A healthy 30 year old flight attendant presents to your office for the third time in 6 months with a recurrent case of furuncles. You would:
a) obtain a more detailed social history. a) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ b) swab her anterior nares. b) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ c) consider swabbing her umbilicus, groin, gluteal cleft and axilla. c) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ d) consider swabbing the nares of close contacts. d) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ e) obtain a blood glucose. e) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ Answer and Commentary _ _ _ _ _ _ _ _ _ _ All of above. Recurrent furuncles are most commonly due to S. aureus. Frequently the source of infection is the patient themselves, the anterior nares the likely site, with the umbilicus, groin, gluteal cleft and axilla also possible sources. If all of these cultures are negative one must consider close contacts as possible sources. A culture should also be obtained from the furuncle itself by removing its head and swabbing the resultant pus. Occasionally, unusual microbes such as pseudomonas can be the cause, and may require special consideration (can be from contaminated hot tubs, hence the question about "social history"). If a carrier is found for S. aureus, topical therapy with fusidic acid ointment or mupirocin ointment tid for 2-3 days should eliminate the carrier state. If still unable to eradicate the carrier state, a 2 week course of cloxacillin or oral rifampin should suffice. You should also check for underlying diabetes. ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯
