Cellulitis: Difference between revisions

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==Background==
==Background==
*Acute non-purulent spreading infection of the subcutanous tissue, causing overlying skin inflammation
{{Skin anatomy background images}}
*Most often caused by strep, staph, MRSA
*Acute spreading infection of the dermis and subcutanous tissue, causing overlying skin inflammation<ref name="Gunderson">Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012 Feb;64(2):148-55.</ref>
*H.flu is most common cause in the orbit.
*Most often caused by streptococcus or staphylococcus (including [[MRSA]])


==DDx==
===Risk factors<ref>Quirke M et al. Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis. Br J Dermatol. 2017 Aug;177(2):382-394.</ref>===
*Deep Venous Thrombosis
*Previous cellulitis
*Necrotizing Fasciitis
*Wound or current leg ulcers
*Osteomyelitis
*Excoriating skin diseases
*[[Lymphedema]]
*Venous insufficiency
*Obesity
*[[Tinea pedis]]


==Diagnosis==
==Clinical Features==
*Often accompanied by fever, chills, malaise, HA, vomiting
[[File:Cellulitis Of The Leg.jpg|thumb|Cellulitis of the leg]]
*Rash
*[[Rash]]
**Local redness, heat, swelling
**Local erythema, warmth, swelling
**Warm tender indistinct margins. Pyrexia may signify systemic spread
**Tender indistinct margins
*Can be accompanied by fever, chills, malaise, headache, nausea/vomiting


==Treatment==
==Differential Diagnosis==
*For MRSA
{{SSTI DDX}}
**Vancomycin, Clindamycin or TMP-SMZ plus a Beta Lactam.
{{Hand Infection DDX}}
*Mild cases or following initial parenteral therapy
{{Foot infection}}
**Dicloxacillin or cephalexin
{{Erythematous rash DDX}}


==Source==
==Evaluation==
*Tintinalli
*Generally clinical diagnosis, may be assisted by ultrasound (above)
*[[Ultrasound: Soft tissue|Ultrasound]] can aid in diagnosis - may see "cobblestoning" of subcutaneous fat due to accumulation of fluid in these tissues. Also helpful to evaluate for [[abscess]].


[[Category:Peds]]
==Management==
[[Category:Derm]]
===[[Antibiotics]]===
{{Cellulitis antibiotics}}
 
===Predictors of Treatment Failure<ref>Peterson D. et al. Predictors of failure of empiric outpatient antibiotic therapy in emergency department patients with uncomplicated cellulitis. Acad Emerg Med. 2014 May;21(5):526-31.</ref>===
*Fever (T>38°C) at triage (odds ratio [OR] 4.3)
*Chronic leg ulcers (OR 2.5)
*Chronic edema or lymphedema (OR 2.5)
*Prior cellulitis in the same area (OR 2.1)
*Cellulitis at a wound site (OR 1.9)
 
==Disposition==
*Admit for:
**Sepsis
**Significant hand, face, or genitalia infection
**Failure of outpatient treatment
**Significant comorbidity (e.g. immunocompromized, poorly controlled diabetes)
 
==See Also==
*[[Orbital cellulitis]]
*[[Hand cellulitis]]
*[[Periorbital cellulitis]]
*[[Erysipelas]]
*[[Facial cellulitis]]
*[[Erythematous rash]]
 
==References==
<references/>
 
[[Category:Dermatology]]
[[Category:ID]]

Latest revision as of 16:18, 11 December 2024

Background

Normal dermal anatomy.
  • Acute spreading infection of the dermis and subcutanous tissue, causing overlying skin inflammation[1]
  • Most often caused by streptococcus or staphylococcus (including MRSA)

Risk factors[2]

  • Previous cellulitis
  • Wound or current leg ulcers
  • Excoriating skin diseases
  • Lymphedema
  • Venous insufficiency
  • Obesity
  • Tinea pedis

Clinical Features

Cellulitis of the leg
  • Rash
    • Local erythema, warmth, swelling
    • Tender indistinct margins
  • Can be accompanied by fever, chills, malaise, headache, nausea/vomiting

Differential Diagnosis

Skin and Soft Tissue Infection

Look-A-Likes

Hand and finger infections

Look-Alikes

Foot infection

Skin and Soft Tissue

Deep Tissue / Limb-Threatening

Bone and Joint

Look A-Likes

Erythematous rash

Evaluation

  • Generally clinical diagnosis, may be assisted by ultrasound (above)
  • Ultrasound can aid in diagnosis - may see "cobblestoning" of subcutaneous fat due to accumulation of fluid in these tissues. Also helpful to evaluate for abscess.

Management

Antibiotics

Tailor antibiotics by regional antibiogram

Outpatient

  • 5 day treatment duration
    • Cephalexin 500mg PO q6hrs OR
      • Add DS 1 tab PO BID if MRSA suspected
    • Clindamycin 450mg PO TID covers Strep and Staph


Pediatric Outpatient

  • Cephalexin 25-50mg/kg/day PO divided q6-8h (max 500mg/dose) OR
    • Add 8-12mg/kg/day (TMP) PO divided BID if MRSA suspected
  • Clindamycin 30-40mg/kg/day PO divided TID (max 1.8g/day)

Inpatient


Pediatric Inpatient

Saltwater related cellulitis

Freshwater related cellulitis

Predictors of Treatment Failure[3]

  • Fever (T>38°C) at triage (odds ratio [OR] 4.3)
  • Chronic leg ulcers (OR 2.5)
  • Chronic edema or lymphedema (OR 2.5)
  • Prior cellulitis in the same area (OR 2.1)
  • Cellulitis at a wound site (OR 1.9)

Disposition

  • Admit for:
    • Sepsis
    • Significant hand, face, or genitalia infection
    • Failure of outpatient treatment
    • Significant comorbidity (e.g. immunocompromized, poorly controlled diabetes)

See Also

References

  1. ↑ Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012 Feb;64(2):148-55.
  2. ↑ Quirke M et al. Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis. Br J Dermatol. 2017 Aug;177(2):382-394.
  3. ↑ Peterson D. et al. Predictors of failure of empiric outpatient antibiotic therapy in emergency department patients with uncomplicated cellulitis. Acad Emerg Med. 2014 May;21(5):526-31.
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