Influenza (Avian and other zoonotic)
Thrombophlebitis Migrans
A 90-year-old man presented with multiple acute, painful, palpable, planar, partly restiform areas of thrombophlebitis over his upper and lower arms. Within the previous 14 days no blood samples had been taken and no peripheral venous indwelling catheters had been inserted. A few weeks earlier, the patient had been diagnosed with hairy-cell leukemia (a low-malignant-potential B-cell non-Hodgkin lymphoma) and started on a course of cytostatic treatment with cladribine. On the basis of the patient's medical history and the characteristic clinical signs, we diagnosed thrombophlebitis migrans. This disease, also known as Trousseau syndrome, is a facultative paraneoplastic syndrome and thus may represent a sign of tumor disease. Etiologically, thrombophlebitis migrans probably arises from an intravasal coagulation caused by procoagulatory factors of the tumor disease. When confronted with an unusual presentation of thrombophlebitis without a readily identifiable cause, one should therefore always consider occult tumor disease as a possible cause. Besides anti-inflammatory drugs and compression treatment, coagulation inhibitors such as low-molecular heparins can be administered. In the case described here, treatment with the selective factor Xa inhibitor fondaparinux led to rapid healing of all the patient's lesions.
Dr. Med. Bijan Koushk-Jalali, Dr. Med. Christian Tigges, Prof. Dr. Med. Alexander Kreuter, Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten-Herdecke, alexander.Kreuter@helios-gesundheit.De
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Koushk-Jalali B, Tigges C, Kreuter A: Thrombophlebitis migrans. Dtsch Arztebl Int 2020; 117: 125. DOI: 10.3238/arztebl.2020.0125
What To Know About Carbuncles
A carbuncle is a cluster of furuncles, or boils, that develops under the skin. A carbuncle can be painful and tender to the touch. Home remedies and medical treatments may help.
Furuncles and carbuncles typically happen as a result of staphylococcal infection. They develop when the infection affects the hair follicle and surrounding tissue. This can cause some swelling and other symptoms.
Read on to learn more about the symptoms and causes of carbuncles. This article also looks at treatment options, possible complications, when to contact a doctor, and more.
View the slideshow below for photos of carbuncles.
A carbuncle is a dome-shaped cluster of boils. It most commonly develops on the:
Carbuncles typically develop over a few days, and will usually measure around 3–10 centimeters (cm). It can cause pain and tenderness.
Other symptoms a person may experience include:
Staphylococcal infection usually causes carbuncles. They develop when the infection causes boils to develop in the hair follicles and surrounding tissues.
Staphylococcus aureus (S. Aureus), also known as staph bacteria, lives on the skin and inside the nose and throat. Usually, the body's immune system keeps them under control, but sometimes they enter the skin through a hair follicle, or through a cut or graze in the skin.
When the skin becomes infected, the immune system responds by sending white blood cells to the affected area to destroy the bacteria. Pus is an accumulation of dead bacteria, dead white blood cells, and dead skin.
This can result in a boil, which can cluster together to form a carbuncle.
Learn more about bacterial skin infections.
Anybody can get carbuncles. However, factors that increase the likelihood of boils include:
Carbuncles are less common than boils. They are more likely to affect people assigned male at birth who are middle-aged.
To assist with reaching an accurate diagnosis, a doctor will usually begin by performing a physical examination and asking questions about symptoms.
If they suspect a carbuncle, they will then usually use a swab to table a sample from the carbuncle. This will allow them to obtain a bacterial culture to confirm the presence of S. Aureus.
A sensitivity test on the sample can help determine the best type of treatment for the infection.
The doctor may use a sterilized needle to lance the abscess, which means pricking it and draining the pus away.
A person must not drain the boils at home. It is important that this happens in a sterile environment by a medical professional with the right equipment.
The doctor will also usually recommend antibiotics. A should follow the guidelines their doctor gives them for taking the antibiotics to help ensure that the infection does not return.
If a person suspects they have a carbuncle, it is important to contact a doctor for advice, as it may be necessary to drain the carbuncle in a sterile environment and treat the infection with antibiotics.
However, the doctor may also recommend some home remedies to help ease symptoms. These can include:
A person can take over-the-counter pain relief medication, such as ibuprofen, to help manage the pain.
It is important not to try to burst or squeeze carbuncles. This can cause the infection to spread and increase the risk of complications.
Learn more about home remedies for boils.
It is important to contact a doctor as early as a person suspects they have a carbuncle, as medical treatment may be necessary.
A boil usually goes away after around 2 weeks without treatment. If it does not go away in this time, or if fever accompanies the abscess, this could indicate a carbuncle.
Patients with a chronic condition such as diabetes or cancer, or those who are taking immunosuppressive medications, should consult their doctor if they have boils or a carbuncle.
If a person frequently gets boils, they may also wish to contact their doctor for advice on ways to help prevent them. This can also help reduce the likelihood of them developing into a carbuncle.
Possible complications of carbuncles include:
Contacting a doctor if a person suspects they have a carbuncle and following a suitable treatment plan can help reduce the risk of complications.
Learn more about boils and cellulitis.
Ways of preventing boils and carbuncles include:
Eating a healthy, well-balanced diet and getting regular physical exercise will improve your general health and your immune system, reducing the risk of developing boils and carbuncles.
A carbuncle is a collection of furuncles, or boils. It can develop when an infection affects the hair follicles and surrounding tissues.
Symptoms of a carbuncle can include pain, tenderness, and swelling. It can also cause fever, weakness, and exhaustion.
Doctors may recommend draining the carbuncle. They may also prescribe antibiotics to treat the infection. Some home remedies, such as applying a warm compress and covering the carbuncle with a clean dressing, may also help.
It is important to contact a doctor as soon as a person suspects they have a carbuncle. The doctor can advise on a suitable treatment plan to help the carbuncle heal, prevent recurrence, and reduce the chance of complications.
Polymyxin B Inj
Polymyxin B Inj Generic Name & Formulations General DescriptionPolymyxin B sulfate 500,000units/vial; pwd for IM, intrathecal inj, IV drip or ophthalmic use after reconstitution.
Pharmacological ClassAntibiotic.
How SuppliedContact supplier.
Polymyxin B Inj Indications IndicationsSusceptible infections due to P. Aeruginosa including UTIs, meninges, bloodstream, and eye infections. Other serious susceptible infections including H. Influenza meningeal, E. Coli UTIs, and bacteremia due to A. Aerogenes and K. Pneumoniae.
Polymyxin B Inj Dosage and Administration Adults and ChildrenInfants: up to 40,000units/kg per day IV or IM inj. Adults and children: IV: 15,000–25,000units/kg per day in divided doses every 12 hours; max 25,000units/kg per day. IM: 25,000–30,000units/kg per day in divided doses every 4–6 hours. P. Aeruginosa meningitis: Give by intrathecal inj only. <2yrs: 20,000units once daily for 3–4 days or 25,000units once every other day, continue with 25,000units once every other day; >2yrs: 50,000units once daily for 3–4 days, then 50,000units once every other day; both: treat for at least 2 weeks after negative CSF cultures and sugar content normalized. Ophthalmic: see literature. Renal impairment: adjust or reduce dose.
Polymyxin B Inj ContraindicationsNot Applicable
Polymyxin B Inj Boxed WarningsNot Applicable
Polymyxin B Inj Warnings/Precautions Warnings/PrecautionsRenal impairment. Monitor renal function before and during therapy; discontinue if nephrotoxicity occurs. Pregnancy: not recommended.
Polymyxin B Inj PharmacokineticsSee Literature
Polymyxin B Inj Interactions InteractionsAvoid other neurotoxic and/or nephrotoxic drugs (eg, bacitracin, aminoglycosides, colistin). May potentiate neuromuscular blockade with anesthetics and/or muscle relaxants.
Polymyxin B Inj Adverse Reactions Adverse ReactionsNephrotoxicity (eg, albuminuria, azotemia, cylindruria), neurotoxicity (eg, flushing, dizziness, paresthesias), meningeal irritation (intrathecal), drug fever, rash, inj site pain, thrombophlebitis; respiratory paralysis (discontinue if occurs).
Polymyxin B Inj Clinical TrialsSee Literature
Polymyxin B Inj Note NotesFormerly known under the brand name Aerosporin.
Polymyxin B Inj Patient CounselingSee Literature
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