cellulitis Flashcards
What is it
Cellulitis is a bacterial soft tissue infection of the dermis and subcutaneous tissue.
What are the risk factors
Advancing age
Immunocompromised e.g. diabetic
Predisposing skin condition e.g. ulcers, pressure sores, trauma, lymphoedema
What are the clinical features
Erythema
Calor (heat)
Swelling
Pain
Poorly demarcated margins
Systemic upset: fever, malaise
Lymphadenopathy
Often evidence of breach of skin barrier e.g. trauma, ulcer etc
What is the cause
Generally caused by Streptococcus and/or Staphylococcus organisms.
What is the management
Cellulitis: flucloxacillin + benzylpenicillin if severe, flucloxacillin alone if mild-moderate. Clarithromycin or clindamycin substituted if penicillin allergic.§
What is the management
Cellulitis: flucloxacillin + benzylpenicillin if severe, flucloxacillin alone if mild-moderate. Clarithromycin or clindamycin substituted if penicillin allergic.§
Where does it commonly occur
commonly occurs on the shins
erythema, pain, swelling
there may be some associated systemic upset such as fever
How do the investigations go
The diagnosis of cellulitis is clinical. No further investigations are required in primary care. Bloods and blood cultures may be requested if the patient is admitted and septicaemia is suspected.
What is the criteria for admission
ERON classification
What is class I
There are no signs of systemic toxicity and the person has no uncontrolled co-morbidities
What is class II
The person is either systemically unwell or systemically well but with a co-morbidity (for example peripheral arterial disease, chronic venous insufficiency, or morbid obesity) which may complicate or delay resolution of infection
What is Class III
The person has significant systemic upset such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable co-morbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromize
What is class IV
The person has sepsis syndrome or a severe life-threatening infection such as necrotizing fasciitis
When should we admit for IV abx
When patient is iron class III or IV
Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin).
Is very young (under 1 year of age) or frail.
Is immunocompromized.
Has significant lymphoedema.
Has facial cellulitis (unless very mild) or periorbital cellulitis.
else treat with oral abx
When is erythromycin used
To treat women in pregnancy
How to treat severe cellulitis
Offer co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.
What is orbital cellulitis
Orbital cellulitis is the result of an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe. It is usually caused by a spreading upper respiratory tract infection from the sinuses and carries a high mortality rate.
What is periorbital/preseptal cellulitis
less serious superficial infection anterior to the orbital septum, resulting from a superficial tissue injury (chalazion, insect bite etc…). Periorbital cellulitis can progress to orbital cellulitis.
What are the risk factors of orbital cellulitis
Childhood
Mean age of hospitalisation 7-12 years
Previous sinus infection
Lack of Haemophilus influenzae type b (Hib) vaccination
Recent eyelid infection/ insect bite on eyelid (periorbital cellulitis)
Ear or facial infection
What is the difference between orbital and preseptal
reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis§
What are we looking for in a FBC
WBC elevated, raised inflammatory markers
What are we looking for in a clinical examination
Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema.
What are we looking for in a CT with contrast
Inflammation of the orbital tissues deep to the septum, sinusitis.
What will the blood culture show
Blood culture and microbiological swab to determine the organism. Most common bacterial causes – Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.
