cellulitis_erysipelas%20(pediatric)
CELLULITIS/ERYSIPELAS (PEDIATRIC)
Cellulitis is an acute spreading skin infection that may go deep, involving the subcutaneous tissues.
It typically occurs in areas where the skin integrity has been compromised.
May result from blood-borne spread of infection to the skin and subcutaneous tissues.
It is commonly caused by beta-hemolytic streptococci and Staphylococcus aureus in adults and Haemophilus influenzae type B in patients <3 year of age.

Introduction

  • 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 & subcutaneous tissues

Definition

Erysipelas

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

Etiology

  • Commonly caused by beta-hemolytic streptococci & Staphylococcus aureus in adults, & 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 w/ recurrent cellulitis, or refractory to treatment 

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, Staphylococcus aureus, H influenzae B, Enterobacteriaceae & anaerobes

Signs and Symptoms

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

Risk Factors

  • Obesity
  • Diabetes mellitus & malignancy
  • Immunocompromise
  • Previous cutaneous damage
  • Edema from venous insufficiency or lymphatic obstruction
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