Cellulitis

Cellulitis is a bacterial infection of the deep dermis and subcutaneous tissue. It is most commonly caused by S. pyogenes and S. aureus.5 Bacteria may gain access to the dermis via a break in the skin barrier in healthy adults, whereas the hematogenous route is more common in immunocompromised patients.

The affected skin is usually erythematous, swollen, painful, and warm to the touch. Severe cellulitis can be complicated by bullae, pustules, or necrotic tissue. Damage to lymphatic vessels can lead to recurrent episodes of cellulitis.6 In areas of the world endemic for lymphatic filariasis, it is important to rule out this disease in cases of recurrent bouts of lower-extremity cellulitis and lymphangitis.

1. CELLULITIS PRESENTED BY R.PRIYA

2. INTRODUCTION Skin  is the largest organ of human body. Skin is first line of defence system of human body. It forms a barrier and protects internal organs from external foreign bodies including bacteria, viruses, fungi etc. Skin has three layers- Dermis, Epidermis and Hypodermis. The tissue beneath the skin is called  Subcutaneous tissue . This consists of fats and collagen which regulate body temperature and protect the body. Normally there are many types of bacteria on skin which may enter our body through cracks, breaks, cuts, injuries, ulcers etc. They can then multiply and spread to cause infection of skin called Ceulitis .

3. DEFINITION Cellulitis  is a  bacterial infection  involving the inner layers of the  skin . [1]  It specifically affects the  dermis  and  subcutaneous fat   Cellulitis may spread rapidly. Affected skin appears swollen and red and may be hot and tender. Without treatment with an antibiotic, cellulitis can be life-threatening. Cellulitis usually affects the skin on the lower legs, but it can occur in the face, arms and other areas. It occurs when a crack or break in your skin allows bacteria to enter.

4. TYPES Typical presentation of all skin infections Soft tissue redness Warmth and swelling Pain/tenderness Mild Cellulitis Features above No systemic features No significant co-morbidities  Moderate Cellulitis Features above with moderate swelling and tenderness Systemic features ( eg fever, tachycardia) Severe Cellulitis Features above with severe swelling or tenderness Large body surface area involved ( eg larger than the patient’s handprint) Marked systemic features ( eg fever or hypothermia, tachycardia, tachypnoea, altered conscious state, unwell appearance, hypotension — this is a late sign). See  Sepsis Features suggestive of necrotising fasciitis include: severe pain out of keeping with apparent severity of infection rapid progression marked systemic features ( eg high fever with rigors, tachycardia, tachypnoea, hypotension, confusion, vomiting). See  Sepsis

5. CAUSES Cellulitis is caused by  bacteria  that enter and infect the tissue through breaks in the skin.  GroupA   Streptococcus  and  Staphylococcus  are the most common causes of the infection and may be found on the skin as normal flora in healthy individuals. Insect or  spider bite ,  blistering , an animal bite,  tattoos ,  pruritic  (itchy) skin rash, recent  surgery ,  athlete's foot ,  dry skin ,  eczema , injecting drugs (especially subcutaneous or intramuscular injection or where an attempted intravenous injection "misses" or blows the vein ), 

6. RISK FACTOR The most common causes are Group A streptococcus (GAS) and  Staphylococcus aureus . Impetigo (commonly called "school sores")  Highly contagious infection of the epidermis, particularly common in young children Causative organisms are GAS and  S. aureus May be associated with scabies Staphylococcal scalded skin syndrome (SSSS)  Blistering skin disorder induced by the exfoliative ( epidermolytic ) toxins of  S. aureus . Primarily affects neonates and young children Necrotising fasciitis  Rapidly progressive soft tissue infection characterised by necrosis of subcutaneous tissue Causative organisms include GAS,  S. aureus , anaerobes and is often polymicrobial It causes severe illness with a high mortality rate (~25%) Recent infection with varicella is a risk factor

7. RISK FACTOR Injury.  Any cut, fracture, burn or scrape gives bacteria an entry point. Weakened immune system.  Conditions that weaken your immune system — such as diabetes, leukemia and HIV/AIDS — leave you more susceptible to infections. Certain medications also can weaken your immune system. Skin conditions.  Conditions such as eczema, athlete's foot and shingles can cause breaks in the skin, which give bacteria an entry point. Chronic swelling of your arms or legs (lymphedema).  This condition sometimes follows surgery. History of cellulitis.  Having had cellulitis before makes you prone to develop it again. Obesity.  Being overweight or obese increases your risk of developing cellulitis. suffered  poliomyelitis Chickenpox  and  shingles  often result in blisters that break open, providing a gap in the skin through which bacteria can enter.    Lymphedema , which causes swelling on the arms and/or legs, can also put an individual at risk . Predisposing factors include skin abrasions, lacerations, burns, eczematous skin, chickenpox, etc. although the portal of entry of organisms is often not seen

8. PATHOPHYSIOLOGY

9. SIGNS AND SYMPTOMS Red area of skin that tends to expand Swelling Tenderness Pain Warmth Fever Red spots Blisters Skin dimpling

10. DIAGNOSTIC EVAUATION History Physical examination  use of  bedside ultrasonography   blood cultures  are positive in fewer than 5% of all cases Swab for Gram stain (charcoal / gel / bacterial transport swab and slide) and culture if discharge present Blood culture is not useful in mild/moderate cellulitis Consider imaging ( eg ultrasound) if abscess, deep infection or foreign body suspected

11. MANAGEMENT Covering your wound.  Properly covering the affected skin will help it heal and prevent irritation. Follow your doctor’s instructions for dressing your wound and be sure to change your bandage regularly. Keeping the area clean.  Follow your doctor’s recommendations for cleaning the affected skin. Elevating the affected area.  If your leg is affected, lie down and elevate your leg above your heart. This will help reduce swelling and ease your pain. Applying a cool compress.  If the affected skin is hot and painful, apply a clean washcloth soaked in cool water. Avoid chemical icepacks, as these can further irritate damaged skin.

12. MANAGEMENT

13. COMPLICATION Recurrent episodes of cellulitis may damage the lymphatic drainage system and cause chronic swelling of the affected limb. Rarely, the infection can spread to the deep layer of tissue called the fascial lining. Necrotizing fasciitis is an example of a deep-layer infection. It's an extreme emergency.

14. PREVENTION Wash your wound daily with soap and water.  Do this gently as part of your normal bathing. Apply a protective cream or ointment.  For most surface wounds, an over-the-counter ointment (Vaseline, Polysporin , others) provides adequate protection. Cover your wound with a bandage.  Change bandages at least daily. Watch for signs of infection.  Redness, pain and drainage all signal possible infection and the need for medical evaluation. People with diabetes and those with poor circulation need to take extra precautions to prevent skin injury. Good skin care measures include the following: Inspect your feet daily.  Regularly check your feet for signs of injury so you can catch infections early. Moisturize your skin regularly.  Lubricating your skin helps prevent cracking and peeling. Do not apply moisturizer to open sores. Trim your fingernails and toenails carefully.  Take care not to injure the surrounding skin. Protect your hands and feet.  Wear appropriate footwear and gloves. Promptly treat infections on the skin's surface (superficial), such as athlete's foot.  Superficial skin infections can easily spread from person to person. Don't wait to start treatment.

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