Recurrent furunculosis – challenges and management: a review

Abstract

Furunculosis is a deep infection of the hair follicle leading to abscess formation with accumulation of pus and necrotic tissue. Furuncles appear as red, swollen, and tender nodules on hair-bearing parts of the body, and the most common infectious agent is Staphylococcus aureus, but other bacteria may also be causative. In some countries, methicillin resistant S. aureus is the most common pathogen in skin and soft tissue infections which is problematic since treatment is difficult. Furunculosis often tends to be recurrent and may spread among family members. Some patients are carriers of S. aureus and eradication should be considered in recurrent cases. Solitary lesions should be incised when fluctuant, whereas patients with multiple lesions or signs of systemic disease or immunosuppression should be treated with relevant antibiotics. The diagnostic and therapeutic approach to a patient suspected of staphylococcosis should include a thorough medical history, clinical examination, and specific microbiological and biochemical investigations. This is particularly important in recurrent cases where culture swabs from the patient, family members, and close contacts are mandatory to identify and ultimately control the chain of infection. Focus on personal, interpersonal, and environmental hygiene issues is crucial to reduce the risk of contamination and recurrences.

<b><i>Staphylococcus aureus</i></b> and Host Immunity in Recurrent Furunculosis

“…Also, in patients with an impaired structure and skin functioning as a barrier which is common in patients with atopic dermatitis, recurrent and severe furuncles are observed [18-20]. Nevertheless, in immunocompetent patients without any history of atopy and metabolic diseases, factors that determine predisposition to the development and recurrence of furuncles are understudied and not fully explained [21]. In the study by Durupt et al [22] carried out on a large group of patients, nasal carriage of S. aureus was found in 37 out of 64 (58%) patients with culture-confirmed staphylococcal infection of the skin.…”

Recurrent Furunculosis: incidence of anaerobes and fungi

“…1 Recurrent furunculosis (RF) is generally defined as three or more attacks within a 12-month period. 2 Colonization of S. aureus in the anterior nares plays a definite role in the etiology of chronic or recurrent furunculosis.…”

“…3 Especially, enteric species such as Enterobacteriaceae and Enterococci are often present at these sites. 1 The aim of this retrospective study is to analyze the incidence of anaerobes and fungal etiologies in cases of recurrent furunculosis.…”

Antibacterial Activity of Caraway Essential Oil Against Staphylococcus Aureus Isolated From Patients With Furunculosis

“…Boils are often located on the limbs and neck, and leave a scar after recovery (Demos et al, 2012). If several adjacent lesions are coalesced form carbuncles as a result (Ibler & Kromann, 2014). It has been observed that furunculosis most often spreads among family members.…”

“…Direct contact with an infected person is a major risk factor for the development of furuncles. Other independent factors include diabetes, infection with HIV, alcoholism, anemia, previous antibiotic therapy, skin diseases (especially atopic dermatitis), previous hospitalization, the multiplicity of lesions, poor personal hygiene, deficiency of mannose binding lectin and impaired function of neutrophils (El-Gilany & Fathy, 2009; Stevens et al, 2010;Demos et al, 2012;Ibler & Kromann, 2014). The most important risk factor of recurrent furunculosis is the exposure to the source of infection -most likely nasal carriage of S. aureus.…”