cellulitis

Question 1

Cellulitis overview

Answer 1

acute inflammatory condition
caused by Indigenousa flora or exogenous bacteria
- access the epidermis
-cracks abrasions cuts burns bites ect

MRSA replacing MSSA inpatient / outpatient
purulent celluitis
- MRSA/MSSA
- focal infections

non - purulent celluitis
- S pyogenes
- rapid spread , diffuse

Question 2

cellulitis causes

Answer 2

most common portal of entry
-web intertrigo with fissuring
-tinea pedis

most common bacteria
-gram positive cocci
- group A beta hemolytic & S. aureus

Gram negative rods
- rare
-P. aeruginosa
- hospitalized and immunocompromised
- stepping on a nail

recurrent streptococcal cellulitis
- group A C G
- venous stasis, saphenous venectomy
- chronic lymphedema, lymph node dissection, and Milroy disease

elderly population:
- streptococcus agalactide

Question 3

cellulitis manifestations

Answer 3

Classic findings:
pain , erythema, swelling, and heat
begins as a small tender patch
expands over hours
6-36

Lab:
leukocytosis
- at least neutrophilia

bilateral cellutitis :
very uncommon
DX stasis dermatitis
consider cryptococcal

Worsening infection:
chills, fever, and malaise
lymphangitis ( will see red steaks up the extremity) and lymphadenopathy

Complications:
Septicemia and shock

Question 4

cellulitis diagnosis

Answer 4

Clinical observation:
definitive diagnosis
wound culture and gram stain
skin biopsy
immunocompromised
uncommon organism

Question 5

cellulitis treatment

Answer 5

Empiric coverage:
Cover for both strep and staph
cefazolin

cover for MRSA ( if warnted)
-vancomycin

animal and human bites
augmentin
ampicillin
cefoxitin

pseudomonas aeruginosa
- ABX coverage
-aminoglycoside
- 3rd gen cephalosporin
- semi-synthetic penicillin
- fluoroquinolone

Surgical I & D