Cellulitis

INTRODUCTION:
  • Cellulitis is a common bacterial skin infection. Cellulitis may first appear as a red, swollen area that feels hot and tender to the touch.
  • The redness and swelling often spread rapidly. Cellulitis is usually painful.
  • In most cases, the skin on the lower legs is affected, although the infection can occur anywhere on your body or face.
  • Cellulitis usually affects the surface of your skin, but it may also affect the underlying tissues of your skin.
  • Cellulitis can also spread to your lymph nodes and bloodstream.
SYMPTOMS :
The symptoms of cellulitis may include:
  • Pain and tenderness in the affected area
  • Redness or inflammation of your skin
  • Skin sore or rash that appears and grows quickly
  • Tight, glossy, swollen appearance of the skin
  • Central area that has an abscess with pus formation
  • Fever,shaking,fatigue,dizziness,lightheadedness,muscle aches,warm skin,sweating
  • Cellulitis of floor of mouth can lead to Ludwigs angia
  • Cellulitis of lower limb Are Infection of skin & subcutaneous tissue showing distinct margins with Fever & malaise
ETIOLOGY & RISK FACTORS:
  • Cellulitis occurs when certain types of bacteria enter through a cut or crack in the skin.
  • Cellulitis is commonly caused by Staphylococcus aureus and Streptococcus bacteria Clostridium perfringens.
TREATMENTS:
Location Likely Organisms Antibiotic Regimen -Oral/ Outpatient Antibiotic Regimen -- Parenteral/ Hospitalized
Uncomplicated cellulitis Group A streptococci
Penicillin Cephalexin or clindamycin
Cefazolin or oxacillin or nafcillin
Cellulitis, concern for methicillin-resistant S aureus is a concern Group A streptococci
 aureus
Vancomycin, Teicoplanin and Linezolid are all active against most Methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin Daptomycin Ceftaroline
Dog bite Pasteurella species
S aureus
Streptococcus pyogenes
Staphylococci
Aerobes -Moraxella and Neisseria
Anaerobes -Fusobacterium, Bacteroides,
Porphyromonas, and Prevotella
Amoxicillin/ clavulanate Penicillin allergic: Moxifloxacin Third-generation cephalosporin (ceftriaxone [Rocephin]) plus metronidazole or beta-lactam/beta-lactamase inhibitor (eg, ampicillin/sulbactam) or fluoroquinolone plus metronidazole or carbapenem (ertapenem)
Human bite Eikenella corrodens Aerobic gram-positive cocci, anaerobes Amoxicillin/ clavulanate Penicillin allergic: Moxifloxacin or (Clindamycin or metronidazole) plus (doxycycline or cefuroxime or trimethoprim/ sulfamethoxazole) Third-generation cephalosporin (Rocephin) plus metronidazole or beta-lactam/beta-lactamase inhibitor (eg, ampicillin/sulbactam) or fluoroquinolone plus metronidazole or carbapenem (ertapenem)
Cat bite Pasteurella multocida(most common)
P septica
StaphylococciStreptococci
Bacteroides
Peptostreptococcus
Actinomyces
Fusobacterium
Porphyromonas
Veillonella parvula
Amoxicillin/ clavulanate Penicillin allergic -Moxifloxacin or (Clindamycin or metronidazole) plus(doxycycline or cefuroxime or trimethoprim/ sulfamethoxazole) Third-generation cephalosporin (Rocephin) plus metronidazole or beta-lactam/beta-lactamase inhibitor (eg, ampicillin/sulbactam) or fluoroquinolone plus metronidazole or carbapenem (ertapenem)
Preseptal (periorbital) cellulitis Haemophilus influenzae type b
Pneumococcus(on culture show greenish colonies and optochin sensitivity)
Streptococcus pneumoniae
S aureusNocardia brasiliensis
Bacillus anthracis
Pseudomonas aeruginosa
Apophysomyces species(severe panophthalmitis with cellulitis shows irregular branching aseptate and broad hyphae)
Aspergillus(hyaline, narrow, septate and branching hyphae)
Neisseria gonorrhoeae
Proteus species
Pasteurella multocida
Mycobacterium tuberculosis
Amoxicillin-clavulanate, cefpodoxime, cefdinir Third-generation cephalosporin (Rocephin)
Lower extremity -Complicating saphenous venectomy site after coronary bypass grafting streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci Dicloxacillin or cephalexin. Add trimethoprim/ sulfamethoxazole or tetracycline or clindamycin if concern for methicillin-resistant S aureus First-generation cephalosporin (cefazolin); clindamycin; vancomycin
Breast/arm - - (not mastitis)Complicating breast cancer surgery/lymph node dissection Group A or Non-group A beta-hemolytic streptococci most likely organisms Dicloxacillin, cephalexin. Add trimethoprim/ sulfamethoxazole or tetracycline or clindamycin if concern for methicillin-resistant S aureus Multiple regimens, none clearly superior –Piperacillin/tazobactam or ceftazidime plus aminoglycoside; or ciprofloxacin plus beta-lactam or monotherapy with piperacillin/tazobactam or cefepime
Aquatic environment Puncture/ laceration Aeromonas hydrophila,
Pseudomonas and Plesiomonas species,
Vibrio species,
Erysipelothrix rhusiopathiae,
Mycobacterium marinum, and others
Fluoroquinolone (eg, ciprofloxacin or levofloxacin) Note: For M marinum infection, use clarithromycin plus either ethambutol or rifampin Third- or fourth-generation cephalosporin (eg, ceftazidime or cefepime) or fluoroquinolone (eg, ciprofloxacin or levofloxacin)
Clenched-fist injury E corrodensaerobic gram-positive cocci,anaerobes Amoxicillin/ clavulanate; penicillin allergic: Moxifloxacin or (clindamycin or metronidazole) plus (doxycycline or cefuroxime or trimethoprim/ sulfamethoxazole) Beta-lactam/beta-lactamase inhibitor (eg, ampicillin/sulbactam)
Odontogenic facial cellulitis Aerobic and facultative organisms: group A beta-hemolytic streptococci,
Neisseria and Eikenella species
Anaerobes: Prevotella and
Peptostreptococcusspecies
Amoxicillin-clavulanate or clindamycin Beta-lactam/beta-lactamase inhibitor (eg, ampicillin/sulbactam) or clindamycin
Exam Question
  • Cellulitis is commonly caused by S aureus , streptococcus pyogenes & Clostridium perfringens.
  • Vancomycin, Teicoplanin and Linezolid are all active against most Methicillin-resistant Staphylococcus aureus (MRSA) infection causing cellulitis
  • Cellulitis of floor of mouth can lead to Ludwigs angia
  • Pasteurella multocida is the most common causative micro organism of cellulitis in case of cat bite
  • Treatment of spreading streptococcal cellulitis is penicillin
  • cellulitis of lower limb Are Infection of skin & subcutaneous tissue showing distinct margins with Fever & malaise
  • Orbital cellulitis is caused by
  • Pneumococcus(on culture show greenish colonies and optochin sensitivity)
  • Apophysomyces species(severe panophthalmitis with cellulitis shows irregular branching aseptate and broad hyphae)
  • Aspergillus(hyaline, narrow, septate and branching hyphae)
Don't Forget to Solve all the previous Year Question asked on Cellulitis