Edit concept Create issue ticket

Cellulitis

Cellulitis is an inflammation of the skin and subcutaneous tissues.


Presentation

Musculoskeletal

There is swelling in the affected areas with restricted movement.

Dermatological

There is erythema, formation of pustules or simply swelling of the whole area involved, and later on once it starts healing, formation of scars [10].

Immune System

Due to active inflammation, there is a high neutrophil count and eosinophilia [2]. Platelet count may be increased in case of bleeding. If the inflammation goes on for more than a few hours, levels of lymphocytes in plasma may also go up.

Sputum
  • Additionally, Mycobacterium tuberculosis was isolated from a skin biopsy specimen as well as gastric fluid and sputum cultures. He was diagnosed with tuberculous cellulitis with pulmonary tuberculosis.[ncbi.nlm.nih.gov]
Pertussis
  • Alerting health care providers to this type of reaction, also seen with pneumococcal and pertussis containing vaccines, should avoid the inappropriate use of antibiotics.[ncbi.nlm.nih.gov]
Pain
  • The clinical aspect of this reaction is usually dominated by chronic pain, with mild functional deficits, and the diagnosis results from excluding other causes of chronic pain, such as infection, osteoarthritis, peripheral neuropathies or angiopaties.[ncbi.nlm.nih.gov]
  • The patient was pleased with treatment outcomes, reporting no lasting pain or discomfort from the scar.[ncbi.nlm.nih.gov]
  • An 18-year-old man presented for evaluation of a 1-year history of painful nodules on the scalp with associated hair loss. Physical examination revealed multiple confluent, fluctuant, boggy nodules on the scalp with overlying alopecic patches.[ncbi.nlm.nih.gov]
  • The patient was a previously healthy 23-year-old woman who made an outpatient visit to our hospital's Department of General Internal Medicine after developing pain and edema of the lower legs a week earlier.[ncbi.nlm.nih.gov]
  • Material expansion and fragmentation have led to pain, limited extraocular motility, ocular masses, infection, and eventual extrusion.[ncbi.nlm.nih.gov]
Fever
  • Simultaneously, fever, malaise and peripheral eosinophilia were noted. The clinical diagnosis of eosinophilic cellulitis (also known as Well's syndrome) was supported by the histopathological finding of typical "flame figures".[ncbi.nlm.nih.gov]
  • A 53-year-old Japanese man with a mood disorder presented to our hospital with fever and a complaint of an inability to walk. Two sets of blood cultures became positive for V. furnissii.[ncbi.nlm.nih.gov]
  • She presented with fever and pain in her left arm, and her medical history revealed a human bite by her cousin on the arm 3 days prior. The wound culture yielded S. pyogenes.[ncbi.nlm.nih.gov]
  • In the most severe cases, people with cellulitis develop a fever and elevated white blood cell count and may need to be hospitalized. Other symptoms of cellulitis include a rapidly spreading rash, dimpled skin, blisters and fever.[nationaleczema.org]
  • She presented with varicella lesions, fever and a painful firm tumefaction on the right lower leg (RLL). Ultrasound showed a local subcutaneous tissue thickening suggestive of cellulitis and antibiotics were initiated.[ncbi.nlm.nih.gov]
Chills
  • Fever, chills or rigors before or at admission was noted in 91% (59/65). Patients presented most often with sharply demarcated erythema and raised borders (54/64).[ncbi.nlm.nih.gov]
  • Signs and symptoms include pain, tenderness and reddening in the affected area, fever, chills, and lymphadenopathy.[fpnotebook.com]
  • Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature 38 C) and/or chills of sudden onset.[ncbi.nlm.nih.gov]
  • The symptoms associated with cellulitis can evolve and worsen due to systemic bacterial migration via the bloodstream, and include fever, malaise, and chills.[hardinmd.lib.uiowa.edu]
Malaise
  • Simultaneously, fever, malaise and peripheral eosinophilia were noted. The clinical diagnosis of eosinophilic cellulitis (also known as Well's syndrome) was supported by the histopathological finding of typical "flame figures".[ncbi.nlm.nih.gov]
  • The symptoms associated with cellulitis can evolve and worsen due to systemic bacterial migration via the bloodstream, and include fever, malaise, and chills.[hardinmd.lib.uiowa.edu]
  • In this form of cellulitis, unilateral swelling and redness of the eyelid and orbital area, as well as fever and malaise are usually present. 3. Serious infections of deeper skin structures 4. CAUSES  Staphylococcus  Streptococcus Group A β  H.[slideshare.net]
  • There is generally no systemic upset or malaise.[independentnurse.co.uk]
  • Complications Complications are very rare and include fever, malaise, widespread infection and shock. Treatment Treatment is fairly straightforward, involving antibiotics.[symptoma.com]
Lymphadenopathy
  • In our case, with the knowledge of tick exposure to the scalp, tularaemia was not initially considered for facial cellulitis without regional lymphadenopathy and also due to apparent failure to respond to doxycycline and gentamicin therapy.[ncbi.nlm.nih.gov]
  • Signs and symptoms include pain, tenderness and reddening in the affected area, fever, chills, and lymphadenopathy.[fpnotebook.com]
  • There may be associated lymphangitis and lymphadenopathy .[dermnetnz.org]
  • Systemic indications:  Increased temperature  Increased pulse  Lymphadenopathy of regional lymph nodes and / or lymphangitis 9. Diagnostic Tests  Swab any wound discharge for culture and sensitivity 10.[slideshare.net]
Thrombosis
  • We report a 16-month-old girl with varicella complicated by cellulitis, invasive Group A Streptococcus (GAS) infection and deep vein thrombosis. She presented with varicella lesions, fever and a painful firm tumefaction on the right lower leg (RLL).[ncbi.nlm.nih.gov]
  • Recent evidence on diagnostic strategies is discussed, the importance of which is underscored by findings that venous insufficiency, eczema, deep vein thrombosis and gout are frequently mistaken for cellulitis.[ncbi.nlm.nih.gov]
  • Noninfectious causes of local symptoms, including lymphedema, venous stasis, and deep vein thrombosis need to be considered.[ncbi.nlm.nih.gov]
  • These conditions include septic bursitis, septic joint, deep vein thrombosis, phlegmasia cerulea dolens, necrotizing fasciitis, flexor tenosynovitis, fight bite (closed fist injury), orbital cellulitis, toxic shock syndrome, erysipelas, abscess, felon[ncbi.nlm.nih.gov]
  • No patients developed cerebral venous sinus thrombosis, and there were no fatalities. Our findings indicate that BHS are the leading cause of facial cellulitis. Most patients exhibit sharply demarcated lesions and systemic symptoms.[ncbi.nlm.nih.gov]
Erythema
  • Mimics of cellulitis presenting with erythema, edema, warmth, and pain can be associated with grave morbidity and mortality if misdiagnosed.[ncbi.nlm.nih.gov]
  • She was taking chlorambucil and developed facial edema with erythema and warmth, misjudged as facial cellulitis. Two days later, she developed bullous lesions in the arms, legs, neck and face.[ncbi.nlm.nih.gov]
  • Furthermore, concluding that the erythema is due to a primary cellulitis may result in monotherapy with systemic antimicrobial agents.[ncbi.nlm.nih.gov]
  • Dermatological There is erythema, formation of pustules or simply swelling of the whole area involved, and later on once it starts healing, formation of scars.[symptoma.com]
  • Patients presented most often with sharply demarcated erythema and raised borders (54/64). Penicillin or penicillinase-resistant penicillin alone or in combination cured 68% (44/65) of the patients.[ncbi.nlm.nih.gov]
Cutaneous Manifestation
  • Cognizance of the increasing incidence of nosocomial infections with uncommon microorganisms such as S. maltophilia is necessary when presented with atypical cutaneous manifestations, particularly in immunocompromised patients.[ncbi.nlm.nih.gov]
Neck Pain
  • Categories Shop by Topic Gift Ideas Respiratory Miscellaneous Home Bath Safety Bath Lifts Bathing Aids - Hygiene Bidet Toilet Seats Commodes and Accessories Grab Bars Shower Chairs Transfer Benches Walk In Tubs Braces Back Supports & Braces Cervical Neck[activeforever.com]
Urethral Disease
  • Our patient was treated for cellulitis and abscess caused by N. gonorrhoeae in the absence of systemic or urethral disease. Recommendations regarding treatment of gonococcal infection have been widely published.[ncbi.nlm.nih.gov]

Workup

The work up of cellulitis includes examination of the site of infection and blood cultures. The blood culture and sensitivity is done to check the causative agent so that specific antibiotics can be given.

If there is abscess formation, fine needle aspiration should be done and the pus drained out. Ultrasonography may be used for better guidance of treatment.

Laboratory

Blood tests showing the total blood count to confirm active inflammation as well as culture and sensitivity are performed to check presence of organisms.

Neisseria Gonorrhoeae
  • This case highlights a rare presentation of Neisseria gonorrhoeae infection primarily with skin involvement without uro-genital disease. A 33-year-old male was admitted to the hospital with complaints of painful swelling of his penis.[ncbi.nlm.nih.gov]

Treatment

Treatment of cellulitis is a course of antibiotics. Broad spectrum antibiotics may be administered or if deemed suitable, cultures can be sent to check for the causative organism and then specific antibiotics given [6].

Rarely there is abscess formation, but if there is, the pus should be drained and the wound should be cleaned [4].

Needle aspiration and biopsy are rarely conducted but can be carried out in special cases.

Patients with severe cellulitis are given antibiotics either intravenously or parenterally [5].

Prognosis

Prognosis is very good with the infection soon clearing out in a few days to weeks, depending upon its severity.

Initial Stage

Initially there is erythema and swelling in the infected area. The area becomes painful to touch, and if the involved region is in the periphery, movement may become restricted till infection resolves.

Advanced Stage

Usually, infections are resolved within a few hours to days, but if the cellulitis is left untreated or the host has a compromised immune system, the cellulitis may start showing more systemic manifestations. These may include fever with or without chills, malaise, lymphangitic spread showing red lines, pain of severe intensity and in some extremely rare cases, shock due to septicaemia.

Etiology

Cellulitis always occurs due to an infection which is caused by entry of microorganism through the skin into the blood or subcutaneous tissue. As a consequence of this, inflammatory process begins. The type of infection depends upon the source, organism involved, host factors etc. Here are a few categories that may cause cellulitis:

Host Defences

Whether a person gets an infection or not, and whether it progresses to cellulitis or simply resolves on its own, depends on host factors. More specifically, it depends on host defences.
A weak immune system predisposes to severe cellulitis. Diseases like AIDS and cancer make an individual more susceptible to cellulitis whereas diseases like diabetes mellitus, arterio-venous stasis, chronic liver disease (particularly susceptible to V.vulnificus [9]) and renal diseases appear to predispose to recurrent infections.

Some families are inherently susceptible to some infections so cellulitis may be more prevalent among them.

Hospital Acquired Cellulitis

Post-operative infections leading to cellulitis around surgical incisions, although not that common, may occur in hospitalised patients.

Patients admitted due to open wounds as a result of trauma may contract infections that could result in cellulitis. The most commonly involved microorganisms in such cases include group A beta hemolytic streptococcus and Clostridium perfringens.
Patents who have undergone lymphadenectomy as a part of their cancer treatment may become a target of infections.

Secondary Cellulitis

This form of cellulitis occurs due to infection in a patient already suffering from a temporary ailment. An example of such a scenario is:
A patient of varicella or measles experiences extreme discomfort and itching around the pustules. Repeated scratching over the involved areas may cause an infection which may lead to cellulitis.

Bite Wounds

Bite wounds from animals like dogs, cats and rats may cause cellulitis due to transfer of pathogens from their saliva. The most commonly encountered bite wounds are dog bites which commonly involve organisms like Capnocytophaga canimorsus and Pastuerella multocida. Bite wounds from rats usually cause infections from Streptobacillus moniliformis.

Bites from human to other humans may sometimes result in infection, most commonly from organisms like Eikenella corrodens [3].

Puncture wounds
These may be caused by IV drug abusers where the causative agent most commonly is Staph. aureus.

Puncture wounds may occur in some athletes from their shoes from organisms like Pseudomonas. Scratches and injuries received in damp or wet areas like beaches or swamps may get infections from non-land based bacteria like Aeromonas hydrophilia, etc

Others
Tinea pedis may be associated with cellulitis between or under toes. Prolonged stay in bed may cause venous stasis leading to infection.

Epidemiology

Cellulitis is a very common, non-reportable disease so the exact prevalence is heretofore unknown.

Sex

It has no sex predilection, occurring equally in both males and females.

Age

Generally, cellulitis has no age predilection. However, it may be noted that some particular scenarios of cellulitis are more prevalent in individuals belonging to specific age groups. A few examples of such scenarios include:

  • Perianal cellulitis, often occurring due to group A beta haemolytic streptococcus is usually found in children under 3 years of age [8].
  • Pneumococcal facial cellulitis is more prevalent in young children.
  • Facial cellulitis by other causes is generally found more in adults over 50 years.
  • Some studies reveal that cellulitis is generally found more in adults aged 45 years and above.

Race

Cellulitis has no known predilection of race. However, some microbes are found more in some particular areas so cellulitis by those organisms may be more localised there. Overall, cellulitis has no association with any ethnicity or race.

Sex distribution
Age distribution

Pathophysiology

Cellulitis is an inflammation of the skin, it's layers, and the underlying subcutaneous tissue. It begins when the skin is breached by microorganisms either due to preexisting injury or a new cut, laceration or puncture. Sometimes, the skin breach may not be apparent or easily visible as it may be extremely small and may go unnoticed at first.

Once the organism has entered the body, it grows and multiplies, releasing toxins that results in active infection. When the immune system senses that there is an ongoing infection, it sends cells of the acute inflammatory cascade to battle the invading microbes.
The cells of acute inflammation include mostly neutrophils and few eosinophils.

This results in release of cytotoxic substances that paralyse or kill the invaders and lead to their phagocytosis. The temperature of the area involved increases giving calor. Vasodilation leads to redness and erythema. Swelling occurs and cellular debris accumulates, both from the cells involved as well as cells of the surrounding structures. This debris is slowly cleared away, resulting in the swelling going down after a few hours to a few days.

At times, pus may form and collect as a small pustule or a cyst but this is not very common. Sometimes, cellulitis may spread via lymphatic route to other regions creating another bout of infection there.

Prevention

A safe and careful lifestyle helps in preventing infection. Wounds and injuries should be immediately treated with antiseptics and appropriately bandaged to prevent cellulitis [7].

Summary

Cellulitis, as the name indicates, is an inflammation of the skin and subcutaneous tissue. It results from an acute infection due to any microbe leading to an inflammatory process launched by the immune system to fight off the invading microorganisms [1]. This results in the following cardinal signs:

Dolor: Pain in the infected tissues and the surrounding area.

Calor: Warmth in the area involved.

Rubor: Redness or erythema of the skin around the infected area.

Tumor: Swelling of the area involved. Swelling may be minimal in mild infections or extensive in severe cases.

Functio Laesa: Normal functioning of the involved area is disturbed as the inflammatory process does its job.

Patient Information

Definition

Cellulitis is an infection of the skin and underlying tissues which is caused by various bacteria.

Symptoms

Symptoms include redness, swelling and warmth in the affected area. The swelling is accompanied with pain in the region. The swelling remains till the infection has resolved, which takes a few days to complete. If the wound was visible, a small scar may also form which later on disappears as well.

Complications

Complications are very rare and include fever, malaise, widespread infection and shock.

Treatment

Treatment is fairly straightforward, involving antibiotics. If there is a collection of pus, it should be drained out and the wound should be cleaned.

Summary

Cellulitis is a very common occurrence in which acute inflammation occurs due to entry of pathogens. It usually persists for a few hours to a few days. Some common organisms causing cellulitis are:

By a 3 day course of antibiotics, the infection is usually resolved, unless it has extensively spread, in which case, the duration of treatment increases.

References

Article

1. Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis. Apr 2007;20(2):118-23.

2. Simon MS, Cody RL. Cellulitis after axillary lymph node dissection for carcinoma of the breast. Am J Med. Nov 1992;93(5):543-8.

3. Daum RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. Jul 26 2007;357(4):380-90.

4. Roberts S, Chambers S. Diagnosis and management of Staphylococcus aureus infections of the skin and soft tissue. Intern Med J. Dec 2005;35 Suppl 2:S97-105.

5. Jenkins TC, Knepper BC, Sabel AL, Sarcone EE, Long JA, Haukoos JS, et al. Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess. Arch Intern Med. Jun 27 2011;171(12):1072-9

6. Kremer M, Zuckerman R, Avraham Z, Raz R. Long-term antimicrobial therapy in the prevention of recurrent soft-tissue infections. J Infect. Jan 1991;22(1):37-40.

7. Brown T. Recurrent Cellulitis: Penicillin Effective for Prevention. Medscape Medical News, May 1, 2013. Available at http://www.medscape.com/viewarticle/803476. Accessed May 8, 2013.

8. Lamagni TL, Darenberg J, Luca-Harari B, et al. Epidemiology of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol. Jul 2008;46(7):2359-67

9. Chuang YC, Yuan CY, Liu CY, Lan CK, Huang AH. Vibrio vulnificus infection in Taiwan: report of 28 cases and review of clinical manifestations and treatment. Clin Infect Dis. Aug 1992;15(2):271-6.

10. Lederman ER, Weld LH, Elyazar IR, et al. Dermatologic conditions of the ill returned traveler: an analysis from the GeoSentinel Surveillance Network. Int J Infect Dis. Nov 2008;12(6):593-602.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2017-08-09 17:48