Cellulitis Flashcards

1
Q

What is the pathophysiology of cellulitis?

A

Entry of bacteria through a break in the skins barrier leading to infection in the subcutaneous and dermis.
Most commonly caused by streptococcus pyogens, less commonly s.aureus

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2
Q

What are the risk factors for cellulitis?

A
  • Breaks in the skin,
  • Chronic conditions which compromise skin integrity eg, venous insufficiency, ulcers.
  • Obesity,
  • Diabetes,
  • Immunosupression,
  • IVDU,
  • History of cellulitis
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3
Q

What are the signs and symptoms of cellulitis?

A
  • Commonly found on the shins and is unilateral. Bilateral cellulitis is rare.
  • Erythema and heat,
  • Swelling and pain,
  • Blistering and bleeding (only in severe disease)
  • Systemic upset
  • Lymphadenopathy
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4
Q

What are the differential diagnosis for cellulitis?

A
  • DVT,
  • Erysipelas (superficial cellulitis which has well-demarcated margins)
  • Superficial thrombophlebitis
  • Necrotizing fasciitis
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5
Q

Explain the Eron classification of Cellulitis

A

Class I - No signs of systemic toxicity and person has no uncontrolled co-morbidities.
Class II - Systemically unwell or has a comorbidities which may delay resolution (PAD, venous insufficency)
Class III - Significant systemic upset (tachycardia, confusion, hypotension) or unstable co-morbidities or limb-threatening infection.
Class IV - Sepsis of life threatening infection eg, Necrotizing fasciitis

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6
Q

What are the investigations for cellulitis?

A

Normally a clinical diagnosis but can do following investigations:
- Bloods (FBC, CRP, U&Es) and blood cultures
- Wound swab if open wound
- USS to look for fluid collections

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7
Q

Which patient’s should be admitted for IV antibiotics?

A
  • Eron class III or IV
  • Severe or rapidly deteriorating cellulitis (extensive area of skin)
  • Very young (<1y) or frail
  • Immunocompromised
  • Significant lymphoedema
  • Facial cellulitis or periorbital cellulitis
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8
Q

What is the management of cellulitis?

A

Eron class I - High dose flucloxacillin is first line. Clarithromycin/doxy if pen allergic, erythromycin in pregnancy.
Eron class II - Admit for 48hours of hospital IV abx then OPAT.
Eron class III-IV - Admit for IV antibiotics such as IV co-amoxiclav and potential surgery

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9
Q

What are the surgical indications for cellulitis?

A
  • Necrotising infection
  • Abscess
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10
Q

What are the complications of an cellulitis

A
  • Abscess formation,
  • Lymphangitis (infection of lymphatic vessels)
  • Sepsis,
  • Persistant leg ulcers
  • Recurrence of cellulitis
  • Chronic lymphoedema
  • Scarring or changes in skin texture
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11
Q

What are the complications of periorbital cellulitis

A

Optic nerve damage, cavernous sinus thrombosis, intracranial infection

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