Cellulitis

Question 1

What is the definition of cellulitis?

Answer 1

Bacterial soft tissue infection of the dermis and subcutaneous tissue.

Question 2

What are typical causative organisms of cellulitis?

Answer 2

Strep. pyogenes
Staph aureus

Question 3

What are some risk factors for cellulitis?

Answer 3

Advancing age
Immunocompromised
Predisposing skin condition (eg ulcers, pressure sores, trauma, lymphoedema)

Question 4

What are some clinical features of cellulitis?

Answer 4

Generalised swelling in legs
Macular hot erythema with ill defined margins often spreading
Fevers, rigours, nausea

Question 5

What are some investigations for cellulitis?

Answer 5

Usually clinical diagnosis
Atypical presentation/failure to respond to treatment/very unwell then culture from possible points of entry
Where diagnosis is in doubt blood culture and swabs and culture of any blister fluid can be done

Question 6

What is the management of cellulitis?

Answer 6

1st line: 0.5-1g flucloxacillin QDS 7/7 (pen allergic: doxycycline/clarithromycin)
Severe: IV flucloxacillin (pen allergic: vancomycin)

Rest, elevation, analgesia, splint
Mark area of erythema to detect rapid spread

Wound debridement in severe cases

Question 7

What are some complications of cellulitis?

Answer 7

Abscess formation
Lymphangitis
Systemic spread of infection
Recurrence
Chronic or recurrent lymphoedema
Scarring and changes in skin texture