Abstract: Carbuncle is an uncommon skin and soft tissue infection, predominantly occurring in diabetics. It is quite surprising that there are very few series on carbuncle over last 2-3 decades. The aim of this study is to provide our experience on carbuncle in diabetics. Majority of the carbuncles occur over the nape of the neck (40%). Most patients present to the hospital 2 weeks after the onset of the symptoms. Our study shows that staphylococcus aureus continues to be the commonest bacteria isolated. There is no mortality in this series

Amit Kumar

C Jain

DNB Mbbs

Nisha St

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Scholars Journal of Applied Medical Sciences (SJAMS)             ISSN 2320-6691 
Sch. J. App. Med. Sci., 2013; 1(5):493-495 
©Scholars Academic and Scientific Publisher       
(An International Publisher for Academic and Scientific Resources) 
www.saspublisher.com 
                           
    493 
 
 
Research Article 
 
Carbuncle in Diabetics-Our Experience 
Amit Kumar C Jain
1
, Nisha ST
2
, Viswanath S
3 
1MBBS, DNB, Assistant Professor, Department of Surgery, St. John’s Medical College, Sarjapur Road,  
Bangalore -560034, India. 
2MBBS, Intern, Department of surgery, St. John’s Medical College, Sarjapur Road, Bangalore -560034, India. 
3MBBS, DNB, Associate Professor, Department of Surgery, St. John’s Medical College, Sarjapur Road,  
Bangalore -560034, India. 
 
Corresponding author  
Dr. Amit Kumar C Jain  
Email:   
 
Abstract: Carbuncle is an uncommon skin and soft tissue infection, predominantly occurring in diabetics. It is quite 
surprising that there are very few series on carbuncle over last 2-3 decades. The aim of this study is to provide our 
experience on carbuncle in diabetics. Majority of the carbuncles occur over the nape of the neck (40%). Most patients 
present to the hospital 2 weeks after the onset of the symptoms. Our study shows that staphylococcus aureus continues to 
be the commonest bacteria isolated. There is no mortality in this series. 
Keywords: Carbuncle, Diabetics, Neck 
 
INTRODUCTION 
 Skin carbuncle is a necrotizing infection of the skin 
and subcutaneous tissues composed of a cluster of 
furuncles with multiple draining sinuses [1, 2]. It is in 
fact an infective gangrene of the skin and subcutaneous 
tissue [3, 4, 5]. The word carbuncle is believed to have 
originated from the latin: Carbunculus, which means 
charcoal [3, 6]. Carbuncle was recognized as a 
complication of diabetes by charak and sushruta (600-
400 BC) [7]. Carbuncle is often a broad, swollen, 
erythematous, deep and painful mass that usually open 
and drain through multiple channels [2]. They are 
commonly associated with diabetic patients [7, 8]. 
Carbuncles are often found on the nape of the neck, 
shoulders, hips, etc [3, 4]. It is quite astonishing that the 
studies on carbuncle are quite sparse with hardly a 
handful of series over the last 2-3 decades. The aim of 
this study is to provide our small experience with 
carbuncle in diabetes. 
 
MATERIALS AND METHOD 
 A retrospective analysis was done from October 2009 
to December 2012, in surgical unit ‘3’ of department of 
surgery at St John’s medical college, Bangalore, India, 
which is a tertiary care referral institute. The inclusion 
and exclusion criteria’s is as follows 
 
Inclusion criteria 
 All carbuncles admitted and treated in our unit 
 Type 2 diabetes mellitus 
 
Exclusion criteria 
 Patients admitted in other surgical units 
 Patients who were operated at another hospital 
and were following with us. 
 Patients who refused our treatment 
 Patients with incomplete records/data 
 
RESULTS 
 Around 21 patients with carbuncle were seen during 
this period out of which 15 patients were included in 
our study. 9 patients (60%) were males and 6 patients 
(40%) were females. The age for males ranged from 40 
– 82 years with an average age of 60.55 years and the 
age for females ranged from 35 – 81 years with an 
average age of 56.67 years.  The commonest site (Table 
1) of carbuncle was neck (40%) followed by the back 
(26.67%). 
 
Table 1: Showing the distribution of carbuncle 
according to the site of occurence 
 
Sl. 
No. 
Site of 
carbuncle 
Number  Percentage 
1.  Nape of the 
neck 
    6       40% 
2.  Back     4      26.67% 
3.  Shoulder/arm     2      13.33% 
4.  Gluteal region     1       6.67% 
5.  Thigh     2      13.33% 
  Total     15      100% 
 
 
 Swelling was the most common presenting symptom 
in 86.67% of the patients followed by the pain 
(66.67%). 33.33% of the patients had both fever and 
pus discharge (Table 2). Majority of the patients (40%) 
presented with symptoms of more than 2 weeks of 
duration (Table 3). 
 
 
Kumar  et al., Sch. J. App. Med. Sci., 2013; 1(5):493-495 
 
    494 
 
 
Table 2: Showing the presentation of the common 
symptoms of carbuncle 
 
Sl. No. Symptoms Number  Percentage 
1. Swelling    13     86.67% 
2. Pain    10     66.67% 
3. Fever     5     33.33% 
4. Pus discharge     5     33.33% 
 
Table 3: Showing the duration of presentation of 
carbuncle 
 
    Duration   Number Percentage 
   < 7 days       5      33.33% 
  7 – 14 days       4      26.67% 
   >14 days       6      40% 
     Total       15      100% 
 
 
Fig. 1: showing the carbuncle over the back. Note 
the sieve like appearance. 
  
 13 Patients (80%) required surgery only once 
whereas 3 patients (20%) required surgery twice. 11 
patients (73.33%) grew staphylococcus aureus out of 
which 3 were MRSA (20%) and 4 patients did not grow 
any organism. 
 There was no mortality in our series. 
 
DISCUSSION 
 Skin and soft tissue infections are common in 
diabetics, especially when uncontrolled. Carbuncle 
belongs to a group of superficial soft tissue infections 
related to infection of hair follicles [2].  
 
 The common sites of carbuncle include nape of the 
neck and the back. The skin over these areas is coarse 
and vitality of the tissue is less [3, 4]. The other sites 
include shoulders, hips, thigh and over the abdomen [1, 
4].  
 
 The most common organism is staphylococcus 
aureus, both methicillin sensitive and methicillin 
resistant strains [2]. Gram negative bacilli and 
streptococci [9] are uncommon organism. The bacteria 
penetrates the skin and the subcutaneous tissues to form 
a series of communicating abscesses, which discharge 
by separate opening on the surface (sieve like 
appearance) [3, 4]. There is a central large slough, 
surrounded by a rosette of small area of necrosis [3, 4], 
due to destruction of the small blood vessels [10]. 
 
 The carbuncle affects adults and children’s are spared 
[11]. It occurs more commonly in diabetics due to an 
impaired leucocyte function.  
 
 Earlier, carbuncles were arbitrarily classified into 
localized nontoxic, localized toxic and spreading [5]. 
This classification is not used now. 
 
 The classical treatment of carbuncle is excision of all 
the necrotic tissue with adequate surgical drainage of 
pus and broad spectrum antibiotics [1, 2]. The wound is 
allowed to heal and later a skin graft, secondary 
suturing or a local skin flap may be employed to close 
the defect [1, 2]. 
 
 We did not include the secondary procedures like 
skin grafting, local flap, etc in our study as most of our 
patients are lost for follow up once the acute problem of 
the patient is dealt. 
 
CONCLUSION 
 Carbuncle in diabetics affects the nape of the neck 
most commonly. Staphylococcus aureus is the most 
common isolated organism. Around 40% of the patients 
presents with symptoms of more than 2 weeks duration. 
20% of patients with carbuncle require repeat surgery. 
There is no mortality in our series of carbuncle. 
 
REFERENCES 
1. Mohammed JA, Al-Ajmi S, Al-Rasheed AA; 
Surgical management of post carbuncle soft 
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2. Chelliah G, Hamzah AA, Ahmed MZ, Ahmad 
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3.  Bhat SM; SRB’s manual of surgery. 3rd 
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6. Carbuncle; Available from 
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8. Hee TG, Jin JB; The surgical treatment of 
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Carbuncle in Diabetics-Our Experience

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Carbuncle in Diabetics-Our Experience

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