Cellulitis and Erysipelas Flashcards

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1
Q

Define:

A
  • 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)
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2
Q

Aetiology:

A
•	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
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3
Q

Most common organisms:

A

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

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4
Q

Risk factors:

A

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

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5
Q

Epidemiology:

A

Very common

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6
Q

Symptoms of cellulitis:

A

reddened skin is less clearly defined, often it is dark-red/purple. Can produce pus.

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7
Q

Symptoms of Erysipelas:

A

painful, shiny light-red swelling of clearly defined area of skin. May also cause blisters and swelling of nearby lymph nodes. Fever and malaise.

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8
Q

Symptoms of oribital and periorbital cellulitis:

A
  • Periorbital Cellulitis - painful swollen red skin around the eye
  • Orbital Cellulitis - painful or limited eye movements, visual impairment
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9
Q

Signs:

A
•	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
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10
Q

Investigations:

A
  • 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)
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11
Q

Management:

A

• 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

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12
Q

Complications:

A
  • Sloughing of overlying skin
  • Orbital cellulitis - may cause permanent loss of vision, spread to the brain, abscess formation, meningitis, cavernous sinus thrombosis
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13
Q

Prognosis:

A

Good prognosis

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