Case Study Analysis of a 42 Year-Old Male with Cellulitis
Scenario: A 42-year-old man comes to the clinic with a chief complaint of pain, redness, and swelling of his right calf. He states that he had been working in his yard using a string trimmer when the trimmer slipped and cut his leg. He cleaned the wound with water from the garden hose and covered the wound with a large Band-Aid. Several days later, he developed a fever to 100.6˚ F and chills and noticed that his leg was swollen and red. He comes to the emergency department for definitive care.
The Assignment (1- to 2-page case study analysis)
Develop a 1- to 2-page case study analysis in which you:
- Explain why you think the patient presented the symptoms described.
- Identify the genes that may be associated with the development of the disease.
- Explain the process of immunosuppression and the effect it has on body systems.
Cellulitis is a serious condition caused by infection of a break in the skin, usually common in the lower limbs. The microorganisms or bacteria that usually cause this infection are those that form the microbiome found in the skin. In other words, they are the normal flora of the skin around the cut or breakage in the skin (Hammer & McPhee, 2018). Any condition that causes a breach in the integrity of the skin or lowered immunity is a predisposing factor to cellulitis. They include obesity, diabetes mellitus, and old age (Cranendonk et al., 2017). The purpose of this paper is to discuss the case of the 42-year-old that suffered an accidental cut on the lower limb and later developed cellulitis.
Why the Patient resented with the Symptoms Described
The patient in the case study presented to the clinic with pain (dolor), redness (rubor), and swelling (tumor). Together with heat or warmth (calor), these are the four major signs of inflammation (Hammer & McPhee, 2018). Hannula-Jouppi et al. (2013) expressly include warmth (calor), fever, leucocytosis, and lymphangitis amongst the presenting symptoms of cellulitis. The most common causes of cellulitis in these circumstances are streptococci and staphylococci. Increasingly, methicillin-resistant Staphylococcus aureus (MRSA) is becoming a common cause of cellulitis and causing serious challenges with antibiotic therapy (Katzung, 2018).
The reason why the patient presented with the symptoms described above and in the case study is that the bacteria that caused the cellulitis infection also caused inflammation in the affected lower limb with the cut (Cranendonk et al., 2017; Hammer & McPhee, 2018). Once they enter the body through the cut, their exotoxins stimulate the release of leucocytes in the local circulatory vasculature of the affected lower limb. These leucocytes then mediate the disruption of endothelial integrity allowing extravasation and infiltration of the affected area by leucocytes. This extravasation of fluid causes the swelling (tumor); with some of the leucocytes acting like phagocytes that engulf the bacteria. The swelling presses on nerve endings causing pain (dolor).
The influx of serous fluid, leucocytes, and other serum components to the affected area of the lower limb makes the skin thinner and appears erythematous or red (rubor). The inflammatory chemokines or chemoattractants cause the blood flow to increase in the area of infection and inflammation. Since blood in the body is generally warm, this causes the warmth (calor) of the swollen site. The fever the patient has is a normal bodily response to infection aimed at altering the normal body homeostasis making it difficult for the bacteria to survive (Hammer & McPhee, 2018).
Genetic Component to Cellulitis
According to Hannula-Jouppi et al. (2013), there is a genetic susceptibility to infection and cellulitis caused by specific host genetic factors. The AGTR1 gene or Angiotensin II receptor type I gene has been strongly linked by scholarly literature to genetic susceptibility to cellulitis and the related condition of erysipelas (Hannula-Jouppi et al., 2013).
The Process of Immunosuppression and Its Effect on Body Systems
Immunosuppression is the repression of the body’s immune system such that it becomes less efficient and effective at protecting the body from disease-causing microorganisms. Immunity is conferred by several lines of defense. The first line of defense is the skin that provides a mechanical barrier to bacterial invasion. In the case of our patient, this skin integrity was breached by the cut. The second line of defense is cellular in status and involves lymphocytes (B cells and T cells), monocytes, and granulocytes (Hammer & McPhee, 2018). Both the first-line and second-line defenses are compromised in immunosuppression. The effect on the body systems is a derangement of functions as the thermoregulatory center raises the body temperature above optimum to try and make it unfavorable for the bacteria.
Cranendonk, D.R., Lavrijsen, A.P.M., Prins, J.M., & Wiersinga, W.J. (2017). Cellulitis: Current insights into pathophysiology and clinical management. The Netherlands Journal of Medicine, 75(9), 366-378. https://www.njmonline.nl/getpdf.php?id=1907
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Hannula-Jouppi, K., Massinen, S., Siljander, T., Mäkelä, S., Kivinen, K., Leinonen, R., … Kere, J. (2013). Genetic susceptibility to non-necrotizing erysipelas/ cellulitis. PLoS ONE, 8(2), e56225. https://doi.org/10.1371/journal.pone.0056225
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. McGraw-Hill Education.