Cellulites [ compatibility mode].pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Cellulitis:Introduction

3. Cellulitis:Introduction Cellulitis is infection of the subcutaneous tissue. The common modern term is SSTI i.e. Skin and Soft Tissue Infection.

4. Cellulitis:Etiology

5. Cellulitis:Etiology Staph. aureus – MRSA Strep.- S.pyogenes(group A, beta hemolytic) S.viridans (alpha hemolytic) S.fecalis (group D entercoccus Peptostreptococcus Microaerophilic streptococcus

6. Cellulitis:Etiology organisms enters through crack or injury to the skin which may sometimes be unrecognised or forgotten.

7. Cellulitis :Clinical Features

8. Cellulitis :Clinical Features Systemic signs of infection: Fever Tachycardia Leukocytosis Local-Classical features of inflammation: Pain Swelling Redness Raised local temperature Tenderness

9. Cellulitis :Clinical Features Several syndromes exist depending on offending bacterium.

10. Cellulitis :Clinical Features Cellulitis caused by Staph. Aureus Large number of infections seen in surgical practice are caused by staph. Aureus. Most important pathogen of post operative wound infection and Infection following penetrating injury. Lesions are indurated areas of cellulitis with central necrosis and abscess formation. Pus: Thick, creamy, odorless, yellow or cream-colored.

11. Cellulitis :Clinical Features Cellulitis caused by Staph. Aureus: Noscomial (hospital aquired) are often antibiotic resistant and highly virulent. Sometimes cellulitis spreads very fast and must be treated vigorously.

12. Cellulitis :Clinical Features Cellulitis caused by Staph. Aureus: Staph can be of three types- Non penicillinase producing, Penicillinase producing Methicillin resistant (MRSA)

13. Cellulitis :Clinical Features Cellulitis caused by Streptococci: S.pyogenes- Lesions are invasive with rapid course Full blown infections are seen within 12 to 24 hours after contamination. Lesions are characterised by Diffuse cellulitis, Lymphangitis, Lymphadenitis and Extension of infection along fascial planes A thin watery pus may develop but frank pus formation is rare Cutaneous gangrene due to thrombosis of small vessels.

14. Cellulitis :Clinical Features Cellulitis caused by Streptococci: S.pyogenes- Bacteremia occurs frequently:- Chills High fever Rapid and thready pulse General signs of toxemia.

15. Cellulitis :Clinical Features Cellulitis caused by Streptococci: Erysipelas: Most often caused by hemolytic streptococci, Occurs in epifascial tissues and skin, Incubation period is 1 to 3 days, Severe toxemia Spreading superficial cellulitis.

16. Cellulitis :Clinical Features Cellulitis caused by Streptococci: Erysipelas Characteristic appearance- Indurated Raised Irregular margin. Lesions are usually self limited Improvement is seen within 4 to 8 days.

17. Cellulitis :Clinical Features Cellulitis caused by Streptococci: Acute recurrent lymphangitis may also be result from infection with S.pyogenes Portal of entry- small cracks in the skin. Syndrome of- Sudden onset of high fever, Chills, Painful swelling of legs with Regional adenopathy May progress to streptococcal gangrene

18. Cellulitis :Clinical Features Cellulitis caused by Streptococci: Streptococcal gangrene- Spreading, Invasive epifascial and subcutaneous infection Usually occurs in lower extremities Thrombosis of nutrient vessels and sloughing of overlying skin. Typically clear bullous lesions form Coalesce Later on get filled with hemorrhagic fluid

19. Cellulitis :Clinical Features Cellulitis caused by Streptococci: Necrotizing fascitis- Occasionally associated with cutaneous gangrene Chronic type of infection may occur with multiple draining sinuses communicating with areas of underlying necrotic fascia.

20. Cellulitis :Clinical Features Cellulitis caused by Streptococci: Surgical scarlet fever: Occurs 2 to 4 days after injury or operation. Caused by wound infection by hemolytic streptococci that produce Erythrogenic toxin. Fever with typical scarlatiniform eruption.

21. Cellulitis :Clinical Features Cellulitis caused by Streptococci: Microaerophilic streptococci: Infections develop and progress slowly- Chroinic burrowing ulcer and Chronic progressive cutaneous gangrene Chroinic burrowing ulcer- Consists of superficial ulcers and communicating and burrowing sinus tracts.

22. Cellulitis :Clinical Features Cellulitis caused by Streptococci: Microaerophilic streptococci: in both conditions there is minimal systemic toxicity but marked local pain.

23. Cellulitis :Clinical Features Cellulitis caused by Gram Negative bacilli: bacteria indigenous to GI and Genitourinary tracts. Caused by contamination of incision with spilled GI contents. Immunocompromised host Perforations of GI/Urinary tract.

24. Cellulitis :Clinical Features Cellulitis caused by Gram Negative bacilli: Often polymicrobial, Both aerobic and anerobic organisms are presents. Longer incubation period. Infection with a species of Bacteroides may associated with thrombophlebitis due to heparinase activity of the organism.

25. Cellulitis :Clinical Features Cellulitis caused by Clostridia : Clostridia cause three surgical diseases: Gas gangrene Tetanus Clostridial

26. Cellulitis :Clinical Features Cellulitis caused by Clostridia : Is a serious septic process of areolar tissue. Caused by one or more of clostridia. Cellulitis. welchii is commonest Crepitant cellulitis that spreads rapidly along fascial planes. Eventually sloughing of areolar tissue, fascia and skin may occur. Pain is severe. Grey or reddish brown discharge.

27. Cellulitis :Clinical Features Cellulitis caused by mixed Bacterial Infections: Synergistic Cutaneous Gangrene. Human bite. Non clostridial crepitant Cellulitis

28. Cellulitis :Clinical Features Cellulitis caused by mixed Bacterial Infections: Synergistic Cutaneous Gangrene: Chronic, progressive gangrene of skin. Caused by synergistic action of- aerobic hemolytic Staph.aureus and microaerophilic nonhemolytic streptococcus Usually starts as a complication around stay sutures or wounds

29. Cellulitis :Clinical Features Cellulitis caused by mixed Bacterial Infections: Synergistic Cutaneous Gangrene: Characterised by a wide area of pale red cellulitis with purplish central area that finally becomes gangrenous Gangrene gradually enlarges Margin is very painful.

30. Diagnostic Studies

31. Diagnostic Studies Blood culture both aerobic and anaerobic.

32. Cellulitis: Non Operative Therapy

33. Cellulitis: Non Operative Therapy Antibiotics Rest Elevation pf the part Heat

34. Cellulitis :Operative Therapy Streptococcal gangrene and necrotizing fascitis: Wide surgical excision along with antibiotic therapy.

35. Cellulitis :Operative Therapy Cellulitis caused by Clostridia : Extensive surgical decompression with elevation of skin flaps superficial to the fascia along with antibiotic therapy in large doses.

36. Cellulitis :Operative Therapy If pus formation has occurred. Incision and drainage If post op- Opening the incision widely and packing loosely.

37. Cellulitis :Operative Therapy Cellulitis caused by Streptococci: Microaerophilic streptococci: Radical incision and drainage or excision combined with antibiotics.

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