Cellulitis

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
  • S 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
  • Staphylococci
  • Streptococci
  • 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 aureus
  • Nocardia 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 corrodens
  • aerobic 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 Important

  • 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)
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