Cellulitis

Question 1

Define Cellulitis

Answer 1

Inflammatory infection caused by indigenous flora or exogenous bacteria that access the epidermis

Question 2

What is the most common cause of purulent and non-purulent cellulitis

Answer 2

Purulent: MRSA/ MSSA
Non-purulent: S. Pyrogenous

Question 3

What is the difference in presentation of purulent vs Non purulent cellulitis

Answer 3

Purulent is a focal infection, non purulent is rapid/diffusely spread

Question 4

What is the most common portal of entry for cellulitic infections?

Answer 4

Web intertrigo with fissuring, tinea pedis

Question 5

What is the most common bacterial cause of cellulitis

Answer 5

Gram positive cocci: group a strep and staph aureus

Question 6

What are the gram negative causes of cellulitis and who are most at risk for becoming infected with them

Answer 6

Rare
P. Aeruginosa
Mostly in immunocompromised patients or those who stepped on a nail

Question 7

What is the most common cause of recurrent cellulitis and who is most likely to be infected? Complications of chronic infection

Answer 7

Group A C or G strep
Venous stasis/ saphenous venectomy
Chronic lymphedema, lymph node dissection, and Milroy disease

Question 8

What is the most common cause of cellulitis in the elderly?

Answer 8

Group b strep

Question 9

Signs and symptoms of cellulitis including lab work findings

Answer 9

S/S: pain, erythema, swelling, and heat, begins as small tender patch, expands over 6-36 hours
Labs: Leukocytosis

Question 10

What are signs of worsening cellulitis infection

Answer 10

Chills, fever, malaise, lymphagitis (red streaks), lymphadenopathy

Question 11

What are complications of cellulitis

Answer 11

Septicemia and shock

Question 12

How to diagnose cellulitis? (Including definitive diagnosis)

Answer 12

Typically done by clinical observation, definitive diagnosis via wound cx and gram stain
Skin biopsy necessary in immunocompromised individuals for rare organisms

Question 13

Treatment for cellulitis (includes Empiric, Animal/human bites, and Pseudomonas)

Answer 13

Empiric: (Covers strep and staph) Cefazolin, if MRSA is of concern start Vanco
Animal/Human bites: Augmentin, or ampicillin, or cefoxitin
Pseudomonas: Aminoglycosides (Gentomycin), or 3rd gen cephalosporins (ceftriaxone), or Semi synthetic PCN (zosyn), or Fluroquinolones (Cipro/levaquin), these NEED I & D