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Original Editors - <a href="Pathophysiology of Complex Patient Problems">Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.</a>
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Definition/Description[edit source]
Cellulitis is a localized bacterial skin infection, which typically affects the lower limbs but can occur on any area of skin and underlying subcutaneous tissue.1,2 It is characterized by acute onset of redness, inflammation, pain, and swelling of the affected area. Accompanying symptoms include generalized fever, rigors, nausea, and vomiting.1 The infection is most commonly caused by B-Hemolytic Streptococci bacteria and reoccurs up to 50% of the time in the lower extremity.1,3 Most individuals diagnosed with cellulitis have a low risk of severe complications but few suffers can have severe sepsis, local gangrene, and/or necrotising fasciitis.1
Prevalence[edit source]
- 650,000 hospital admissions per year in the United States are due to Cellulitis.5
- When hospitalized, patients with recurrent cellulitis require longer hospitalizations relative to nonrelapsing Cellulitis patients.5
- From 1998-2006, 10% of all infectious-disease hospitalizations were related to Cellulitis5
- 22-49% of patients who have cellulitis report at least one previous episode5
- Recurrences, typically in the same location, occur approximately 14% of cellulitis cases within 1 year and in 45% of cases within 3 years5
Characteristics/Clinical Presentation[edit source]
Typical symptoms include acute poorly demarcated and spreading erythema along with pain, swelling, and warmth of the lower extremity but can occur on any area of skin or underlying subcutaneous tissue.2,3 Additional symptoms may include fever, nausea, vomiting, and rigors.3,10 Other features include proximal dilated and edematous skin lymphatics and bulla formation.3 Cellulitis predominantly has a unilateral presentation.3
Associated Co-morbidities[edit source]
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Medications[edit source]
Cephalexin, Dicloxacillin, Penicillin VK, Amoxicillin, and Clindamycin are typical Antistreptococcal Antimicrobial agents for the treatment of typical cellulits that is considered mild and does not show signs of systemic involvement.3 Figure 1 states which medications would be appropriate based on the severity of symptoms and the risk of Methicillin-resistant Staphylococcus aureus (MRSA).4
Clinical Presentation | Appropriate Antibiotic Treatment |
---|---|
Routine Cellulitis with low suspicion of MRSA | Dicloxacillin, Cephalexin, Nafcillin, or Cefazolin |
High suspicion of MRSA or Penicillin allergy | Doxycycline, Clindamycin, Trimethoprim-sulfamethoxazole |
High suspicion of MRSA with signs and symptoms of severe infection or did not respond to initial routine treatment | Vancomycin*, Linezolid |
- Vancomycin is the drug of choice for infections resulting from MRSA4
Diagnostic Tests/Lab Tests/Lab Values[edit source]
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Etiology/Causes[edit source]
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Systemic Involvement[edit source]
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Medical Management (current best evidence)[edit source]
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Physical Therapy Management (current best evidence)[edit source]
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Differential Diagnosis[edit source]
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Case Reports/ Case Studies[edit source]
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Resources
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Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>)[edit source]
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References[edit source]
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