Question

I was completing an ER practicum as a student nurse when I was asked to evaluate a 6-year-old boy who was brought to the ER by his mother. The boy’s mother explained that her son had been stung by a bee on his right index finger a few days prior. She had removed the stinger and washed the area following the incident. Despite her first-aid measures, that morning her son had awoken complaining of pain in the affected area. Upon examining the site, the mother noticed that the area was visibly more reddened than the day before, and the swelling had spread to involve the entire hand and wrist.

The child’s vital signs were normal except for a mild elevation in temperature (37.7°C, or 99.9°F). The affected hand was noticeably swollen, reddened, and warm to the touch. The child cradled his hand and did not use it. When asked, he stated that it “hurt” when he tried to move his fingers. After my examination, the physician on duty examined the boy’s hand and diagnosed him with cellulitis. He prescribed oral antibiotics and instructed the boy’s mother to bring the boy back to the ER if his symptoms worsened.

The patient’s encounter with a bee resulted in a breach of the first line of defense—the skin. The skin is the largest organ of the body and protects the body from the environment. Although few pathogens can penetrate this barrier, bacteria can gain entry through breaks in the skin. In this case, a seemingly innocuous bee sting provided a portal of entry for bacterial invasion.

The symptoms experienced by the patient are typical of the inflammatory response: rubor (redness), calor (warmth), tumor (swelling, or edema), and dolor (pain). The patient also had some loss of function related to discomfort. The symptoms experienced by the patient are evidence that immune components have been attracted to the injury site, and tissue repair and the destruction of microbes are underway.

Research and Review

Please locate this article using an online search engine: Derlet, R.W. and Richards, J.R. (2003). Cellulitis from insect bites: A case series. Cal J Emerg Med 4(2): 27-30. Read the article thoroughly and then answer the questions, linking the introductory case file, the chapter content, and this article.

1. Describe cellulitis, and explain why it is often misdiagnosed as an allergic reaction in the case of insect bites.

2. Summarize the signs and symptoms that occurred after the insect bites in these cases, including their timing.

3. What was the treatment in all seven of these cases, and what does that tell you about the likely causative agents?

4. What microorganisms are usually responsible for most cases of cellulitis? Conducting further research, describe these organisms, including other infections that they can cause?

5. Compare the cases in this article to the boy in the introductory case file.

Answer 1

1. CelluIitis is an acute infection of the skin commonly fo acquired after the bacteria innoculates through a break in the skin barrier. They occur majorly in the emergency department. Staphylococcus and streptococcus species are responsible for the condition. It is often misdiagnosed as an allergy response as the symptoms of both the condition overlap

2.Within a few minutes pain, erythema and warmth which disappeared within 30 minutes and upto 8 hoursof cleaning the wound with betadine. Within the 24 hours, new erythema developed which increased and became tender withing 48 hours.The patient had elevated blood pressure, beats per minute, temperature and respiratory rate.

3. In all seven cases, antibiotics were given as a treatment which means that the condition is not an allergic reaction but a cellulitis infection caused upon injury, abrasion etc. by bacteria staphylococcus and streptococcus.

4. Staphylocccus.

5. The boy and the 7 patients in the article developed, deiagnosed and treated for cellulitis.