Cellulitis Flashcards
What is cellulitis?
Bacterial infection of the dermis layer of skin and deeper subcutaneous tissues
Infection often due to break or puncture to skin but sometimes no break in integrity can be found.
Common sites: legs and face but can be anywhere.
Typically is unilateral leg symptoms following a break in the skin.
Usually minor however elderly or comobidities it can bring morbidity and mortality.
Very common, incidence 24.6/1000
Risk factors for cellulitis?
- wounds to the skins
- diabetes
- old age
- insect bites
- obesity
- fungal infections between toes
- skin conditions such as eczema
- chronic swollen legs (lymphoedema)
- chronic venous insufficiency
- IV drug user
- immunosuppression
- previous cellulitis
Cellulitis causative organisms?
Most common:
- Group A beta-haemolytic streptococci (Strep pyrogenes)
- Staphylococcus aureus
Less commonly:
- Strep pneumo
- Hib
- gram negative bacilli
- anaerobes
Symptoms of cellulitis?
- often in one lower limb
- spreads quickly
- Rubor, Dolor, Tumor, Calor
- erythema which blends into surrounding skin
- tracking can occur along blood vessels
- often a site of damage (ulcer, wound, bite, injection site)
- systemic effects (fever, malaise, nausea, rigors, confusion in elderly)
Differential when thinking cellulitis?
- DVT
- varicose eczema
- ruptured bakers cyst
- necrotising fasciitis
- metastatic cancer (carcinoma erysipeloides)
Investigation in cellulitis?
Primary care:
- not usually required
- clinical Hx and Exam
- obvious wound with discharge could be swabbed
Secondary care:
- bloods: raised WCC, CRP, fasting glucose, lipids, cholesterol, cultures
- xray, CT, MRI; if concerned for deeper structures or foreign body in situ
Treatment of cellulitis?
and when to send to hospital
Minor / mild with GP:
- PO FLUCLOXACILLIN 500mg QDS for 7 days
- or pen allergic ERYTHROMYCIN 500mg QDS or CLARITHROMYCIN 500mg BD for 7 days
Requiring Hopsital management:
- FLUCLOXACILLIN 1 gram QDS IV for 48 hrs then review for oral
- or pen allergic CLINDAMYCIN 600mg QDS IV for 48 hrs then review for oral
General considerations:
- ANALGESIA
- ELEVATE LEGS
- requirement for TETANUS vaccination
Send to hospital if:
- unwell: tachycardia, tachypnoea, hypotension, vomiting, acute confusion
- unstable comorbities eg poor diabetes
- contaminated would
- wound threatening infection due to vascular compromise
- sepsis or life threatening eg necrotising fasciitis
- frail or <1yr old
- immunocompromised
- gross limb swelling
- facial cellulitis
- periorbital cellulitis
Complications of cellulitis?
ACUTE:
- abscess formation
- sepsis
- myositis / osteomyelitis
- necrotising fasciitis (consider if pain not eased by analgesia!)
- if around eye can spread to meninges
- post streptococcal nephritis
CHRONIC
- persistent leg ulceration
- chronic lymphoedema
Majority make an uncomplicated recovery. Recurrence rate of 11-16% are reported.
