Cellulitis

Question 1

Pathophysiology?

Answer 1

Inflammation of the skin and subcutaneous tissues, typically due to an infection

Question 2

Common causative organisms?

Answer 2

Streptococcus pyogenes or Staphylcoccus aureus

Question 3

Symptoms?

Answer 3

Erythema, pain and swelling. May be some associated systemic upset such as fever

Question 4

Where does this commonly occur?

Answer 4

Shins

Question 5

How to diagnose?

Answer 5

Clinically

Question 6

When would you order bloods or blood cultures?

Answer 6

When you suspect septicaemia

Question 7

What classification guide is used to guide management of patients with cellulitis?

Answer 7

Eron classification

Question 8

How many classes in Eron classification and what do they each mean?

Answer 8

4 classes.

1. No signs of systemic toxicity and no uncontrolled co-morbidities
2. Pt is either systemically unwell or systemically well but with a co-morbidity which may complicate resolution of infection
3. Pt has significant systemic upset such as acute confusion, tachycardia, tachypnoea, hypotension or unstable co-morbidities that may interfere with a response to treatment, or a limb threatening infection due to vascular compromise
4. Pt has sepsis syndrome or a severe life-threatening infection such as necrotitizing fasciitis

Question 9

Who should be admitted for IV antibiotics?

Answer 9

• Eron class 3 or 4
• severe or rapidly deteriorating cellulitis
• <1yr or frail pt
• immunocompromised
• has significant lymphoedema
• has facial cellulitis or periorbital cellulitis

Question 10

Treatment for mild/moderate cellulitis?

Answer 10

Flucloxacillin

Question 11

What treatments are recommended in patients allergic to penicillin?

Answer 11

Clarithromycin, erythromycin (in pregnancy) or doxycycline

Question 12

Treatment for severe cellulitis?

Answer 12

Co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.