Cellulitis: Difference between revisions

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m (Aidan moved page Skin and soft tissue Cellulitis to Cellulitis without leaving a redirect)
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* Infection of superficial skin and skin structures
= Cellulitis =
 
   
== Definition ==
+
= Etiology =
 
* Infection of superficial skin and soft tissue
 
 
== Etiology ==
 
   
 
* ''Streptococcus pyogenes'' (much more common)
 
* ''Streptococcus pyogenes'' (much more common)
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** Butchers: ''Erysipelothrix'' (erysipeloid)
 
** Butchers: ''Erysipelothrix'' (erysipeloid)
   
== Differential Diagnosis ==
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= Differential Diagnosis =
   
 
* Skin and soft tissue infections
 
* Skin and soft tissue infections
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* For an exhaustive list, see [Cellulitis mimickers](Cellulitis mimickers.md)
 
* For an exhaustive list, see [Cellulitis mimickers](Cellulitis mimickers.md)
   
== Presentation ==
+
= Presentation =
   
 
* Hot, red, swollen, tender area of skin with poorly demarcated margins
 
* Hot, red, swollen, tender area of skin with poorly demarcated margins
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* Legs more common than elsewhere
 
* Legs more common than elsewhere
   
== Management ==
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= Management =
   
 
* Source control: drain any abscess
 
* Source control: drain any abscess
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** Metastasis
 
** Metastasis
   
=== Prophylaxis ===
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== Prophylaxis ==
   
 
* May be indicated for patients with recurrent cellulitis
 
* May be indicated for patients with recurrent cellulitis
 
* Penicillin V 250 mg po bid
 
* 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.
 
* 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]]

Revision as of 23:51, 14 August 2019

  • Infection of superficial skin and skin structures

Etiology

  • 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 Streptococcus
    • 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)

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
  • For an exhaustive list, see [Cellulitis mimickers](Cellulitis mimickers.md)

Presentation

  • Hot, red, swollen, tender area of skin with poorly demarcated margins
  • With or without pus and/or bullae
  • Legs more common than elsewhere

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 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
    • If penicillin allergy
      • Clindamycin300mg po qid
      • Moxifloxacin 400mg po daily
      • Linezolid 600mg po bid
      • Clindamycin 600mg IV tid
      • Vancomycin 1g 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 or human bites
    • Poor adherence/absorption/distribution
    • Wrong diagnosis
    • Impatience!
  • Complications of infection
    • Abscess (drain it)
    • Deep infection
    • Metastasis

Prophylaxis