Cellulitis and Erysipelas Flashcards
What is cellulitis?
Infection of the deep dermis and subcutaneous tissue
What is erysipelas?
A more superficial infection, involving only the upper dermis and superficial lymphatics
It can be quite hard to make the distinction between the two.
Causative organisms of cellulitis and erysipelas.
Streptococcus pyogenes and Staphylococcus aureus, but infection can be caused by Streptococcus pneumoniae, Haemophilus influenzae, gram-negative bacilli, and anaerobes.
E. coli as well
In what patients may gram-negative and anaerobic bacteria be seen?
In immunocompromised people and those with diabetes.
E. coli e.g.
Clinical presentation of cellulitis.
Acute onset of red, painful hot and swollen skin.
Most commonly of the lower leg or arm, it may however spread proximally
It can also involve the abdomen, perianal area and periorbital area.
There might also be bleeding, blistering, fever, malaise, lymphadenopathy, toe-web abnormalities.
In severe cases signs of sepsis and signs of necrotising fasciitis.
Clinical presentation of erysipelas.
Well-demarcated bright-red raised skin.
Typically affects the face and lower limbs
The skin will often be fiery red with small vesicles on the surface.
There might also be systemic symptoms such as a fever, malaise etc…
Investigations of cellulitis and erysipelas.
FBC
ESR
CRP
U&Es
Blood cultures and sensitivites
Consider;
Skin swab, skin aspirate, skin biopsy however these might come back negative.
If suspected sepsis follow Sepsis 6
Severe - Empirical antibiotic therapy with IV flucloxacillin first line. If allergic give IV clarithromycin.
Review IV abx after 48 hours and consider switching to oral.
Consider hospital admission and supportive care.
If in danger triangle (near eyes or nose) - Give co-amoxiclav oral
Non-severe - Give Flucloxacillin PO
Complications of cellulitis and erysipelas
Sepsis
Chronic oedema in affected extremity
