Cellulitis_erysipelas%20(pediatric) Signs and Symptoms

• An acute spreading skin infection that may go deep, involving the subcutaneous tissues
• Typically occurs in areas where the skin integrity has been compromised
• May also result from blood-borne spread of infection to the skin and subcutaneous tissues

Erysipelas

• A type of cellulitis with sharply demarcated margins involving the epidermis and superficial lymphatics
• Onset of symptoms is acute whereas cellulitis has an indolent course
• More commonly caused by beta-hemolytic streptococci

• Commonly caused by beta-hemolytic streptococci and Staphylococcus aureus in adults, and Haemophilus influenzae type B in patients <3 years
  
  • Infection due to streptococci is rapidly spreading because of streptokinase while that of staphylococci is localized
  • Consider Methicillin-resistant S aureus (MRSA) in patients with recurrent cellulitis, or refractory to treatment 
  • Can also be caused by Streptococcus pneumoniae, Gram-negative bacilli and anaerobes

Uncomplicated Cellulitis

• Beta-hemolytic streptococcal etiology in 90% of infections but S aureus is difficult to exclude especially if mixed infection occurs

Complicated Cellulitis

• Group A streptococci, S aureus, H influenzae B, Enterobacteriaceae and anaerobes

• Rapidly spreading area of acute inflammation of the dermis and subcutaneous tissue
• Lymphangitis and inflammation of the regional lymph nodes may occur
• Area is usually tender, erythematous and warm to the touch
• Patient may have malaise, fever and chills

• Obesity
• Diabetes mellitus and malignancy
• Immunosuppression
• Previous cutaneous damage
• Edema from venous insufficiency or lymphatic obstruction