Cellulitis_erysipelas Signs and Symptoms

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 and subcutaneous tissues
• Commonly caused by beta-hemolytic streptococci and Staphylococcus aureus
  • Infection due to streptococci is rapidly spreading because of streptokinase while that of S aureus is localized
  • Consider Methicillin-resistant S aureus (MRSA) in patients with recurrent cellulitis, refractory to treatment, or exposed to a hospital or nursing facility
• Can also be caused by Streptococcus pneumoniae, Haemophilus influenzae, Gram-negative bacilli and anaerobes

 Erysipelas

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

Cellulitis

• Etiology of cellulitis remains unidentified in most patients and 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 and anaerobes

• 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

• Obesity
• Diabetes mellitus (DM) and malignancy
• Immunosuppression
• Alcoholism
• Intravenous (IV) drug abuse
• Atopic dermatitis
• Previous cutaneous damage (eg animal bites, abrasions, wounds, etc)
• Surgery
• Edema from venous insufficiency or lymphatic obstruction
• Water exposure