Cellulitis + necrotising fasciitis Flashcards
What is cellulitis?
Severe inflammation of dermal and subcutaneous layers of skin
What causes cellulitis?
Staphylococcus aureus
Streptococcus pyogenes
Gram stain of streptococcus pyogenes
Gram positive cocci in chains
Gram stain of staphylococcus aureus
Gram positive cocci in clusters
Symptoms of cellulitis
Inflammation + warm
Rash/erythema
Fever
Itchy
Fatigue
bullae
golden yellow crust (staph aureus infection)
What is used to classify celluitis severity?
Eron classification
What are the eron classifications?
What is it used for?
- class 1: no systemic toxicity or comorbidity
- class 2: systemic toxicity or comorbidity
- class 3: significant systemic toxicity or comorbidity
-
class 4: sepsis or life threatening infection.
.
Used to classify the severity of cellulitis
Management of cellulitis
-
mild (class1/2): Oral flucloxacillin - beta lactam - inhibits cell wall synthesis
doxycycline if penicillin allergy - Severe (class3/4): admit + give IV co.amoxiclav or flucloxacillin
- Painkillers
- Monitor temp
- Rest + fluids
What are the virulence factors of streptococcus pyogenes?
- Streptokinase - breaks down blood clots
- M protein - disrupts respiratory burst
- Hyaluronic acid capsules
Acute complications of cellulitis
- necrotising fasciitis
- sepsis
- abscess
- myositis
Chronic complications of cellulitis
- persistent leg ulceration
- recurrent cellulitis
- lymphoedema
Causes of necrotising fasciitis
- infection of bacteria into wounds in the skin e.g. cuts, burns, insect bites, surgery
- strep pyogenes (most common)
- staph aureus/MRSA
Presentation of necrotising fasciitis
- severe pain at site which is out of proportion to the appearance of the wound
- swelling of skin
- fever + flu like symptoms
- confusion
- blistering of skin
- fast developing/spreading red rash
Treatment of necrotising fasciitis
- board spectrum abx until cultures identify causative bacteria: clindamycin, penicillin, meropenem
- reconstructive surgery e.g. skin grafts
- amputation if extreme
