Cellulitis: Difference between revisions

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== Background ==
* Infection of superficial skin and skin structures
 
   
 
*Infection of superficial skin and skin structures
== Etiology ==
 
   
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===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)
 
   
 
*''[[Streptococcus pyogenes]]'' (much more common)
== Differential Diagnosis ==
 
 
*''[[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)
   
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==Clinical Manifestations==
* 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]]
 
   
 
*Hot, red, swollen, tender area of skin with poorly demarcated margins
== Presentation ==
 
 
*With or without pus and/or bullae
 
*Legs more common than elsewhere
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== Diagnosis ==
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* Clinical based on typical appearance
  +
 
== Differential Diagnosis ==
   
 
*Skin and soft tissue infections
* Hot, red, swollen, tender area of skin with poorly demarcated margins
 
 
**Cellulitis (Strep >> Staph)
* With or without pus and/or bullae
 
 
**[[Erysipelas]] (usually Strep)
* Legs more common than elsewhere
 
 
**[[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]]
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**[[Acute inflammatory edema]]
 
*For an exhaustive list, see [[Cellulitis mimickers]]
   
== Management ==
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==Management==
   
* Source control: drain any abscess
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*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
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***[[Cephalexin]] or [[cefazolin]] are good first-line empiric choices
** Doxycycline or vancomycin can also be considered
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***Doxycycline or vancomycin can also be considered
* Non-purulent SSTI
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**Non-purulent SSTI
** Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
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***[[Cephalexin]] 500 mg po qid or [[cefazolin]] 1-2 g IV q8h for 5-7 days
** If penicillin allergy
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***If penicillin allergy
*** Clindamycin300mg po qid
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****[[Clindamycin]] 300 mg po qid
*** Moxifloxacin 400mg po daily
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****[[Moxifloxacin]] 400 mg po daily
*** Linezolid 600mg po bid
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****[[Linezolid]] 600 mg po bid
*** Clindamycin 600mg IV tid
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****[[Clindamycin]] 600 mg IV tid
*** Vancomycin 1g IV q12h
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****[[Vancomycin]] 1 g IV q12h
* Non-resolving cellulitis
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*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
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**Unusual organism
*** Water exposure (fresh- or saltwater)
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***Water exposure (fresh- or saltwater)
*** Fish
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***Fish
*** Shellfish, meats, hides
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***Shellfish, meats, hides
*** IV drug use
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***IV drug use
*** Animal or human bites
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***[[Animal bites|Animal or human bites]]
** Poor adherence/absorption/distribution
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**Poor adherence/absorption/distribution
** Wrong diagnosis
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**Wrong diagnosis
** Impatience!
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**Impatience!
* Complications of infection
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*Complications of infection
** Abscess (drain it)
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**[[Abscess]] (drain it)
** Deep infection
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**Deep infection
** Metastasis
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**Metastasis
   
=== Prophylaxis ===
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===Prophylaxis===
   
* May be indicated for patients with recurrent cellulitis
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*May be indicated for patients with recurrent cellulitis
* Penicillin V 250 mg po bid
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*[[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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*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]]

Latest revision as of 13:46, 14 July 2022

Background

  • Infection of superficial skin and skin structures

Microbiology

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

Management

  • Source control: drain any abscess
  • Antibiotics for 5-7 days
  • Non-resolving cellulitis
    • Bug-drug mismatch
    • Resistance
    • Poor antibiotic choice
    • Unusual organism
    • Poor adherence/absorption/distribution
    • Wrong diagnosis
    • Impatience!
  • Complications of infection
    • Abscess (drain it)
    • Deep infection
    • Metastasis

Prophylaxis