cellulitis_erysipelas%20(pediatric)
CELLULITIS/ERYSIPELAS (PEDIATRIC)
Treatment Guideline Chart
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.

Cellulitis_erysipelas%20(pediatric) Signs and Symptoms

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 and subcutaneous tissues

Definition

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

Etiology

  • 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

Signs and Symptoms

  • 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

Risk Factors

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