Cellulitis vs necrotizing soft tissue infection

DIFFERENCE BETWEEN CELLULITIS AND NF

1. Cellulitis vs Necrotizing Soft Tissue Infection Afiq Azri bin Zakri 1110252

2. Definition Cellulitis- Cellulitis is an acute inflammatory condition of the dermis and subcutaneous tissue. Necrotising soft tissuse infection- A rapidly progressive infection of the deep fascia causing necrosis of subcutaneous tissue. Famously known as flesh eating disease.

3. Etiology -Most often caused by group A  β- hemolytic streptococci ( Streptococcus pyogenes ) or  Staphylococcus aureus .  -It can also be caused by other bacteria species and fungi and can be polymicrobial or monomicrobial .

4. Risk Factors Cellulitis: - Immunosuppressed individuals A pre-existing skin infection and inflammatory condition of the skin Necrotising soft tissuse infection: Immunosuppressed individuals Mother in postpartum period, especially if the mother has diabetes and has undergo caesarean delivery or episiotomy. 

5. Pathophysiology Infection begins at the site of trauma -Cut on the skin -Puncture wound -Surgical wound -Insect bites O rganisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis. R elease enzymes and toxins → enable the organisms to spread through the fascia → occlusion of small subcutaneous vessels → tissue ischemia and necrosis (necrotizing soft tissue infection).

6. Signs and Symptoms Cellulitis P ain and tenderness in the affected area R edness or inflammation on your skin S wollen appearance of the skin W armth in the affected area F ever with   chills and sweats, tenderness and swollen lymph nodes.

7. Necrotizing Soft Tissue Infection Early signs and symptoms resemble those of cellulitis. It can be distinguished by: M argins of infection are poorly defined, with tenderness extending beyond the apparent area of involvement Present of oedema, extending beyond the margin of erythema Present of bullae and ecchymosis Gangrenous skin Present of crepitus Wooden hard feel subcutaneous tissue Severe pain

8. Diagnosis History History suggestive to trauma, infection Underlying medical illness ( eg . DM) Treatment (chemotherapy) Physical Examination Signs of sepsis ( eg . Fever, shock) Local signs of NSTI, cellulitis Investigations Blood – FBC, CRP Tissue C&S X-ray

9. Treatment What to do? Manage patient in the ward Treatment of shock (if any) Start IV broad spectrum antibiotic immediately ( eg . IV penicillin, cephalosporin) Refer to the orthopaedic surgeon for surgical debridement and excision Once organism identified, start specific IV antibiotics Hyperbaric oxygen (NSTI) Skin grafts after the infection goes away to help your skin heal and look better(NSTI)

10. Prognosis Cellulitis - Have good prognosis and can be treatable by antibiotic treatment to eradicate the infection and avoid complications and spread of the infection. Necrotizing soft tissue infection Untreated necrotizing fasciitis has a poor prognosis; death or severe morbidity (for example, limb loss) With appropriate treatment, mortality rate can be as high as 25% Morbidity and mortality rates increases with MRSA or other multidrug resistant organisms

11. Prevention Prevention of infection: Good hygiene. Proper care and inspection of wound and cut especially in immunosuppressed patient. Sterile technique in surgery, episiotomy, caesarean section. Seek immediate treatment for any infection.

12. http://journalofethics.ama-assn.org Oxford Handbook of Clinical Medicine, 7 th Ed. 2007, Longmore , Wilkinson, Turmuzei & Chee KC, Oxford University Press. http://www.msdmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/cellulitis www.medicinenet.com www.medscape.com http://patient.info/doctor/necrotising-fasciitis-pro Browse Introduction to Investigation and Management of Surgical Disease, 2010, Norman L ., John Black, Kevin G ., Steven A ., William E. G ., Hodder Arnold Ltd. Reference