Cellulitis- Causes, Diagnosis and its Management.

Cellulitis is usually a superficial infection of the skin (left). But if severe (right) or if left untreated, it can spread into the lymph nodes and bloodstream.

Cellulitis usually affects the lower legs, but it can occur on the face, arms and other areas. The infection happens when a break in the skin allows bacteria to enter.

Left untreated, the infection can spread to the lymph nodes and bloodstream and rapidly become life-threatening. It isn't usually spread from person to person.
Most cellulitis patients can be treated as outpatients with oral antibiotics. Consider the dangerous differential diagnoses in all patients with cellulitis
Evaluate all patients for risk of MRSA as it will change antibiotic choice

1. Cellulitis Sachin Dwivedi Clinical instructor College of Nursing, AIIMS Rishikesh

2. Introduction Cellulitis is a common infection of the dermis and subcutaneous tissues. Cellulitis typically presents with pain, erythema, oedema, and warmth. Cellulitis is not transmitted by person-to-person contact as the epidermis is not involved. Early diagnosis and treatment are essential to prevent complications like abscess formation or bloodstream infection.

3. Definition Cellulitis is a common bacterial skin infection involving dermis and the subcutaneous layer characterized by inflammation, redness, warmth, and pain in the affected area. It occurs when bacteria enter the skin through a crack or break, leading to infection of the deeper skin layers. Cellulitis commonly affects the lower legs, but it can occur anywhere on the body including face, hands, torso, neck and buttocks respectively.

4. Epidemiology

5. Etiological Factor β hemolytic Streptococcus pyogenes. Staphylococcus aureus (MRSA). Risk factors include: Traumatic injury, Leg ulcers, Overweight, Lymphedema, Diabetes mellitus, Vasculitis, Previous surgery, Radiotherapy and immunocompromised states.

6. Pathophysiology The skin is a protective barrier that stops normal skin flora and other microbial pathogens reaching the subcutaneous tissue and lymphatic system If a skin breakage occurs (Risk factors & Causative agent)normal skin flora and other bacteria can enter the dermis and subcutaneous tissue. Leading potentially to an acute infection affecting the deep dermis and subcutaneous tissue. Affected area poorly demarcated and spreading erythema along with pain, swelling, and warmth.

7. Clinical Manifestation CLINICAL HALLMARKS OF CELLULITIS Warmth. Erythema. Edema with nonpalpable margins. Tenderness of affected area, Associated lymphangitis, Regional lymphadenopathy and Fever.

8. Diagnostic measures

9. Diagnostic measures Blood Examination: raised CRP levels, ASO titres in suspected Streptococcal infections, X-ray to rule out gas gangrene or underlying osteomyelitis or necrotizing fasciitis. Colour Doppler is done to rule out DVT/ Venous insufficiency. Swab cultures are done to isolate the causative organism. Blood cultures to know if bacteraemia is present.

10. Management

11. Physical Therapy Management

12. Complications C ellulitis that leads to Bacteremia, Endocarditis, or Osteomyelitis will require a longer duration of antibiotics and possibly surgery. Severe sepsis, gangrene, or necrotizing fasciitis.

13. Preventative Measures:

14. References 1.https:// www.researchgate.net /publication/318665012_Limb_cellulitis_in_rural_setting_in_India_a_case_control_study 2. Badipatla VN, Gurugubelli SR,Chandra MR, Teja PL, Bade V, Erabati SR. A clinical study of lower limb cellulitis. Int Surg J 2022;9:1421-5 3. Bailey E, Kroshinsky D. Cellulitis: Diagnosis and Management. Dermatologic Therapy. 2011;24:229–39. http://onlinelibrary.wiley.com/doi/10.1111/j.1529-8019.2011.01398.x/full (accessed 10 July 2024). Tsai C-YL, Calvin MK, Chung C, Susan Shin-Jung L, Yao-Shen C, Hung C. Development of a prediction model for bacteremia in hospitalized adults with cellulitis to aid in the efficient use of blood cultures: a retrospective cohort study. BMC Infectious Diseases. 2016;16(1):581.

15. Thank you!