Cellulitis
incomplete-TODO: empirical abx
| Headline | |
|---|---|
| Etiology | Strep pyogenes and Staph aureus most common organisms. |
| Epidemiology | |
| Clinical presentation | Unilateral red hot leg swelling +/- blisters/bullae; lymphagitis; a discrete border Check for abscess/fluctuance... |
| Pathogenesis | |
| Diagnostic investigations | Swabs not routinely recommended |
| Management | Referral - see below. Does not necessarily apply to sensitive areas (eyes, nose/face) Empirical abx: Flucloxacillin/clarithromycin (CKS) Near eyes/nose: co-amoxiclav (CKS) |
eron classification
- Class I — there are no signs of systemic toxicity and the person has no uncontrolled comorbidities.
equivalent to ASA I - Class II — the person is either systemically unwell or systemically well but with a comorbidity (for example peripheral arterial disease, chronic venous insufficiency, or morbid obesity) that may complicate or delay the resolution of infection.
equivalent to ASA II - Class III — the person has significant systemic upset, such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable comorbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromise.
- Class IV — the person has sepsis or a severe life-threatening infection, such as necrotizing fasciitis.
red flags
- severity: Necrotising fasciitis, osteomyelitis, septic arthritis, limb-threatening infection
- sensitive areas: facial cellulitis, eyes/nose involvement, orbital/periorbital
- uncommon pathogens e.g. after swimming/travel
pathogens and associations
- Pseudomonas aeruginosa — following exposure to contaminated hot tubs, sponges, or a nail puncture wound.
- Vibrio vulnificus — following salt water exposure.
- Aeromonas hydrophila — following freshwater exposure.
- Erysipelothrix rhusiopathiae — in butchers, vets, or fish handlers.
- Mycobacterium marinum — in aquarium keepers.
- Pasteurella multocida and Capnocytophaga canimorsus — following cat or dog bites.
- Eikenella corrodens — following a human fist or bite injuries.
- Streptobacillus moniliformis — following a rat bite.
- Streptococcus pneumoniae, Haemophilus influenzae, Gram-negative bacilli, and anaerobes — following injury, burns, and other co‐existing diseases (for example people who are immunocompromised, have diabetes mellitus, cancer, or malnutrition).