cellulitis_erysipelas
CELLULITIS/ERYSIPELAS
Cellulitis is a spreading bacterial skin infection that infects deeply involving the subcutaneous tissues.
It typically occurs in areas where the skin integrity has been compromised.
It may also result from blood-borne spread of infection to the skin and subcutaneous tissues.
It is commonly caused by beta-hemolytic streptococci and Staphylococcus aureus.
Erysipelas is a type of cellulitis with margins that are sharply demarcated, involves the epidermis and superficial lymphatics.
Onset of symptoms is acute whereas cellulitis has an indolent course.
It is more commonly caused by beta-hemolytic streptococci.

Definition

Cellulitis

  • A diffuse, spreading bacterial skin infection that involves the subcutaneous tissues
  • Typically occurs in areas where the skin integrity has been compromised
    • More commonly affects the lower extremities in adults, and the face and neck in children
  • May also result from blood-borne spread of infection to the skin & subcutaneous tissues
  • Commonly caused by beta-hemolytic streptococci & Staphylococcus aureus
    • Infection due to streptococci is rapidly spreading because of streptokinase while that of S aureus islocalized
    • Consider Methicillin-resistant S aureus (MRSA) in patients with recurrent cellulitis, refractory to treatment,or exposed to a hospital or nursing facility

 Erysipelas

  • A type of cellulitis with margins that are sharply demarcated, involves the epidermis and superficial lymphatics
  • Onset of symptoms is acute with accompanying systemic manifestations whereas cellulitis has an indolent course
  • More commonly caused by beta-hemolytic streptococci

Etiology

Cellulitis

  • Etiology of cellulitis remains unidentified in most patients & treatment needs to be empiric based on clinical presentation

Uncomplicated

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

Complicated

  • Group A streptococci, S aureus, Enterobacteriaceae & anaerobes

 

Signs and Symptoms

  • Rapidly spreading area of acute inflammation of the dermis and subcutaneous tissue
  • Typically unilateral and common in the lower extremities
  • “Butterfly” involvement of the face and of the ears (Milian’s ear sign) is suggestive of erysipelas
  • 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 (DM) and malignancy
  • Immunosuppression
  • Alcoholism
  • Intravenous drug use (IV) drug abuse
  • Previous cutaneous damage (eg animal bites, abrasions, wounds, etc)
  • Surgery
  • Edema from venous insufficiency or lymphatic obstruction
  • Water exposure

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