151: Cellulitis and Erysipelas Flashcards
What are the common clinical features of cellulitis?
- Ill-defined erythema and edema
- Often warm and painful
- Most common site: lower extremity (adults); also upper extremities, trunk, head, and neck
- Facial involvement: children > adults
- Majority unilateral; bilateral involvement prompts consideration of an alternative diagnosis
- Linear streaking, lymphangiitis, and tender regional lymphadenopathy may be observed
- Peau d’orange appearance indicates significant involvement of lymphatics or superficial edema
- Bulla formation and superficial necrosis may occur
- Hemorrhage can occur due to disruption of superficial vessels by inflammation and edema
- Crepitus, anesthesia, or disproportionate pain should raise concern for necrotizing soft-tissue infection.
What are the complications associated with cellulitis?
- Lymphedema from lymphatic damage, increasing the risk of recurrence
- Superficial thrombophlebitis, which may be seen in the acute setting
- Bacteremia (5%) leading to sepsis, bacterial endocarditis, postinfectious glomerulonephritis, and toxin-mediated systemic syndromes
- Spread of infection to deeper tissues is rare in the absence of other risk factors or chronic systemic disease.
How does erysipelas differ from classic cellulitis?
Erysipelas
- Sharply demarcated and bright red
- Leg (76%-90%)
- Fever more common
- Recurrence may be observed
- Systemic complications less common
Classic Cellulitis
- Ill-defined plaques
- Lower extremity
- Fever less common
- Recurrence less common
- Systemic complications more common
What are the noncutaneous findings associated with cellulitis?
- Fever: inconsistent complication, seen in 12% to 71% of hospitalized patients
- Tachycardia
- Hemodynamic instability, requiring prompt assessment for complicating sepsis or other serious infections.
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- Common condition with increased prevalence from 4.6 million in 1997 to 9.6 million in 2005
- Incidence rate increased from 17.3 to 32.5 per 1000 population during this time, paralleling the rise of community-acquired MRSA
- > 10% of hospitalizations for infectious diseases in the United States
- Recurrent cellulitis occurs in 22% to 49% of patients, most of whom can be managed in the ambulatory setting.
A 45-year-old patient presents with unilateral lower extremity erythema, warmth, and swelling. What is the most likely diagnosis, and what are the cardinal signs to confirm it?
The most likely diagnosis is cellulitis. Cardinal signs include erythema, swelling, warmth, and pain.
A patient presents with erysipelas involving the face. What are the distinguishing features of erysipelas compared to cellulitis?
Erysipelas is characterized by sharply demarcated, bright red areas of involvement, often with fever, compared to the ill-defined plaques of cellulitis.
A patient with cellulitis has a history of obesity and presents with erythema and edema. What is the most common site of cellulitis in adults?
The most common site of cellulitis in adults is the lower extremity.
A patient with cellulitis has a history of systemic illness and presents with erythema and pain. What are the cardinal signs of cellulitis?
The cardinal signs of cellulitis are erythema, swelling, warmth, and pain.
A patient with cellulitis has a history of systemic illness and presents with erythema and scaling. What is the most common site of erysipelas?
The most common site of erysipelas is the leg.
What is the most common site for cellulitis in adults?
Lower extremity.
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Redness, swelling, heat, and pain.
What is a common complication of cellulitis related to lymphatic damage?
Lymphedema.
What percentage of hospitalized patients experience fever as a complication of cellulitis?
12% to 71%.
What is the typical appearance of erysipelas compared to classic cellulitis?
Erysipelas has a sharply demarcated and bright red area of involvement.
What is a significant risk factor for recurrent cellulitis?
Lymphedema from lymphatic damage.
What should raise concern for a necrotizing soft-tissue infection in cellulitis cases?
Crepitus, anesthesia, or pain disproportionate to clinical findings.
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Increased from 4.6 million in 1997 to 9.6 million in 2005.
What is the most common clinical variant of cellulitis?
Erysipelas.
What type of cellulitis is characterized by the presence of pustules or abscesses?
Purulent cellulitis.
What are the common clinical features of cellulitis and how do they differ from erysipelas?
Cellulitis:
- Ill-defined erythema and edema
- Often warm and painful
- Most common site: lower extremity
- Unilateral involvement is typical
Erysipelas:
- Sharply demarcated and bright red area
- Most common site: leg (76%-90%)
- Fever is more common than in cellulitis
- Recurrence may be observed
Both conditions share classic signs of inflammation: redness, swelling, heat, and pain.
What complications can arise from cellulitis and how do they impact patient management?
Complications of cellulitis include:
1. Lymphedema:
- From lymphatic damage
- Increases risk of recurrence
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Superficial thrombophlebitis:
- May be seen in acute settings
- Decreases risk of deep venous thrombosis
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Bacteremia (5%):
- Can lead to sepsis, bacterial endocarditis, and other serious complications
-
Spread of infection to deeper tissues:
- Rare in absence of other risk factors or chronic disease
These complications necessitate prompt assessment for sepsis and may require more aggressive treatment strategies.
How does the clinical presentation of cellulitis differ in children compared to adults?
In children, cellulitis often presents with:
- Facial involvement being more common than in adults.
What are the key considerations for diagnosing cellulitis in the presence of systemic symptoms?
When diagnosing cellulitis with systemic symptoms, consider the following:
- Fever: Inconsistent complication; occurs in 12% to 71% of hospitalized patients.
- Tachycardia and hemodynamic instability may indicate complicating factors such as sepsis or toxin-mediated systemic illness.
- Pain disproportionate to clinical findings (e.g., crepitus or anesthesia) should raise concern for necrotizing soft-tissue infections.
Prompt assessment and management are crucial to prevent severe complications.