Cellulitis: Difference between revisions
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== Background == |
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* Infection of superficial skin and skin structures |
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*Infection of superficial skin and skin structures |
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= Etiology = |
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===Microbiology=== |
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* ''[[Streptococcus pyogenes]]'' (much more common) |
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* ''[[Staphylococcus aureus]]'' (especially if purulent) |
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* Rare, depending on exposures: |
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** Hand or foot puncture: ''[[Pseudomonas aeruginosa]]'' |
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** Facial cellulitis in children: ''[[Haemophilus influenzae]]'' |
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** Human bite wounds: Anaerobes, ''[[Eikenella]]'', [[viridans-group Streptococci]] |
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** Cat or dog bites: ''[[Pasteurella multocida]]'' |
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** Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral) |
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** Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites) |
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** Butchers: ''[[Erysipelothrix]]'' (erysipeloid) |
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*''[[Streptococcus pyogenes]]'' (much more common) |
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= Differential Diagnosis = |
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*''[[Staphylococcus aureus]]'' (especially if purulent) |
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*Rare, depending on exposures: |
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**Hand or foot puncture: ''[[Pseudomonas aeruginosa]]'' |
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**Facial cellulitis in children: ''[[Haemophilus influenzae]]'' |
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**Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]] |
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**Cat or dog bites: ''[[Pasteurella multocida]]'' |
|||
**Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral) |
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**Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites) |
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**Butchers: ''[[Erysipelothrix]]'' (erysipeloid) |
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==Clinical Manifestations== |
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* Skin and soft tissue infections |
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** Cellulitis (Strep/Staph) |
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** Erysipelas (usually Strep) |
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** Abscess (usually Staph) |
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** Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment |
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** Impetigo (usually Staph): watchful waiting, or topical or systemic antibiotics |
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** Carbuncles |
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** Necrotizing fasciitis |
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* Other disease |
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** Deep vein thrombosis |
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** Gout (if over a joint) |
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** Erythema nodosum |
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* For an exhaustive list, see [Cellulitis mimickers](Cellulitis mimickers.md) |
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*Hot, red, swollen, tender area of skin with poorly demarcated margins |
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= Presentation = |
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*With or without pus and/or bullae |
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*Legs more common than elsewhere |
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== Diagnosis == |
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* Hot, red, swollen, tender area of skin with poorly demarcated margins |
|||
* With or without pus and/or bullae |
|||
* Legs more common than elsewhere |
|||
* Clinical based on typical appearance |
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= Management = |
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== Differential Diagnosis == |
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* Source control: drain any abscess |
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* Antibiotics for 5-7 days |
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* Purulent SSTI |
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** Cephalexin or cefazolin are good first-line empiric choices |
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** Doxycycline or vancomycin can also be considered |
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* Non-purulent SSTI |
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** Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days |
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** If penicillin allergy |
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*** Clindamycin300mg po qid |
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*** Moxifloxacin 400mg po daily |
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*** Linezolid 600mg po bid |
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*** Clindamycin 600mg IV tid |
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*** Vancomycin 1g IV q12h |
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* Non-resolving cellulitis |
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** Bug-drug mismatch |
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** Resistance |
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** Poor antibiotic choice |
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** Unusual organism |
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*** Water exposure (fresh- or saltwater) |
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*** Fish |
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*** Shellfish, meats, hides |
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*** IV drug use |
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*** Animal or human bites |
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** Poor adherence/absorption/distribution |
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** Wrong diagnosis |
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** Impatience! |
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* Complications of infection |
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** Abscess (drain it) |
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** Deep infection |
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** Metastasis |
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*Skin and soft tissue infections |
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== Prophylaxis == |
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**Cellulitis (Strep >> Staph) |
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**[[Erysipelas]] (usually Strep) |
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**[[Abscess]] (usually Staph) |
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**Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment |
|||
**[[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics |
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**Carbuncles |
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**[[Necrotizing fasciitis]] |
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*Other disease |
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**[[Deep vein thrombosis]] |
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**[[Gout]] (if over a joint) |
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**[[Erythema nodosum]] |
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**[[Acute inflammatory edema]] |
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*For an exhaustive list, see [[Cellulitis mimickers]] |
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==Management== |
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* May be indicated for patients with recurrent cellulitis |
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* Penicillin V 250 mg po bid |
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*Source control: drain any abscess |
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* Read more: Oh CC ''et al''. [https://doi.org/10.1016/j.jinf.2014.02.011 Antibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis]. ''J Infect''. 2014;69(1):26-34. |
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*Antibiotics for 5-7 days |
|||
**Purulent SSTI |
|||
***[[Cephalexin]] or [[cefazolin]] are good first-line empiric choices |
|||
***Doxycycline or vancomycin can also be considered |
|||
**Non-purulent SSTI |
|||
***[[Cephalexin]] 500 mg po qid or [[cefazolin]] 1-2 g IV q8h for 5-7 days |
|||
***If penicillin allergy |
|||
****[[Clindamycin]] 300 mg po qid |
|||
****[[Moxifloxacin]] 400 mg po daily |
|||
****[[Linezolid]] 600 mg po bid |
|||
****[[Clindamycin]] 600 mg IV tid |
|||
****[[Vancomycin]] 1 g IV q12h |
|||
*Non-resolving cellulitis |
|||
**Bug-drug mismatch |
|||
**Resistance |
|||
**Poor antibiotic choice |
|||
**Unusual organism |
|||
***Water exposure (fresh- or saltwater) |
|||
***Fish |
|||
***Shellfish, meats, hides |
|||
***IV drug use |
|||
***[[Animal bites|Animal or human bites]] |
|||
**Poor adherence/absorption/distribution |
|||
**Wrong diagnosis |
|||
**Impatience! |
|||
*Complications of infection |
|||
**[[Abscess]] (drain it) |
|||
**Deep infection |
|||
**Metastasis |
|||
===Prophylaxis=== |
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*May be indicated for patients with recurrent cellulitis |
|||
*[[Penicillin V]] 250 mg po bid |
|||
*Read more: Oh CC ''et al''. [https://doi.org/10.1016/j.jinf.2014.02.011 Antibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis]. ''J Infect''. 2014;69(1):26-34. |
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[[Category:Skin and soft tissue infections]] |
[[Category:Skin and soft tissue infections]] |
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Latest revision as of 17:46, 14 July 2022
Background
- Infection of superficial skin and skin structures
Microbiology
- Streptococcus pyogenes (much more common)
- Staphylococcus aureus (especially if purulent)
- Rare, depending on exposures:
- Hand or foot puncture: Pseudomonas aeruginosa
- Facial cellulitis in children: Haemophilus influenzae
- Human bite wounds: anaerobes, Eikenella, Viridans group streptococci
- Cat or dog bites: Pasteurella multocida
- Saltwater exposure: Vibrio vulnificus (e.g. injury on coral)
- Fresh- or saltwater exposure: Aeromonas hydrophila (e.g. leech bites)
- Butchers: Erysipelothrix (erysipeloid)
Clinical Manifestations
- Hot, red, swollen, tender area of skin with poorly demarcated margins
- With or without pus and/or bullae
- Legs more common than elsewhere
Diagnosis
- Clinical based on typical appearance
Differential Diagnosis
- Skin and soft tissue infections
- Cellulitis (Strep >> Staph)
- Erysipelas (usually Strep)
- Abscess (usually Staph)
- Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
- Impetigo (usually Staph): watchful waiting, or topical or systemic antibiotics
- Carbuncles
- Necrotizing fasciitis
- Other disease
- Deep vein thrombosis
- Gout (if over a joint)
- Erythema nodosum
- Acute inflammatory edema
- For an exhaustive list, see Cellulitis mimickers
Management
- Source control: drain any abscess
- Antibiotics for 5-7 days
- Purulent SSTI
- Cephalexin or cefazolin are good first-line empiric choices
- Doxycycline or vancomycin can also be considered
- Non-purulent SSTI
- Cephalexin 500 mg po qid or cefazolin 1-2 g IV q8h for 5-7 days
- If penicillin allergy
- Clindamycin 300 mg po qid
- Moxifloxacin 400 mg po daily
- Linezolid 600 mg po bid
- Clindamycin 600 mg IV tid
- Vancomycin 1 g IV q12h
- Purulent SSTI
- Non-resolving cellulitis
- Bug-drug mismatch
- Resistance
- Poor antibiotic choice
- Unusual organism
- Water exposure (fresh- or saltwater)
- Fish
- Shellfish, meats, hides
- IV drug use
- Animal or human bites
- Poor adherence/absorption/distribution
- Wrong diagnosis
- Impatience!
- Complications of infection
- Abscess (drain it)
- Deep infection
- Metastasis
Prophylaxis
- May be indicated for patients with recurrent cellulitis
- Penicillin V 250 mg po bid
- Read more: Oh CC et al. Antibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis. J Infect. 2014;69(1):26-34.
