Cellulitis Flashcards
Cellulitis most common causative organisms?
Streptococcus or staphylococcus spp.
Cellulitis definition
Infection of dermis and subcutaneous tissue, infection has poorly demarcated borders
Cellulitis vs Erysipelas?
- 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
Cellulitis/Erysipelas RF
- Previous Hx
- Venous insufficiency
- Elderly age
- Alcoholism
- IV drug use
- Lymphoedema
- Obesity
- Athlete’s foot
Cellulitis/Erysipelas causative organisms
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
Cellulitis Presentation
- 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
Erysipelas Presentation
- 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
Cellulitis/Erysipelas Differentials
Necrotising fasciitis, DVT, insect bite, superficial thrombophlebitis, varicose eczema, pyoderma gangrenosa
Cellulitis/Erysipelas Ix
- 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
Cellulitis/Erysipelas Management
- 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
Cellulitis Red Flags
Disproportionate systemic illness, bullae, crepitus, necrotic skin, severe pain on passive movement, pain disproportionate to examination (necrotising fasciitis)
Cellulitis/Erysipelas Referral Indications
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
Cellulitis/Erysipelas Prognosis?
Very good (with treatment)
