cellulitis Flashcards
what is cellulitis?
Cellulitis is a bacterial soft tissue infection of the dermis and subcutaneous tissue.
what is this?
cellulitis
pathophysiology of cellulitis?
The pathophysiology of cellulitis involves bacterial entry through breaks in the skin’s barrier, leading to infection and inflammation. The bacteria multiply in the subcutaneous tissue, triggering an immune response, which results in the characteristic signs and symptoms of cellulitis.
which organisms typically cause cellulitis?
Streptococcus pyogenes or Group A beta-haemolytic streptococc
staph aureus
RF for cellulitis?
Breaks in the skin, such as cuts, abrasions, insect bites, or surgical wounds
Chronic conditions that compromise skin integrity - venous insufficiency or lymphedema, pressure sores, ulcers, recent trauma
Obesity
Diabetes
Immunosuppression
Intravenous drug use
Recent history of cellulitis
features of cellulitis?
Erythema
Calor (heat)
Swelling
Pain
Poorly demarcated margins
Systemic upset: fever, malaise
Lymphadenopathy
Rarely blisters and pustules (severe disease)
Often evidence of breach of skin barrier e.g. trauma, ulcer etc.
how do you classify cellulitis?
eron classification
what is eron class 1?
Class I — there are no signs of systemic toxicity and the person has no uncontrolled comorbidities.
what is eron class 2?
Class II — the person is either systemically unwell or systemically well but with a comorbidity (for example peripheral arterial disease, chronic venous insufficiency, or morbid obesity) which may complicate or delay resolution of infection.
what is eron class 3?
Class III — the person has significant systemic upset, such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable comorbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromize.
what is eron class4?
Class IV — the person has sepsis or a severe life-threatening infection, such as necrotizing fasciitis.
how do you ix cellulitis?
Blood tests - FBC (high WCC), CRP, U+E (may be AKI if severe infection), blood cultures
Wound swab if there is an open wound, penetrating injury, drainage, or an obvious portal for microbial entry, exposure to water borne-organisms, an infection acquired outside the UK or in severe cellulitis
Ultrasound scan - for distinguishing nonpurulent cellulitis from cellulitis with underlying abscess and for identifying drainable fluid collection
when do you admit pt with cellulitis?
Class III - Class IV cellulitis
Rapidly deteriorating cellulitis
Under 1 year of age or frail
Immunosuppression
Significant lymphoedema
Facial cellulitis (unless very mild)
Suspected orbital or periorbital cellulitis (admit to ophthalmology)
Class II cellulitis (systemically unwell or systemically well but with a comorbidity)
what are general principles of cellulitis mx?
Mark the area of erythema to aid in detection of rapidly spreading cellulitis, and to monitor treatment response
Elevate if possible
Review if wound debridement is required
how do you manage iron class 1?
Class I - high-dose oral flucloxacillin (clarithromycin/doxycyline if penicillin allergic and erythomycin if pregnant)
