Cellulitis

Source: Wikipedia, the free encyclopedia.
This article is about the subcutaneous infection. For subcutaneous fat, see Cellulite.
Cellulitis
cephalexin[1][6]
Frequency21.2 million (2015)[7]
Deaths16,900 (2015)[8]

Cellulitis is usually

Lymphatic vessels may occasionally be involved,[1][4] and the person may have a fever and feel tired.[2]

The legs and face are the most common sites involved, although cellulitis can occur on any part of the body.

streptococci and Staphylococcus aureus.[1] In contrast to cellulitis, erysipelas is a bacterial infection involving the more superficial layers of the skin, present with an area of redness with well-defined edges, and more often is associated with a fever.[1] The diagnosis is usually based on the presenting signs and symptoms, while a cell culture is rarely possible.[1][3] Before making a diagnosis, more serious infections such as an underlying bone infection or necrotizing fasciitis should be ruled out.[4]

Treatment is typically with

pain killers.[4][6]

Potential complications include abscess formation.[1] Around 95% of people are better after 7 to 10 days of treatment.[2] Those with diabetes, however, often have worse outcomes.[10] Cellulitis occurred in about 21.2 million people in 2015.[7] In the United States about 2 of every 1,000 people per year have a case affecting the lower leg.[1] Cellulitis in 2015 resulted in about 16,900 deaths worldwide.[8] In the United Kingdom, cellulitis was the reason for 1.6% of admissions to a hospital.[6]

Signs and symptoms

The typical signs and symptoms of cellulitis are an area that is red, hot, and painful. The photos shown here are of mild to moderate cases and are not representative of the earlier stages of the condition.[citation needed]

  • Cellulitis following an abrasion: Note the red streaking up the arm from the involvement of the lymphatic system.
    Cellulitis following an abrasion: Note the red streaking up the arm from the involvement of the lymphatic system.
  • Infected left shin in comparison to the right-sided shin with no sign of symptoms.
    Infected left shin in comparison to the right-sided shin with no sign of symptoms.
  • Cellulitis of the leg with foot involvement.
    Cellulitis of the leg with foot involvement.

Complications

Potential complications may include abscess formation, fasciitis, and sepsis.[1][11]

Causes

Cellulitis is usually, but not always,

bacteria that enter and infect the tissue through breaks in the skin. Group A Streptococcus and Staphylococcus are the most common causes of the infection and may be found on the skin as normal biota in healthy individuals.[12]

About 80% of cases of Ludwig's angina, or cellulitis of the submandibular space, are caused by dental infections. Mixed infections, due to both aerobes and anaerobes, are commonly associated with this type of cellulitis. Typically, this includes alpha-hemolytic streptococci, staphylococci, and bacteroides' groups.[13]

Predisposing conditions for cellulitis include an insect or

eczema, injecting drugs (especially subcutaneous or intramuscular injection or where an attempted intravenous injection "misses" or blows the vein), pregnancy, diabetes, and obesity, which can affect circulation, as well as burns and boils, although debate exists as to whether minor foot lesions contribute. Occurrences of cellulitis may also be associated with the rare condition hidradenitis suppurativa or dissecting cellulitis.[14]

The appearance of the skin assists a doctor in determining a diagnosis. A doctor may also suggest blood tests, a wound culture, or other tests to help rule out a blood clot deep in the veins of the legs. Cellulitis in the lower leg is characterized by signs and symptoms similar to those of a deep vein thrombosis, such as warmth, pain, and swelling (inflammation).

Reddened skin or rash may signal a deeper, more serious infection of the inner layers of skin. Once below the skin, the bacteria can spread rapidly, entering the lymph nodes and the bloodstream and spreading throughout the body. This can result in influenza-like symptoms with a high temperature and sweating or feeling very cold with shaking, as the affected person cannot get warm.[14]

In rare cases, the infection can spread to the deep layer of tissue called the

fascial lining. Necrotizing fasciitis, also called by the media "flesh-eating bacteria", is an example of a deep-layer infection. It is a medical emergency.[15]

Risk factors

The elderly and those with

poliomyelitis are also prone because of circulatory problems, especially in the legs.[citation needed
]

Immunosuppressive drugs, and other illnesses or infections that weaken the immune system, are also factors that make infection more likely. Chickenpox and shingles often result in blisters that break open, providing a gap in the skin through which bacteria can enter. Lymphedema, which causes swelling on the arms and/or legs, can also put an individual at risk.[citation needed] Diseases that affect blood circulation in the legs and feet, such as chronic venous insufficiency and varicose veins, are also risk factors for cellulitis.[citation needed]

Cellulitis is also common among dense populations sharing hygiene facilities and common living quarters, such as military installations, college dormitories, nursing homes, oil platforms, and homeless shelters.[citation needed]

Diagnosis

Cellulitis is most often a clinical diagnosis, readily identified in many people by history and physical examination alone, with rapidly spreading areas of cutaneous swelling, redness, and heat, occasionally associated with inflammation of regional lymph nodes. While classically distinguished as a separate entity from erysipelas by spreading more deeply to involve the subcutaneous tissues, many clinicians may classify erysipelas as cellulitis. Both are often treated similarly, but cellulitis associated with furuncles, carbuncles, or abscesses is usually caused by S. aureus, which may affect treatment decisions, especially antibiotic selection.[16] Skin aspiration of nonpurulent cellulitis, usually caused by streptococcal organisms, is rarely helpful for diagnosis, and blood cultures are positive in fewer than 5% of all cases.[16]

It is important to evaluate for co-existent abscess, as this finding usually requires surgical drainage as opposed to antibiotic therapy alone. Physicians' clinical assessment for abscess may be limited, especially in cases with extensive overlying induration, but use of bedside ultrasonography performed by an experienced practitioner readily discriminates between abscess and cellulitis and may change management in up to 56% of cases.[17] Use of ultrasound for abscess identification may also be indicated in cases of antibiotic failure. Cellulitis has a characteristic "cobblestoned" appearance indicative of subcutaneous edema without a defined hypoechoic, heterogeneous fluid collection that would indicate abscess.[18]

Differential diagnosis

Other conditions that may mimic cellulitis include

bullae, skin sloughing, subcutaneous edema, and systemic toxicity.[16] Misdiagnosis can occur in up to 30% of people with suspected lower-extremity cellulitis, leading to 50,000 to 130,000 unnecessary hospitalizations and $195 to $515 million in avoidable healthcare spending annually in the United States.[19] Evaluation by dermatologists for cases of suspected cellulitis has been shown to reduce misdiagnosis rates and improve patient outcomes.[20][21]

Associated musculoskeletal findings are sometimes reported. When it occurs with

pilonidal cysts, the syndrome is referred to as the follicular occlusion triad or tetrad.[22]

cephalexin, is not useful in Lyme disease.[5] When it is unclear which one is present, the IDSA recommends treatment with cefuroxime axetil or amoxicillin/clavulanic acid, as these are effective against both infections.[5]

Prevention

In those who have previously had cellulitis, the use of antibiotics may help prevent future episodes.[26] This is recommended by CREST for those who have had more than two episodes.[6] A 2017 meta-analysis found a benefit of preventative antibiotics for recurrent cellulitis in the lower limbs, but the preventative effects appear to diminish after stopping antibiotic therapy.[27]

Treatment

Antibiotics are usually prescribed, with the agent selected based on suspected organism and presence or absence of

purulence,[16] although the best treatment choice is unclear.[28] If an abscess is also present, surgical drainage is usually indicated, with antibiotics often prescribed for co-existent cellulitis, especially if extensive.[17] Pain relief is also often prescribed, but excessive pain should always be investigated, as it is a symptom of necrotizing fasciitis. Elevation of the affected area is often recommended.[29]

Steroids may speed recovery in those on antibiotics.[1]

Antibiotics

Antibiotics choices depend on regional availability, but a penicillinase-resistant semisynthetic penicillin or a first-generation cephalosporin is currently recommended for cellulitis without abscess.[16] A course of antibiotics is not effective in between 6 and 37% of cases.[30]

Epidemiology

Cellulitis in 2015 resulted in about 16,900 deaths worldwide, up from 12,600 in 2005.[8]

Cellulitis is a common global health burden, with more than 650,000 admissions per year in the United States alone. In the United States, an estimated 14.5 million cases annually of cellulitis account for $3.7 billion in ambulatory care costs alone. The majority of cases of cellulitis are nonculturable and therefore the causative bacteria are unknown. In the 15% of cellulitis cases in which organisms are identified, most are due to β-hemolytic Streptococcus and Staphylococcus aureus.[31]

Other animals

NSAIDs, such as phenylbutazone, cold hosing, applying a sweat wrap or a poultice, and mild exercise.[citation needed
]

See also

References

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  12. ^ "Cellulitis". The Lecturio Medical Concept Library. Archived from the original on 20 August 2021. Retrieved 7 July 2021.
  13. ISBN 978-81-312-2364-2
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  14. ^ a b "Cellulitis: All You Need to Know". National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases (CDC). 4 February 2021. Archived from the original on 8 July 2021. Retrieved 7 July 2021.
  15. ^ "Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy". CDC. June 15, 2016. Archived from the original on 9 August 2016. Retrieved 7 July 2021.
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  24. ^ "Lyme Disease Data and surveillance". Lyme Disease. Centers for Disease Control and Prevention. 2019-02-05. Archived from the original on 2019-04-13. Retrieved April 12, 2019.
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  33. S2CID 18579931
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Further reading

External links

  • "Cellulitis". MedlinePlus. U.S. National Library of Medicine. 24 December 2023.
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