Cellulitis: Difference between revisions

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* Infection of superficial skin and skin structures
+
*Infection of superficial skin and skin structures
   
== Etiology ==
+
==Etiology==
   
* ''[[Streptococcus pyogenes]]'' (much more common)
+
*''[[Streptococcus pyogenes]]'' (much more common)
* ''[[Staphylococcus aureus]]'' (especially if purulent)
+
*''[[Staphylococcus aureus]]'' (especially if purulent)
* Rare, depending on exposures:
+
*Rare, depending on exposures:
** Hand or foot puncture: ''[[Pseudomonas aeruginosa]]''
+
**Hand or foot puncture: ''[[Pseudomonas aeruginosa]]''
** Facial cellulitis in children: ''[[Haemophilus influenzae]]''
+
**Facial cellulitis in children: ''[[Haemophilus influenzae]]''
** Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]]
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**Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]]
** Cat or dog bites: ''[[Pasteurella multocida]]''
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**Cat or dog bites: ''[[Pasteurella multocida]]''
** Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral)
+
**Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral)
** Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites)
+
**Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites)
** Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
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**Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
   
== Differential Diagnosis ==
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==Differential Diagnosis==
   
* Skin and soft tissue infections
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*Skin and soft tissue infections
** Cellulitis (Strep >> Staph)
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**Cellulitis (Strep >> Staph)
** [[Erysipelas]] (usually Strep)
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**[[Erysipelas]] (usually Strep)
** [[Abscess]] (usually Staph)
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**[[Abscess]] (usually Staph)
** Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
+
**Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
** [[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics
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**[[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics
** Carbuncles
+
**Carbuncles
** [[Necrotizing fasciitis]]
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**[[Necrotizing fasciitis]]
* Other disease
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*Other disease
** Deep vein thrombosis
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**[[Deep vein thrombosis]]
** Gout (if over a joint)
+
**[[Gout]] (if over a joint)
** Erythema nodosum
+
**[[Erythema nodosum]]
  +
**[[Acute inflammatory edema]]
* For an exhaustive list, see [[Cellulitis mimickers]]
+
*For an exhaustive list, see [[Cellulitis mimickers]]
   
== Clinical Manifestations ==
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==Clinical Manifestations==
   
* Hot, red, swollen, tender area of skin with poorly demarcated margins
+
*Hot, red, swollen, tender area of skin with poorly demarcated margins
* With or without pus and/or bullae
+
*With or without pus and/or bullae
* 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
* Antibiotics for 5-7 days
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*Antibiotics for 5-7 days
* Purulent SSTI
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*Purulent SSTI
** Cephalexin or cefazolin are good first-line empiric choices
+
**Cephalexin or cefazolin are good first-line empiric choices
** Doxycycline or vancomycin can also be considered
+
**Doxycycline or vancomycin can also be considered
* Non-purulent SSTI
+
*Non-purulent SSTI
** Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
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**Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
** If penicillin allergy
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**If penicillin allergy
*** Clindamycin300mg po qid
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***Clindamycin300mg po qid
*** Moxifloxacin 400mg po daily
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***Moxifloxacin 400mg po daily
*** Linezolid 600mg po bid
+
***Linezolid 600mg po bid
*** Clindamycin 600mg IV tid
+
***Clindamycin 600mg IV tid
*** Vancomycin 1g IV q12h
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***Vancomycin 1g IV q12h
* Non-resolving cellulitis
+
*Non-resolving cellulitis
** Bug-drug mismatch
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**Bug-drug mismatch
** Resistance
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**Resistance
** Poor antibiotic choice
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**Poor antibiotic choice
** Unusual organism
+
**Unusual organism
*** Water exposure (fresh- or saltwater)
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***Water exposure (fresh- or saltwater)
*** Fish
+
***Fish
*** Shellfish, meats, hides
+
***Shellfish, meats, hides
*** IV drug use
+
***IV drug use
*** Animal or human bites
+
***Animal or human bites
** Poor adherence/absorption/distribution
+
**Poor adherence/absorption/distribution
** Wrong diagnosis
+
**Wrong diagnosis
** Impatience!
+
**Impatience!
* Complications of infection
+
*Complications of infection
** Abscess (drain it)
+
**Abscess (drain it)
** Deep infection
+
**Deep infection
** 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.
   
 
[[Category:Skin and soft tissue infections]]
 
[[Category:Skin and soft tissue infections]]

Revision as of 19:00, 24 March 2021

  • Infection of superficial skin and skin structures

Etiology

Differential Diagnosis

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

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