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Year 3 > Cellulitis (DERM) > Flashcards

Cellulitis (DERM) Flashcards

1
Q

Define cellulitis.

A

Acute spreading infection of the skin with visually distinct borders, that involves the deep dermis and subcutaneous tissue

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2
Q

What is the difference between cellulitis and erysipelas?

A
  • cellulitis - involves deep dermis and subcutaneous tissue
  • erysipelas - distinct form of superficial cellulitis involving only the upper dermis and superficial lymphatics –> raised and sharply demarcated from uninvolved skin
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3
Q

What is cellulitis characterised by?

A

Redness, swelling, heat and tenderness, and commonly occurs in an extremity

(Immunocompromised patients may present with atypical infections)

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4
Q

How does cellulitis develop?

A
  • when microorganisms gain entry into dermal and subcutaneous tissues via disruptions in cutaneous barrier e.g. minor skin injury
  • often results from: penetrating injury, local lesions (e.g. insect bites), fissuring (e.g. anal fissures)
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5
Q

What are the most common causative bacteria of cellulitis? (2)

A
  • Staphylococcus aureus (catalase +ve)
  • Streptococcus pyogenes (catalase -ve)
  • beware of MRSA
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6
Q

What is orbital cellulitis usually caused by?

A

Haemophilus influenzae

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7
Q

What are the clinical features of cellulitis? (5)

A
  • acute onset of red, painful, hot, swollen skin
  • poorly defined (not well demarcated) lesions - compared to erysipelas –> well-demarcated, bright red raised skin
  • most commonly occurs on shins
  • Hx of cut/scratch/injury
  • systemic symptoms - fever, chills, nausea, headache
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8
Q

What systemic symptoms can be seen in cellulitis? (4)

A
  • fever
  • chills
  • nausea
  • headache
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9
Q

How does erysipelas differ clinically to cellulitis?

A
  • more superficial, limited version of cellulitis
  • causes well-defined lesions + bright red raised skin
  • caused by Streptococcus pyogenes
  • treated with flucloxacillin
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10
Q

How does periorbital cellulitis present?

A

Painful swollen red skin AROUND the eye

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11
Q

How does orbital cellulitis present?

A

Painful or limited eye movements, VISUAL IMPAIRMENT

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12
Q

What might you see on examination of cellulitis?

A
  • lesion: erythema, oedema, warm tender indistinct margins
    • pyrexia - may suggest systemic spread
    • NB exclude the presence of an abscess - aspirate if pus suspected
  • orange-peel appearance, blistering, bleeding, lymphangitis (red line that spreads proximally along lymphatics towards lymph nodes)
  • unilateral
  • toe-to-web abnormalities (evidence of fungal infection AKA tinea may reveal the point of bacterial entry)
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13
Q

What are some risk factors for cellulitis?

A

DOOVE + skin break

  • diabetes (–> poor vascularisation)
  • obesity
  • oedema (& lymphoedema)
  • venous insufficiency (–> poor vascularisation)
  • eczema
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14
Q

What observations show septic signs of cellulitis? (5)

A
  • high HR
  • high RR
  • low BP
  • confusion (low GCS)
  • fever
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15
Q

What is a sign of systemic illness in cellulitis?

A

Pyrexia

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16
Q

How do we usually diagnose cellulitis?

A

Clinical diagnosis - only request further tests if there are signs of systemic illness or septicaemia

  • acute, red, hot, swollen skin
  • Hx trauma/cracked skin/scratch/injury
  • Hx lymphoedema/poor vascularisation
17
Q

What are the 1st-line investigations for cellulitis? (1 + 6)

A
  • clinical diagnosis
  • FBC
  • ESR
  • CRP
  • U&Es
  • blood culture and sensitivities - if patient needs admission
  • skin swab/aspirate
18
Q

What would bloods show for cellulitis?

A

High WCC and CRP/ESR

19
Q

How can we identify the causative pathogen and know which Abx to use for cellulitis?

A

Blood MC&S and skin swab

20
Q

When do we admit patients with cellulitis?

A

If septicaemia suspected, or if significant systemic upset and/or comorbidities

21
Q

What do we do after admitting a patient with cellulitis?

A

Blood MC&S to identify pathogen and test antibiotic sensitivity - do before giving Abx

22
Q

What imaging could we do for cellulitis? (2)

A
  • XR - if osteomyelitis or necrotising fasciitis
  • CT/MRI - if orbital cellulitis is suspected to check if infection has spread posteriorly to brain
23
Q

What are some differentials for cellulitis?

A
  • necrotising fasciitis - marked pain, necrotic bullous, crepitus, surgical exploration
  • thrombophlebitis - tender palpable cord along affected vein
  • DVT - prolonged immobility, tender vein
  • gout
  • Lyme disease
  • contact dermatitis
  • insect bites and stings
  • fixed drug eruptions
  • eosinophilic cellulitis
  • sweet syndrome
  • inflammatory carcinoma
  • calciphylaxis
  • lipodermatosclerosis (venous insufficiency)
24
Q

What is the first thing you do with patients with cellulitis?

A

Exclude sepsis!!

  • fever
  • tachycardic
  • hypotensive
  • low O2 sats
  • high respiratory rate
25
Q

What is the 1st line treatment for cellulitis? (Mild/moderate vs severe)

A
  • flucloxacillin (oral if mild/mod, IV if severe)
  • clarithromycin if allergic
  • secondary option: amoxicillin/clavulanate
26
Q

What do we do for severe systemic cellulitis e.g. septic signs, tachycardic + hypotensive?

A

Hospital admission + IV co-amoxiclav/cefuroxime/clindamycin/ceftriaxone

27
Q

What do we give for cellulitis if penicillin allergy?

A

Clarithromycin / erythromycin (in pregnancy) / doxycycline

28
Q

What do we give for cellulitis if near eye/nose?

A

Co-amoxiclav (or clarithromycin+metronidazole)

29
Q

What do we give for cellulitis if MRSA suspicion?

A

Flucloxacillin + vancomycin/teicoplanin/linezolid

30
Q

What do we give for cellulitis if Aeromonas hydrophila (freshwater exposure)?

A

Flucloxacillin + ciprofloxacin/doxycycline/trimethoprim

31
Q

What do we give for cellulitis if Vibrio vulnificus (softwater exposure)?

A

Flucloxacillin + doxycycline

32
Q

How do we manage periorbital cellulitis?

A

Incision, drainage and culture of peri-ocular abscess, possible antifungal therapy

33
Q

How do we manage orbital cellulitis?

A

Nasal decongestant, possible antifungal therapy, possible lateral canthotomy and cantholysis, possible orbitotomy and surgical drainage of orbital abscess

34
Q

What is 1st line treatment for erysipelas (cellulitis)?

A

Flucloxacillin

35
Q

What are some complications of cellulitis? (4)

A
  • sepsis - cellulitis caused by Vibrio vulnificus after salt water exposure, usually occurs in patients with pre-existing liver disease
  • chronic oedema (in affected extremity)
  • necrotising fasciitis
  • periorbital/orbital cellulitis
36
Q

Describe the prognosis of cellulitis.

A

Excellent - most episodes resolve with therapy and major sequelae are absent

Year 3 (80 decks)

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