Cellulitis and Erysipelas Flashcards
Define:
- Acute non-purulent spreading infection of the subcutaneous tissue, causing overlying skin inflammation
- Cellulitis and erysipelas are very similar -difference is that cellulitis affects deeper layers of the skin (subcutis)
Aetiology:
• Often results from: o Penetrating injury o Local lesions (e.g. insect bites) o Fissuring (e.g. anal fissures) • These allow pathogenic bacteria to enter the skin
Most common organisms:
o Streptococcus pyogenes – more commonly causes erysipelas
o Staphylococcus aureus – more commonly causes cellulitis
o NOTE: beware of MRSA
• Cellulitis of the orbit (orbital cellulitis) is usually caused by Haemophilus influenzae
Risk factors:
o Skin break e.g. cut, open ulcer, surgery wound, insect bite, eczema
o Poor hygiene
o Poor vascularisation of tissue (e.g. due to diabetes mellitus)
o Immunocompromised – steroids, chemotherapy, HIV
o Obesity
Epidemiology:
Very common
Symptoms of cellulitis:
reddened skin is less clearly defined, often it is dark-red/purple. Can produce pus.
Symptoms of Erysipelas:
painful, shiny light-red swelling of clearly defined area of skin. May also cause blisters and swelling of nearby lymph nodes. Fever and malaise.
Symptoms of oribital and periorbital cellulitis:
- Periorbital Cellulitis - painful swollen red skin around the eye
- Orbital Cellulitis - painful or limited eye movements, visual impairment
Signs:
• Lesion o Erythema o Oedema o Warm tender indistinct margins o Pyrexia - may suggest systemic spread • NOTE: exclude the presence of an abscess (aspirate if pus suspected) • Periorbital o Swollen eye lids o Conjunctival infection • Orbital Cellulitis o Proptosis o Impaired visual acuity and eye movements o Test for RAPD, visual acuity and colour vision
Investigations:
- Bloods - WCC, blood culture
- Discharge - sample and send for MC&S
- Aspiration (if pus is suspected)
- CT/MRI - if orbital cellulitis is suspected (helps assess posterior spread of infection)
Management:
• Medical
o Oral penicillins (e.g. flucloxacillin) or tetracyclines are effective
o If hospital-acquired - treat empirically based on local guidelines and change depending on the sensitivity of cultured organisms
o Anti-inflammatory painkillers such as ibuprofen also help
• Surgical
o Orbital decompression may be needed in orbital cellulitis (EMERGENCY)
• Abscess
o Aspirate
o Incision and drainage
o Excised completely
Complications:
- Sloughing of overlying skin
- Orbital cellulitis - may cause permanent loss of vision, spread to the brain, abscess formation, meningitis, cavernous sinus thrombosis
Prognosis:
Good prognosis