Cellulitis

CASE SCENARIO

A 28-year-old man presents to the hospital with an enlarging area of redness, swelling, warmth, and pain on his right leg for 3 days. It started as a painful red bump that he thought was due to a spider bite. He does not recall any trauma. Additionally, he has subjective fevers and chills. He says his pain is somewhat controlled with ibuprofen, which is his only medication

CASE SCENARIO
No past medical history No remarkable drug Hx Surgical: No Hx of surgical procedure. Trauma: No Hx of trauma Blood transfusion: No Hx of blood transfusion. Allergy: No Known Drug Allergies, no food allergies No remarkable family Hx

Examination:
Temperature 38.5 degrees C Pulse 115 Resp. rate 20/m BP 110/70 O2 sat 98%
Extremities/ in RL 4 X 12 inch area of indurated erythema, tender to palpation, all extremities with grossly normal motor strength and sensation

differential diagnosis
Lyme disease

DVT

Impetigo

Cellulitis
dermatitis
Necrotizing fasciitis

differential diagnosis

Cellulitis

differential diagnosis

Lyme disease DVT Impetigo Necrotizing fasciitis Contact dermatitis

differential diagnosis
Erythema migrans Resembles cellulites , but is not painful and progresses slowly, and fever is less marked.

Lyme disease DVT Impetigo Necrotizing fasciitis Contact dermatitis

differential diagnosis
usually in the calf. Not usually associated with fever, chills. Hemodynamic instability with pulmonary embolism

Lyme disease DVT Impetigo Necrotizing fasciitis Contact dermatitis

differential diagnosis

Lyme disease DVT Impetigo Necrotizing fasciitis Contact dermatitis

Impetigo is characterized by blisters and sores on the face or Extremities and usually occurs in children

differential diagnosis

Lyme disease DVT Impetigo Necrotizing fasciitis Contact dermatitis

involves deeper tissue planes (fascia and Muscle)

differential diagnosis

Lyme disease DVT Impetigo Necrotizing fasciitis Contact dermatitis

Look for unusual patterns of distribution. There is no fever, but pruritis is present. Exposure to irritant

Cellulitis

Classification of SSTIs
Simple Uncomplicated

(mostly Gram +)

Cellulitis Impetigo Erysipelas Simple abscess Furuncles (boils) Complicated: (Gram & Gram + ) Decubitus ulcers Necrotising fasciitis Cellulitis

Cellulitis

Cellulitis is a bacterial
infection of the skin. Bacteria get into the skin through a cut, scrape, or other wound. Cellulitis can also affect the deeper layers of connective tissue beneath the skin and, in severe cases, spread to lymph nodes. Cellulitis most often affects the legs, but it may also affect the arms, face, and scalp

CLINICAL MANIFESTATIONS

Diagnosis
Generally, no workup is required in uncomplicated cases of cellulitis that meet the following criteria:

Limited area of involvement Minimal pain No systemic signs of illness (eg, fever,
altered mental status, tachypnea, tachycardia, hypotension)

No risk factors for serious illness (eg, extremes of age, immunocompromise

Laboratory
CBC/ Elevated leukocyte count suggests systemic infection.

Ultrasonography / With necrotizing fasciitis caused by group A streptococcus, distortion or thickening of the fascia with fluid accumulation can occur in children. In adults, CT is better than ultrasonography at defining the extent of disease.
Culture / for identification of the cause of infection. testing

Management
Antibiotic are effective in more than 90% of patients smallest of abscesses require drainage for resolution, regardless of the pathogen beta-lactam antibiotics are appropriate therapy, as noted in the following: In mild cases of cellulitis treated on an outpatient basis: Dicloxacillin, amoxicillin, or cephalexin In patients who are allergic to penicillin: Clindamycin or a macrolide (clarithromycin or azithromycin)