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      Diagnosing Cellulitis of the Penis with Point-of-Care Ultrasonography in a Resource-Limited Setting


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          Cellulitis is a potentially serious bacterial skin infection. Penile cellulitis refers to the inflammation of the penile shaft and commonly occurs in uncircumcised, sexually active young adults. We reported the case of a 25-year-old heterosexual circumcised male patient with a two-day history of swelling and pain over the penile shaft. Local examination revealed a diffusely swollen penile shaft, erythematous, warm to the touch, and tender. The penile discharge culture was suggestive of a Streptococcus species infection. Ultrasonography of the penis showed increased echogenicity of the left side of the penile shaft soft tissue with a markedly increased Doppler signal, indicating cellulitis. Based on these findings, the patient was diagnosed with cellulitis of the penis and managed with broad-spectrum antibiotics. Though history and clinical examination are sufficient to diagnose penile cellulitis, our case highlighted that ultrasound could also support the diagnosis of penile cellulitis and help rule out differentials.

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          Most cited references15

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          Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America.

          A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
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            Cellulitis: A Review.

            Cellulitis is an infection of the deep dermis and subcutaneous tissue, presenting with expanding erythema, warmth, tenderness, and swelling. Cellulitis is a common global health burden, with more than 650,000 admissions per year in the United States alone.
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              Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008

              Background Over the last decade, utilization of ultrasound technology by non-radiologist physicians has grown. Recent advances in affordability, durability, and portability have brought ultrasound to the forefront as a sustainable and high impact technology for use in developing world clinical settings as well. However, ultrasound's impact on patient management plans, program sustainability, and which ultrasound applications are useful in this setting has not been well studied. Methods Ultrasound services were introduced at two rural Rwandan district hospitals affiliated with Partners in Health, a US nongovernmental organization. Data sheets for each ultrasound scan performed during routine clinical care were collected and analyzed to determine patient demographics, which ultrasound applications were most frequently used, and whether the use of the ultrasound changed patient management plans. Ultrasound scans performed by the local physicians during the post-training period were reviewed for accuracy of interpretation and image quality by an ultrasound fellowship trained emergency medicine physician from the United States who was blinded to the original interpretation. Results Adult women appeared to benefit most from the presence of ultrasound services. Of the 345 scans performed during the study period, obstetrical scanning was the most frequently used application. Evaluation of gestational age, fetal head position, and placental positioning were the most common findings. However, other applications used included abdominal, cardiac, renal, pleural, procedural guidance, and vascular ultrasounds. Ultrasound changed patient management plans in 43% of total patients scanned. The most common change was to plan a surgical procedure. The ultrasound program appears sustainable; local staff performed 245 ultrasound scans in the 11 weeks after the departure of the ultrasound instructor. Post-training scan review showed the concordance rate of interpretation between the Rwandese physicians and the ultrasound-trained quality review physicians was 96%. Conclusion We suggest ultrasound is a useful modality that particularly benefits women's health and obstetrical care in the developing world. Ultrasound services significantly impact patient management plans especially with regards to potential surgical interventions. After an initial training period, it appears that an ultrasound program led by local health care providers is sustainable and lead to accurate diagnoses in a rural international setting.

                Author and article information

                Case Rep Emerg Med
                Case Rep Emerg Med
                Case Reports in Emergency Medicine
                15 July 2023
                : 2023
                : 1626736
                1Internal Medicine, Addis Hiwot Hospital, Addis Ababa, Ethiopia
                2Department of Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
                3B. P. Koirala Institute of Health Sciences, Dharan, Nepal
                4University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
                5Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
                6National medical College and Teaching Hospital, Birgunj, Nepal
                7Rajah Muthiah Medical College, Chidambaram, India
                8Tribhuvan University, Institute of Medicine, Maharajgunj 44600, Nepal
                9Department of Emergency, Larkin Community Hospital Palm Springs Campus, Hialeah, Florida, USA
                10Department of Family Medicine, Larkin Community Hospital South Miami Campus, Hialeah, Florida, USA
                Author notes

                Academic Editor: Aristomenis K. Exadaktylos

                Author information
                Copyright © 2023 Yonathan Aliye Asfaw et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 2 March 2023
                : 2 May 2023
                : 8 July 2023
                Case Report

                Emergency medicine & Trauma
                Emergency medicine & Trauma


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