23 - 151 - CELLULITIS AND ERYSIPELAS

Question 1

sharply demarcated, bright red, edematous plaques resulting from superficial lymphatic infiltration

Answer 1

ERYSIPELAS

Question 2

common infection of the deep dermis and subcutaneous tissue, most often caused by bacteria, that presents with the classic signs of inflammation

Answer 2

Cellulitis

Question 3

presence of pustules or abscess development, which may precede or follow cellulitis

Answer 3

Purulent cellulitis

Question 4

Question 5

Most common causes of cellulitis and erysipelas

Answer 5

GAS and S. Aureus

Question 6

Most common causes of cellulitis from animal and human bites

Answer 6

Pasteurella spp.
Streptococci
Staphylococci

Question 7

Most common causes of cellulitis from aquatic trauma

Answer 7

• aeromonas spp.
• Erysipelothrix rhusiopathiae
• Mycobacterium marinum and other atypical mycobacteria;
• Vibrio vulnificus

Question 8

Systemic and Local Risk Factors for Primary and Recurrent Cellulitis

Answer 8

Question 9

Highest risk factor for cellulitis

Answer 9

Lymphedema (> 70-fold), followed by disruption skin barrier (24-fold)

Question 10

ALT-70 Risk Prediction for Cellulitis

Answer 10

Question 11

A skin surface temperature gradient greater than ________ between a patient’s involved and uninvolved skin, as determined by thermal imaging, has also shown promise, with a sensitivity of 96.6% for the diagnosis of cellulitis

Answer 11

0.47°C (0.85°F)

Question 12

most common cause of pseudocellulitis

Answer 12

Stasis dermatitis

Question 13

Question 14

systemic inflammatory response syndrome criteria

Answer 14

• (temperature >38°C [100.4°F] or <36°C [96.8°F];
• pulse >90 beats/min;
• respiratory rate >20 breaths/min; or
• leukocyte count >12,000 cells/µL or <4000 cells/µL)

Question 15

first-line agents of choice in MSSA

Answer 15

Cephalexin and dicloxacillin

Question 16

First-line agents for MRSA

Answer 16

clindamycin, tetracyclines, and trimethoprim-sulfamethoxazole

Question 17

If penicillin or cephalosporin allergy exists, what can we give?

Answer 17

Clindamycin

Question 18

In patients with purulent cellullitis with systemic infection or failure of outpatient treatment, what parenteral antibiotics are appropriate for MSSA?

Answer 18

Oxacillin, nafcillin, and cefazolin,

Question 19

In patients with purulent cellullitis with systemic infection or failure of outpatient treatment, what parenteral antibiotics are appropriate for MRSA?

Answer 19

Vancomycin, clindamycin, or linezolid

Question 20

Indications for Parenteral Administration of Antibiotics

Answer 20

Question 21

most common site of cellulitis in adults

Answer 21

lower extremities

Question 22

cellulitis affects what part of the skin

Answer 22

deep dermis and subcutaneous tissue

Question 23

Erysipelas is a variant of cellulitis that predominantly affects what?

Answer 23

superficial lymphatic vessels and surrounding tissue

Question 24

cellulitis affecting the face is more common in what population?

Answer 24

children

Question 25

a frequent complication of cellulitis that increases the risk of recurrence

Answer 25

Lymphatic damage leading to **lymphedema**

Question 26

When there is significant involvement of the lymphatics or superficial edema, the skin may acquire a peau d’orange appearance.

Answer 26

Cellulitis

Question 27

MC site of involvement of erysipelas

Answer 27

leg ## Footnote followed by the face and upper extremity

Question 28

A skin surface temperature gradient greater than what temperature (0.85°F) between a patient’s involved and uninvolved skin, as determined by thermal imaging, has also shown promise, with a sensitivity of 96.6% for the diagnosis of cellulitis, but additional confirmatory studies are needed

Answer 28

0.47°C

Question 29

Nonpurulent cellulitis without systemic evidence of infection should be treated with what oral medications?

Answer 29

oral antistreptococcal antibiotics such as **cephalexin, dicloxacillin, or penicillin V**

Question 30

In cases of true Type I hypersensitivity reactions to penicillins or cephalosporins, in patients with nonpurulent cellulitis without systemic evidence of infection, what alternative medications should be considered?

Answer 30

clindamycin or macrolides

Question 31

Patients with nonpurulent cellulitis **WITH** evidence of **systemic infection,** including 2 or more systemic inflammatory response syndrome criteria or those who fail outpatient treatment whould receive parenteral antibiotics such as?

Answer 31

cefazolin, ceftriaxone, or penicillin G

Question 32

If there is associated penetrating trauma in moderate nonpurulent cellulitis, including injection drug use, or known MRSA colonization or infection elsewhere, empiric coverage with what drug?

Answer 32

vancomycin