Cellulitis Flashcards

1
Q

Cellulitis most common causative organisms?

A

Streptococcus or staphylococcus spp.

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2
Q

Cellulitis definition

A

Infection of dermis and subcutaneous tissue, infection has poorly demarcated borders

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3
Q

Cellulitis vs Erysipelas?

A
  • Erysipelas is superficial form of cellulitis, involving dermis and upper subcutaneous tissues
  • Difficult to distinguish clinically
  • Erysipelas has sharply demarcated borders
  • Fiery red rash that can be painful
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4
Q

Cellulitis/Erysipelas RF

A
  • Previous Hx
  • Venous insufficiency
  • Elderly age
  • Alcoholism
  • IV drug use
  • Lymphoedema
  • Obesity
  • Athlete’s foot
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5
Q

Cellulitis/Erysipelas causative organisms

A
Cellulitis
-Streptococci
-Can be (rarely) anaerobes or fungus which are more common in children, people with diabetes and immunocompromised individuals
Erysipelas
-Mostly group A strep
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6
Q

Cellulitis Presentation

A
  • Commonly seen in lower limb affecting one limb
  • Usually an obvious precipitating lesion
  • Erythema, pain, swelling and warmth
  • Margins may be indistinct
  • Blisters and bullae may form
  • Systemic symptoms
  • Red streaking lines show progression into lymphatic system
  • Crepitus means anaerobic organisms
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7
Q

Erysipelas Presentation

A
  • Face or one leg most commonly affected, then arm or upper thigh
  • On face nasopharynx is most often source of infection
  • May be recent trauma but often no precipitating cause is noted
  • Athletes foot may be portal of entry
  • Flu like symptoms often precede skin lesion
  • Within 48hrs rapid onset of skin infection with pruritus
  • Lesions begin as small patch, then progress
  • Skin eventually becomes deeper red
  • Facial infection often symmetrical
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8
Q

Cellulitis/Erysipelas Differentials

A

Necrotising fasciitis, DVT, insect bite, superficial thrombophlebitis, varicose eczema, pyoderma gangrenosa

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9
Q

Cellulitis/Erysipelas Ix

A
  • Diagnosis clinical
  • Cultures from visible portals
  • Can do fine needle aspiration (of leading edge), foreign body scans, bullae fluid culture
  • Imaging if bone involvement suspected
  • If recurrent, exclude diabetes and immunodeficency
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10
Q

Cellulitis/Erysipelas Management

A
  • Raise, rest, elevate
  • Analgesia
  • Flucloxacillin
  • Erythromycin if penicillin allergic
  • Clindamycin second line
  • Consider co-amoxiclav is there is facial involvement
  • NSAIDs, emollient
  • Manage underlying conditions
  • Follow up after seven days of treatment (come back if symptoms are worse after 48hrs or systemic symptoms develop)
  • Prevent recurrence
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11
Q

Cellulitis Red Flags

A

Disproportionate systemic illness, bullae, crepitus, necrotic skin, severe pain on passive movement, pain disproportionate to examination (necrotising fasciitis)

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12
Q

Cellulitis/Erysipelas Referral Indications

A

Severe or rapidly worsening infection, systemic illness or vomiting, complications, facial infection, eye involvement, immunocompromised, diabetes, significant comorbidity, lymphoedema, recurrent infection, child under 1, lack of home support/frailty/memory impairment

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13
Q

Cellulitis/Erysipelas Prognosis?

A

Very good (with treatment)

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