Cellulitis and Eryipsela Flashcards
Cellulitis is…
Cellulitis is an acute infection of the deeper layers of the dermis and the subdermal tissues. It typically occurs when bacteria enter through breaks in the skin barrier, such as lacerations or puncture wounds. The infection can present with or without systemic symptoms, and is usually caused by beta-hemolytic Streptococci (e.g., Group A Streptococcus) and Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA). Clinical features include poorly demarcated areas of erythema, warmth, tenderness, and swelling.
Erysipelas:
Erysipelas is an acute infection of the upper layer of the dermis along with the superficial lymphatics and vessels. It is characterized by a well-demarcated area of erythema, induration, warmth, and tenderness. The infection typically occurs when bacteria enter through breaks in the skin barrier. The primary pathogens are beta-hemolytic Streptococci, such as Group A Streptococcus. Unlike cellulitis, erysipelas usually does not present with systemic symptoms like fever and chills.
Q: What are the primary clinical features of erysipelas?
A: Erysipelas presents with acute onset of skin redness, swelling, and pain, usually around the face or extremities, and is characterized by a well-demarcated area of erythema with superficial induration, warmth, and tenderness to touch.
Q: What are the distinguishing clinical features of cellulitis compared to erysipelas?
A: Cellulitis typically presents with skin redness, swelling, and pain, but the area of erythema is not well-demarcated and can extend to deeper layers of the dermis and subdermal tissues. It may or may not present with systemic symptoms such as fever and chills.
Q: What systemic symptoms might accompany cellulitis?
A: Systemic symptoms that might accompany cellulitis include fever, chills, and elevated temperature.
Q: How can marking the edges of erythema help in the management of cellulitis?
A: Marking the edges of erythema with a pen during the physical exam helps in assessing if the area of redness is spreading, which is crucial for monitoring the response to treatment.
Q: What is the initial approach in diagnosing erysipelas and cellulitis?
A: The initial approach includes obtaining a focused history and performing a physical examination to identify signs of skin redness, swelling, and pain, and to distinguish between well-demarcated erysipelas and poorly demarcated cellulitis.
Q: How can you differentiate between erysipelas and cellulitis on physical examination?
A: Erysipelas presents with a well-demarcated area of erythema and superficial induration, while cellulitis presents with an area of erythema that is not well-demarcated and affects deeper layers of the dermis.
Q: What additional diagnostic steps should be taken for patients with cellulitis and systemic symptoms?
A: For patients with cellulitis and systemic symptoms, blood cultures and laboratory tests such as CBC should be obtained, and empiric IV antibiotics should be started.
Q: What is the first-line treatment for erysipelas?
A: The first-line treatment for erysipelas is oral antibiotics, such as penicillin or a first-generation cephalosporin.
Q: How should you manage a patient with cellulitis without systemic symptoms?
A: Patients with cellulitis without systemic symptoms should be started on empiric oral antibiotics such as penicillin or a first-generation cephalosporin. Consider coverage for MRSA if risk factors are present.
Q: What should be done if a patient with cellulitis does not respond to initial antibiotic treatment within 24 to 48 hours?
A: If there is an inadequate response to treatment, assess for signs of spreading infection, abscess, or necrotizing soft tissue infection, and consider broadening the antibiotic coverage or switching to a different antibiotic or IV antibiotics.
Q: What antibiotics are recommended for treating cellulitis without systemic symptoms?
A: Recommended antibiotics for cellulitis without systemic symptoms include oral penicillin or first-generation cephalosporin. For MRSA coverage, consider Trimethoprim-Sulfamethoxazole.
Q: How should you treat cellulitis with systemic symptoms?
A: Treat cellulitis with systemic symptoms with empiric IV antibiotics that cover streptococci and staphylococci, such as first-generation cephalosporins or clindamycin. Consider vancomycin for high-risk MRSA cases.
Q: What is the next step if a patient with cellulitis with systemic symptoms shows an inadequate response to IV antibiotics?
A: If there is an inadequate response, suspect an abscess or necrotizing soft tissue infection, broaden antibiotic coverage, and consult the surgical team for potential drainage or debridement.
