nèŋlɔ gaƒoɖokui ƒe ɣeyiɣi si sɔ ɖe ŋutigbalẽa dzi la naa wò kple ɖɔkta siwo kpɔa nudzɔdzɔ kpatawo gbɔ la kpɔa dzidzenu si ŋu woate ŋu akpɔ nu le si ŋu woate ŋu akpɔ nu le be nàdzidze nenye be dɔlékuia le kekem ɖe enu kple alesi wòle kabakabae. Ne dzodzroa kaka to wò nuŋlɔtsi ƒe fli ŋu le gaƒoƒo 1 va ɖo 2 siwo kplɔe ɖo hafi wodze dɔlékuiwutikewo zazã gɔme, alo yi edzi le kekem ɖe enu wòwu gaƒoƒo 48 le dɔlékuiwutikewo nono gɔmedzedze megbe la, efia be ehiã be woada dɔlékuiwutikewo kpɔ kpata le kɔdzi alo woadoe ɖe ʋuka me.

Nukae fli dzĩ alo fli si le ʋuʋum yi dzi le nye alɔnu alo afɔ dzi tso lãɖeɖe alo nudzodzoewo ƒe ɖuɖu me fia?¶

Fli dzĩ si keke tso afisi wotso, ƒoƒo, nudzodzoewo ƒe ɖuɖu, alo ʋuʋudedi yi ŋgɔgbe alo afɔ si le ete dzi ɖo ta abɔta alo akɔta nye ʋuka me dɔléle si le dzi yim vevie, ke menye ʋu ƒe sisi le ʋuka me o. Efia be dɔlékui vɔ̃ɖiwo (siwo bɔ wu Group A Streptococcus) ge ɖe ʋuka siwo me ʋu sina tona me eye wole mɔ zɔm ɖo ta wò nutome ʋukawo kple titina ʋukawo gbɔ. Esi wònye be ʋumenugbagbeviɣidɔ ate ŋu ava zu dɔlékuiwo kple dɔlékuiwutikewo le gaƒoƒo ʋɛ aɖewo ko me ta la, ele be nàdi atikewɔla kpata gbemagbe ke hena dɔlékuiwutike siwo wozãna le ɖoɖo nu.

Nukatae afɔku le eme be woamimi alo aƒo ƒoƒoe alo MRSA ŋutigbalẽ ƒe ʋuʋudedi le aƒeme?¶

To vovo na ŋutigbalẽ ƒe ʋuʋudedi sue aɖe la, ŋutigbalẽ ƒe ʋuʋudedi alo ƒoƒoe nye kotoku goglo si me ʋuʋudedi le si ŋu fibrin gli si kpɔa ame ta nyuie si nana dɔlékuiawo megena ɖe wò ʋukawo me o. Ne womi abi la naa tsi ƒe nyaƒoɖeamenu sesẽ aɖe nɔa ʋuʋudedi ƒe doa me, eye enuenu la, egbãa megbegli la yia eme eye wòzia Staphylococcus aureus (MRSA) gbagbe dzi ɖe ŋutigbalẽ te lãkusi goglowo, ʋukawo, kple ʋuka siwo me ʋu sina tona me, afisi wòate ŋu ana ʋukawo me ʋu ƒe sisi, dzitodzito me dɔlékui, alo aklã ƒe ƒu ƒe dɔléle. Le mo (ŋɔti alo nuyi si le etame) gome la, ƒoƒoe aɖe mimi ate ŋu atutu tsiɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔwo ɖe megbe ayi ahɔhɔ̃a ƒe do si me do le la me.

Aleke mawɔ ade dzesi vovototo si le cellulitis dzro kple lãɖuɖu ƒe necrotizing fasciitis dome?¶

Le cellulitis dzrowo me la, ŋutigbalẽa nyea pink va ɖo dzĩ, dzoxɔxɔ, eye wòvivina le mɔ si sɔ nu ne woka asi eŋu, eye vevesesea ƒe agbɔsɔsɔme sɔ kple alesi ŋutigbalẽa le. Le necrotizing fasciitis me la, dɔlékuia ƒua du to fascia goglo si le ŋutigbalẽa te la dzi, si hea vevesese goglo 10/10 vevesesetɔe si mesɔ kple eƒe gogloƒe ƒe dzobibi fafɛ o, eye wòkplɔnɛ ɖo kabakaba kple abi si sesẽ abe ati ene, ʋuʋudedi siwo yɔ fũ kple aɖabɛ alo ʋu, ŋutigbalẽ ƒe akpa aɖewo siwo me lãmekawo ku le, gas si le ʋuʋum le ŋutigbalẽa te, kple kɔkɔ asrã, tɔtɔ, alo taɖuame. Necrotizing fasciitis nye amekoko ƒe nɔnɔme kpata si hiã be woaɖe lãgbalẽ le amekokoxɔ me enumake.

Nukatae ɖɔktawo gblɔ be ele be nàkɔ afɔ ɖe dzi kple cellulitis?¶

Dɔlékui ƒe cellulitis hea teƒea ƒe dɔdzẽ sesẽ vɛ si wɔnɛ be ʋuka suesuesuewo tsina, si naa tsi si sɔ gbɔ ɖe ŋutigbalẽa kple ŋutigbalẽ te lãkusiwo me (edema). Ne afɔa le xɔxlɔ̃m la, nuheŋusẽ ƒoa tsi ma nu ƒu ɖe nyitsu kple afɔkpodzi, si naa ŋutigbalẽa kekena sesĩe, tea ʋuka suewo, si wɔnɛ be vevesesea nu sẽna ɖe edzi, eye wònaa dɔlékuiwutikewo kple ʋumenugbagbevi ɣiwo ƒe dɔwɔwɔ dzi ɖena kpɔtɔna. Ne ètsɔ afɔa ɖo akɔtaɖonu siwo wu dzia ƒe kɔkɔme dzi la, tsi si sɔ gbɔ ɖe eme la dona eye wònana wòhayana kabakaba ŋkeke geɖe.

Ðe ame aɖe ate ŋu axɔ cellulitis le afɔ eveawo me le ɣeyiɣi ɖeka tututu mea?¶

Dɔlékui ƒe lãmenugbagbeviwo ƒe dɔléle sesẽ vavãtɔ si gblẽa nu le afɔ eveawo siaa ŋu le ɣeyiɣi ɖeka me la mebɔ kura o negbe ɖe amea xɔ dzo alo abi si me dɔlékui le le afɔ eveawo ŋu zi ɖeka hafi. Le nɔnɔme siwo wu 90 le alafa me siwo me ame tsitsi aɖe ƒe afɔ evea siaa biãna atraɖii, woƒe afɔwo vuvu, eye wo vuvu tso afɔkpodzi va ɖo nyivi titina asrã manɔmee me la, nɔnɔmea ŋutɔŋutɔe nye venous stasis dermatitis (vein valve circulation nyuie o), si bia be woakɔ afɔ ɖe dzi ahatsɔ aŋe aƒoe tsɔ wu be woazã dɔlékuiwutikewo enuenu.

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• Dɔléle siwo xɔa dɔlékuiwo ƒe habɔbɔ si le Amerika (IDSA, United States): Dɔwɔwɔ ƒe Mɔfiamewo hena ŋutigbalẽ kple lãmenugbagbevi falɛfalɛwo ƒe dɔlélewo didi kple wo dzi kpɔkpɔ (Stevens et al., Dɔléle siwo xɔa dɔlékuiwo le dɔdaƒe, purulent vs. non-purulent SSTI pathways, MRSA abscess incision and drainage, kple necrotizing infection triage).
• Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE, United Kingdom): Cellulitis kple Erysipelas: Dɔlékuiwutikewo ƒe Atikewɔwɔ (NICE Mɔfiame NG141) kple Sepsis: Dzesidede, Dɔlélewo Didi Kple Wo Dzi Kpɔkpɔ Kaba (NG51).
• Xexeame ƒe Amekoko Kpata Habɔbɔ (WSES) kple Amekoko Dɔlékui Habɔbɔ Europa (SIS-E): WSES/GAIS/SIS-E/WSIS/AAST Xexeame Katã ƒe Dɔdamɔnu Mɔwo na Dɔnɔ siwo ŋu ŋutigbalẽ kple lãmeka falɛfalɛwo ƒe dɔléle le.
• Dɔlélenutsitsi Kple Mɔxexe Ðe Enu Dɔwɔƒewo (CDC, United States): Dɔwɔƒe ƒe Mɔfiame na Hadometɔwo ƒe Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Ŋutilãmedɔlélewo kple Vibrio vulnificus Abidɔlékuiwo.
• Surviving Sepsis Campaign (SCCM / ESICM, International): Dukɔwo Dome Mɔfiamewo na Sepsis kple Septic Shock Dzikpɔkpɔ.

Mɔfiame siwo do ƒome kplii¶

• Necrotizing fasciitis (lã ɖuɖu dɔlékui) kple cellulitis red flags
• Sepsis kple septic shock ƒe dzesidede kple triage kpata
• Orbital cellulitis, cavernous sinus thrombosis, kple mo ƒe afɔku-dzogoe etɔ̃ ƒe dɔlékuiwo
• Aklã me ʋu ƒe sisi kple ʋuka goglo me ʋu ƒe sisi (DVT) .
• Lãwo ƒe ɖuɖu, avuwo ƒe ƒoƒo, kple dɔlélenutsiŋutete ƒe mɔxexeɖedɔléle nu