Transcript imunity-skin-and-soft-tissue-infection-copy

MANAGEMENT
OF
SKIN & SOFT TISSUE INFECTIONS
WITH AYURVEDA w.s.r. Ayurvedic
Rasayan Chikitsa
DR.SHAILESH S. PHALLE
MD (AYURVEDA MEDICINE )
Ayurved consultant at Ayusanjivani ayurveda
www.ayusanjivani.com
INTRODUCTION :
Suffered by everyone at least once in life time,
most common infection and challenge to a
physician in his day today practice but
unfortunately the most misdiagnosed and
mismanaged these days.
 SSTI s can be defined as an inflammatory
microbial invasion of the epidermis ,dermis and
subcutaneous tissues.
 ‘‘ Over use of antibiotics is a global problem’’.
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Anatomy of skin :
Skin and Soft Tissue Infections
General Considerations :
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Primary vs. Secondary infections
Portal of entry(micro organism entry)
Status of host defenses (IMMUNITY )
Associated manifestations
 Toxicity, severity of illness
Localization and morphology of lesions
Environmental exposure
Classification :
SSTI may be classified according to the
1.Layer of infection
2.Severity of infection
3.Microbiologic aetiology.
(A-The practice guidelines of the infectious Diseases Society of
America (IDSA) For the diagnosis element of SSTI’s)
Classifies into five categories 1-Superficial uncomplicated infection :
(includes Impetigo,Erysipelas and Cellulitis)
2-Necrotising infection
3-Infections associated with bites and animal
contact
4-surgical site infections
5-Infections in the immunocompromised host
Classifications
:
B-Classification according to the layer affected :
 Epithelium
:Varicella and measels
 Keratin layer
:Ring worm (Dermatophyte fungi )
 Epidermis
:Impetigo (streptococcus pyogenes ,
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staph.aureus)
 Dermis
:Erysepelas (streptococcus pyogens )
 Hair follicles
:Folliculitis ,boils,carbuncles(S.aureus)
 Sebum glands
:Acne (Propionobacterium acnes)
 Subcutaneous fat: Cellulitis (Beta hemolytic Strepto. )
 Fascia
: Necrotising fascitis (strept.pyogenes and
anaerobic infection)
C-Purulent OR non –purulent :
1-Purulent
: e.g. Furuncle,abscess,carbuncles,Folliculitis
2-Non –purulent : e.g. cellulitis,erysipelas,Impetigo
Classification :continued
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D-Eron classification ,based on the severity of
local and systemic signs is also useful
1-class1:SSTI but NO signs or symptoms of
systemic toxicity or co-morbidities.
2-Class 2 :Either systemically unwell or
systemically well but with COMORBIDITY that
may complicate or delay resolution.
3-CLASS-3: TOXIC AND UNWELL
(Fever,tachyacardia,tachypnoea and or
hypotension )
4-class 4 :SEPSIS SYNDROME and life
threatning infection.
SECONDARY PYODERMAS
 Bite
wounds
 Infections
of burns, wounds, or underlying
dematitis
 Diabetic
wound infections
 Decubitus
 Surgical
ulcers
wound infections
Manifestation
Characteristics
Microbiology
Comments
Purulent SSTIs :
Abscess :
Collection of pus within
dermis,
Folliculitis:
Immunocompetent
patients: Staphylococcus
Inflammation of hair
aureus
follicles
Immunocompromised
patients: gram-negative
Purulence limited to
organisms (e.g.,
epidermis
Klebsiella, Proteus, or
Common on beared,arms
Enterobacter species)
back,buttocks
Polymicrobial, commonly
skin flora (staphylococci
erythema with fluctuance and streptococci),
organisms from adjacent
on palpation,
mucous membranes
overlying pustule may be
present
Considered complicated if
perianal or perineal areas
are affected
Common in body areas
associated with friction
and heavy perspiration
Furuncle :
Purulence surrounding
hair follicles and more
extensive than follculitis
Immunocompetent
patients: S. aureus
Immunocompromised
patients: gram-negative
extends to subcutaneous
organisms (e.g.,
tissue .Carbuncle is
Klebsiella, Proteus, or
mixture (coalescence ) of
Enterobacter species)
several furuncles.
Common in body areas
associated with friction
and heavy perspiration
Nonpurulent SSTIs :
Cellulitis
Unlike erysipelas,the
borders are not elevated
or sharpely demarcated,
warmth edema,
Streptococci without
Often occurs with trauma;
abscess formation,
sequelae may include
staphylococci with abscess lymphangitis,
necrotizing infections,
gangrene
Pain
Regional
lymphadenopathy
Erysipelas
Intense erythema; welldemarcated border
painful plaque
Beta-hemolytic
streptococci, commonly
Streptococcus pyogenes
More common with
extremes of age (very
young or old)
Staphylococci or
streptococci
Commonly seen in
preschool-aged children;
associated with poor
hygiene, humid or warm
temperatures
Impetigo
Crusted exudates with
pustules or vesicles,
common on face and
extremities
Moderate:
SIRS
Severe:
septic, failed treatment,
immunocompromised, deep
involvement
Stevens, DL, Bisno, AL, Chambers, HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by
the Infectious Diseases Society of America. Clin Infect Dis. 2014.
Empiric Oral Treatment against MRSA
Daum, RS. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007; 357:380-90.
Treatment plan of SSTIs
Antibiotics : PENICILLIN
 Antifungal
 Medications steroids
 I & D AND Dressing care
 Nutrition
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 Improve
Immunity
What about resistant ??
Recent data has shown us:Emerging resistance
Community acquired (CA)- Methicillin-resistant
Staphylococcus aureus (MRSA) greatest concern ??
What we have to do ?
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Better understanding of mechanisms of antimicrobial
resistance.
- e.g.selective pressure
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Better understanding of risk factors predisposing to CAMRSA infection
Future :
 Molecular
testing for resistance organisms
 Newer antimicrobials ?
 Adopt immunomodulator medicines for treatment
Building a better mouse trap ?
ROLE OF RASAYANA :
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Ayurveda is aimed for the maintenance of dhatusamya .
It is basically achived by preservation of health.
Concept of rasayana is designed for both condition that is
health as well as disease.
Rasayana works at various levels in the body and overall
result in absolute state of vyadhikshamatva .
Here more emphasis is given on the improvement of internal
invironment rather than cure and destruction of disease
agent . Rasayan chikitsa is capable to full fill this aim.
Results of various studies on rasayan shows that it works as
a immunomodulator in both conditions that is health and
disease.
“SEVEN DHATUS- Rasayan karma”
Dhatu or Body
Tissue
1.
2.
Rasa
Rakta
3.
4.
5.
6.
7.
Mansa
Meda
Asthi
Majja
Shukra
Medicinal Plants
Guduchi, Neem,
Haridra, Punarnava,
Neem
Aswagandha
Pippali
Aswagandha, Guduchi
Guduchi
Aswagandha
With Imunocin
Host Defense mechanism prevails, eradicating microbes
IMMUNITY
COMPONENTS
ENHANCERS
Ashwagandha
Punarnava
PIPPALI
Haridra
Guduchi
Tulsi,Neem
HERBAL
INGREDIENTS TO
IMPROVE IMMUNITY
HERBS & IMMUNITY
 Improves phagocytic activity of the
polymorphonuclear cells.
 Enhances immunoglobulin synthesis.
 Increases the chemotaxis of polymorphs at
the site of infection.
 Possesses antibacterial, anti-inflammatory
and wound healing properties.
 Exhibits potent
antioxidant activity.
1.ASHWAGANDHA
(Withania somnifera)
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Withania somnifera or Indian winter cherry
Ashwagandha is a stimulant of immune system. It
increases concentration of red blood cell counts and
white blood cell counts & enhances the function of T
cells & B cells.
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Ashwagandha Possess great healing properties
therefore has great effects in healing wounds and
injuries.
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Ashwagandha Works as a rasayan i.e. a substance that
helps in preventing early aging (antioxidant properties )
and rejuvenates whole body to provide youth.
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Ashwagandha extracts, has strong pleiotropic
biological effects related to immune health and
stress reduction.
These include increasing cytokine levels and
phagocytosis, as well as reducing corticosterone
levels.
North American Journal of Medical Sciences 2011 July, Volume 3. No. 7.
Immune enhancing effects of WB365, a novel
combination of Ashwagandha (Withania somnifera) and
Maitake (Grifola frondosa) extracts
Vaclav Vetvicka, Jana Vetvickova Department of Pathology, University of Louisville, Louisville,
KY, USA
2:GUDUCHI (Tinospora cordifolia)
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Guduchi helps to increase the effectiveness &
functioning of protective WBC(Innate &
Adaptive) and builds up the body's own
defense mechanism .(immune system)
Guduchi inhibits growth of bacteria and
enhances the buildup of Surface Barriers .
Research suggests that Guduchi possesses
antibacterial, anti-inflammatory, antirheumatic, and anti-allergic properties.
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The direct drug treatment to J774A cells showed activation as
assessed by biochemical assays.
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Enhanced secretion of lysozyme by macrophage cell line
J774A on treatment with Tinospora cordifolia and
lipopolysacharide was observed, suggesting activated state of
macrophages.
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The enhanced inhibitory effects of T. cordifolia (direct effect) and T.
cordifolia treated cell supernatant (indirect effect) on the bacteria
(E. coli) indicates the susceptibility of bacteria. This study is an
attempt to check the potential significance of the T. cordifolia to be
used as immunomodulator for activation of macrophages.
Int Immunopharmacol. 2004 Jun;4(6):841-9.
Immune response modulation to DPT vaccine by aqueous extract of Withania somnifera in
experimental system.
Gautam M, Diwanay SS, Gairola S, Shinde YS, Jadhav SS, Patwardhan BK.
Source :
Bioprospecting Laboratory, Interdisciplinary School of Health Sciences, University of Pune,
Pune 411007, Maharastra, India. [email protected]
Abstract :
The immunostimulation was evaluated using serological and hematological parameters.
Treatment of immunized animals with test material (100 mg/kg/day) for 15 days resulted
in significant increase of antibody titers to B. pertussis (P=0.000007). Immunized animals
(treated and untreated) were challenged with B. pertussis 18,323 strain and the animals
were observed for 14 days. Results indicate that the treated animals did show significant
increase in antibody titers as compared to untreated animals after challenge
(P=0.000003).
Immuno protection against intracerebral challenge of live B. pertussis cells was evaluated
based on degree of sickness, paralysis and subsequent death. Reduced mortality
accompanied with overall improved health status was observed in treated animals after
intracerebral challenge of B. pertussis indicating development of protective immune
response. Copyright 2004 Elsevier B.V.
Indian J Pharmacol. 2008 Jun;40(3):107-10.
Immunomodulatory effect of Tinospora cordifolia extract in human
immuno-deficiency virus positive patients.
Kalikar MV, Thawani VR, Varadpande UK, Sontakke SD, Singh RP,
Khiyani RK.
CONCLUSION:
Tinospora cordifolia extract, a plant derived immunostimulant,
significantly affected the symptoms of HIV. This was validated by
clinical evaluation. However not all of the objective parameters studied
by us, Tinospora cordifolia could be used as an adjunct to HIV/AIDS
management.
3.NEEM (Azadirachta indica) :
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Neem enhances immune system by boosting both
the lymphocytic and Leukocytes systems, including
"Killer T”, “B Cells”, “Neutrophils”, “Macrophages”.
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Compounds of Neem helps to control fungi that can
causes athlete's foot, ringworm and candida.
It having anti fungal as well as antibacterial
property.
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4.PUNARNAVA (Boerhaavia diffusa) :
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Punarnava produces significant
leucocytosis.
Studies have revealed that punarnava is
an excellent diuretic, anti-inflammatory,
mild laxative and is a heart tonic.
Punarnava is also used in treating
obesity, improving appetite, jaundice,
and general fever.
5.TULSI (Ocimum sanctum)
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Tulsi is an immuno-modulator is an agent that
balances and improves the immune response
of the body in fighting antigens & exhibits
anti–microbial property.
Tulsi is rich in antioxidants and is
recommended to guard against free radicals
and protect body cells.
Tulsi is an adaptogen that helps the body
adapt more efficiently to stress & reduce the
intensity and negative impact of the stress.
6.HARIDRA (Curcuma longa) :
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Haridra is nature’s own antiseptic and
antimicrobial which helps to fight against
recurrent infections.
Haridra possesses powerful antioxidant
properties and has been prescribed in the
treatment of inflammatory, biliary, and
respiratory disorders..
Haridra has anti-hepatotoxic (liversupporting) properties.
7.PIPPALI (Piper longum) :
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Pipali is most commonly used to treat
respiratory infections, bronchitis,
diseases of spleen, tumor, cough and
asthma.
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Pippali acts as an anti-allergic and
hepatoprotective.
Non healing ulcers :
Non healing ulcers :
Cellulitis :
Eczema :
Psoriasis :
THANK YOU……………………