Chapter 151 - Cellulitis and Erysipelas Flashcards
Unilateral LE involvement is typical and systemic symptoms are usual.
True or False
False, usually absent
Sharply demarcated, bright red, edematous plaques resulting from superficial lymphatic infiltration
Erysipelas
Localized pustules or abscesses associated with cellulitis
Purulent cellulitis
Classic signs of inflammation (4)
Rubor
Tumor
Calor
Dolor
More than ___% of hospitalizations in US are due to cellulitis
10%
Spreading, ill defined erythema, edema, often warm and painful
Classic cellulitis
Presence of the ff (3) warrants concern for necrotizing soft tissue infection
- Crepitus
- Anesthesia
- Pain disproportionate to clinical finding
Frequent complication of cellulitis that increases risk of recurrence
Lymphedema
Fever is more common in erysipelas than classic cellulitis.
True or False
True
Important clues to diagnosis of orbital cellulitis (4)
Proptosis
Bulbar conjunctival edema
Ophthalmoplegia
Decreased visual acuity
Risk factors for bilateral cellulits (2)
Deficient cellular immunity
- Solid organ transplant recipients
- HIV
Portal of entry is identified in ___%
62
MC etiology
Toe web infections
Etiology of cellulitis from aquatic trauma (4)
Aeromonas spp
Erysipelothrix rhusiopathiae
Mycobacterium marinum
Vibrio vulnificus
At greater risk for polymicrobial or atypical infections (3)
Surgical site infections
Pressure or diabetic ulcers
Cellular immunodeficiency
Systemic risk factors for primary and recurrent cellulitis (4)
Age
Obesity
Systemic disease
Summer
Local risk factors for primary cellulitis (2)
Lymphedema 70%
Disrupted skin barrier 24%
The 2014 update to Infectious Diseases Society of America guidelines recommends routinely culturing blood or cutaneous aspirates or swabs.
True or False
False, does not
ALT risk prediction for cellulitis (4)
Asymmetry 3
WBC >10,000 cells/ul 1
Tachycardia > 90bpm 1
70 y/o and older 2
ALT -70 risk score of ___ has 83.3% likelihood of pseudocellulitis
0-2
ALT -70 risk score of ___ has 83.3% likelihood of true cellulitis
> /= 5
Skin surface temp gradient greater than __ on therma imaging has sensitivity if 96.6% for diagnosis of cellulitis
0.47 C
The MC of pseudo cellulitis
Stasis dermatitis
Genetic testing of ___ expression was 34 fold higher among cases with cellulitis
HLADQA1
Recurrence occurs in more than ___% of patients
10
1st line Tx for mild nonpurulent cellulitis
Cephalexin
Dicloxacillin
Pen V
1st line Tx for moderate nonpurulent cellulitis
Cefazolin
Ceftriaxone
Pen G
1st line Tx for severe nonpurulent cellulitis
Vancomycin
Piperacillin-Tazobactam
1st line Tx for mild purulent cellulitis
MSSA 1. Cephalexin 2. Dicloxacillin MRSA 1. Clindamycin 2. Tetracycline 3. TMP SMX
1st line for moderate purulent cellulitis
MSSA Oxacillin Nafcillin Cefazolin MRSA Clindamycin Vancomycin
Criteria for SIRS (4)
36 < T> 38 C
HR > 90bpm
RR > 20
4,000 < WBC > 12,000
In general, recommended duration of Tx for uncomplicated; immunosuppressed
5- 10 days
7-14 days
In IDSA guidelines, uncomplicated cases should be treated for; if signs of infection persist then should
5 days
Extend
Significant involvement of lymphatics or superficial edema
Peau d’orange appearance
MC site of cellulitis
Lower extremity
MC site of erysipelas
Leg (76-90%)
Small areas of spared intervening skin in cellulitis are termed as
Skip areas
Inconsistent complication of cellulitis
Fever
Most common etiology of cellulitis (2)
GABHS
S. Aureus
Increase in both cellulitis and pseudocellulitis
ESR
CRP
Reassessment at ___ is impt to assess response to therapy
24-72hrs
