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==Overview==
==Overview==
[[Group A streptococcal infection|Group A streptococcus]] and [[staphylococcus]are the most common causative agents of cellulitis.  These bacteria are part of the normal flora living on the skin.


[[Group A streptococcal infection|Group A]] [[streptococcus]] and [[staphylococcus]]<ref name="pmid6768328">{{cite journal| author=Fleisher G, Ludwig S| title=Cellulitis: a prospective study. | journal=Ann Emerg Med | year= 1980 | volume= 9 | issue= 5 | pages= 246-9 | pmid=6768328 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6768328  }} </ref> are the most common causative agents of cellulitis.  These bacteria are part of the normal flora living on the skin.
==Causes==  
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.


==Causes==  
===Common Causes===
*[[Group A streptococcal infection|Group A streptococcus]] <ref name="pmid6768328">{{cite journal| author=Fleisher G, Ludwig S| title=Cellulitis: a prospective study. | journal=Ann Emerg Med | year= 1980 | volume= 9 | issue= 5 | pages= 246-9 | pmid=6768328 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6768328  }} </ref>
*[[Staphylococcus]] <ref name="pmid6768328">{{cite journal| author=Fleisher G, Ludwig S| title=Cellulitis: a prospective study. | journal=Ann Emerg Med | year= 1980 | volume= 9 | issue= 5 | pages= 246-9 | pmid=6768328 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6768328  }} </ref>
===Less Common Causes===
Less common causes of cellulitis include:
*Gram-negative aerobic bacilli <ref name="pmid27434444">{{cite journal| author=Raff AB, Kroshinsky D| title=Cellulitis: A Review. | journal=JAMA | year= 2016 | volume= 316 | issue= 3 | pages= 325-37 | pmid=27434444 | doi=10.1001/jama.2016.8825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27434444  }} </ref>
 
===Causes by Organ System===
 
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Chronic venous insufficiency]], [[coronary artery bypass graft surgery]], [[lymphatic obstruction]], [[lymphedema]], [[peripheral vascular disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Acute bacterial dermohypodermatitis]],  [[Chediak-Higashi syndrome]], [[dermatitis]], [[erysipelas]], [[hidradenitis suppurativa]], [[insect bites and stings]], [[lymphatic obstruction]], [[lymphedema]], [[non-necrotising cellulitis]], [[paronychia]], [[stasis dermatitis]], [[systemic lupus erythematosus]], [[tattoo]], [[Wells syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Belimumab]], [[corticosteroids]], [[luliconazole]], [[oritavancin]], [[panitumumab]], [[pergolide]], [[romidepsin]], [[tiagabine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"|[[deep neck infection|Deep neck space infections]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Diabetes mellitus]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"|[[Paronychia]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Chronic liver disease]], [[cirrhosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Chediak-Higashi syndrome]], [[Wells syndrome]], [[WHIM syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|[[Wells syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Mastectomy]], [[radiation therapy]], [[radical surgery|radical neck surgery]], [[vein stripping|saphenous vein stripping]], [[venectomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acute bacterial dermohypodermatitis]], [[adenitis]], [[aeromonas hydrophila]], [[animal bite]], [[athlete's foot]], [[beta-hemolytic streptococci]], [[candida albicans]], [[capnocytophaga canimorsus]], [[citrobacter]], [[clostridium perfringens]], [[clostridium]], [[cryptococcus neoformans]], [[deep neck infection|deep neck space infections]], [[dermatitis]], [[eikenella corrodens]], [[enterobacter]], [[erysipelas]], [[erysipelothrix rhusiopathiae]], [[fusarium]], [[group A streptococcus]], [[haemophilus influenzae]], [[helicobacter|helicobacter cinaedi]], [[herpes simplex]], [[HIV]], [[mastitis]], [[meningococcus]], [[MRSA]], [[nocardiosis]], [[non-necrotising cellulitis]], [[orbital cellulitis]], [[pasteurella multocida]], [[pasteurella]],[[periorbital cellulitis]], [[peritonsillar abscess]], [[pneumococcus]], [[pseudomonas aeruginosa]], [[quinsy]], [[serratia]], [[staphylococcus aureus]], [[streptobacillus moniliformis]], [[streptococcus agalactiae]], [[streptococcus|streptococcus iniae]], [[streptococcus pneumoniae]], [[streptococcus]], [[varicella]], [[vibrio vulnificus]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|[[Chediak-Higashi syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Orbital cellulitis]], [[periorbital cellulitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"|[[Substance abuse]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Nephrotic syndrome]], [[systemic lupus erythematosus]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Eosinophilic cellulitis]], [[systemic inflammatory response syndrome]], [[systemic lupus erythematosus]], [[WHIM syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Animal bite]], [[trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| [[Ludwig's angina]], [[Ludwig's angina|submandibular cellulitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[breast implant|Breast implant infections]], [[mastectomy]], [[deep inguinal lymph nodes|pelvic lymph node dissection]]
|-
|}
 
===Causes in Alphabetical Order===
{{columns-list|
*[[Acute bacterial dermohypodermatitis]]
*[[Adenitis]]
*[[Aeromonas hydrophila]]
*[[Animal bite]]
*[[Belimumab]]
*[[Beta-hemolytic streptococci]] 
*[[breast implant|Breast implant infections]]
*[[Candida albicans]]
*[[Capnocytophaga canimorsus]]
*[[Chediak-Higashi syndrome]]
*[[Chronic liver disease]]
*[[Chronic venous insufficiency]]
*[[Cirrhosis]]
*[[Citrobacter]]
*[[Clostridium]]
*[[Clostridium perfringens]]
*[[Coronary artery bypass graft surgery]]
*[[Corticosteroids]]
*[[Cryptococcus neoformans]]
*[[deep neck infection|Deep neck space infections]]
*[[Dermatitis]]
*[[Diabetes mellitus]]
*[[Eikenella corrodens]]
*[[Enterobacter]]
*[[Eosinophilic cellulitis]]
*[[Erysipelas]]
*[[Erysipelothrix rhusiopathiae]]
*[[Fusarium]]
*[[Group A streptococcus]]
*[[Haemophilus influenzae]]
*[[helicobacter|Helicobacter cinaedi]]
*[[Herpes simplex]]
*[[Hidradenitis suppurativa]]
*[[HIV]]
*[[Insect bites and stings]]
*[[Ludwig's angina]]
*[[Luliconazole]]
*[[Lymphatic obstruction]]
*[[Lymphedema]]
*[[Mastectomy]]
*[[Mastitis]]
*[[Meningococcus]]
*[[MRSA]]
*[[Mucormycosis]] <ref name="pmid23524816">{{cite journal| author=Gen R, Horasan EŞ, Vaysoğlu Y, Arpaci RB, Ersöz G, Özcan C| title=Rhino-orbito-cerebral mucormycosis in patients with diabetic ketoacidosis. | journal=J Craniofac Surg | year= 2013 | volume= 24 | issue= 2 | pages= e144-7 | pmid=23524816 | doi=10.1097/SCS.0b013e31827c7eb8 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23524816  }} </ref>
*[[Nephrotic syndrome]] <ref name="pmid23502669">{{cite journal| author=Ajayan P, Krishnamurthy S, Biswal N, Mandal J| title=Clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome. | journal=Indian Pediatr | year= 2013 | volume= 50 | issue= 8 | pages= 779-81 | pmid=23502669 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23502669  }} </ref>
*[[Nocardiosis]]
*[[Non-necrotising cellulitis]]
*[[Orbital cellulitis]]
*[[Oritavancin]]
*[[Panitumumab]]
*[[Paronychia]]
*[[Pasteurella]]
*[[Pasteurella multocida]]
*[[deep inguinal lymph nodes|Pelvic lymph node dissection]]
*[[Pergolide]]
*[[Periorbital cellulitis]]
*[[Peripheral vascular disease]]
*[[Peritonsillar abscess]]
*[[Pneumococcus]]
*[[Pseudomonas aeruginosa]]
*[[Quinsy]]
*[[Radiation therapy]]
*[[radical surgery|Radical neck surgery]]
*[[Romidepsin]]
*[[vein stripping|Saphenous vein stripping]]
*[[Serratia]]
*[[Staphylococcus aureus]]
*[[Stasis dermatitis]]
*[[Streptobacillus moniliformis]]
*[[Streptococcus]]
*[[Streptococcus agalactiae]]
*[[streptococcus|Streptococcus iniae]]
*[[Streptococcus pneumoniae]]
*[[Ludwig's angina|Submandibular cellulitis]]
*[[Substance abuse]]
*[[Systemic inflammatory response syndrome]]
*[[Systemic lupus erythematosus]]
*[[Tattoo]]
*[[Tiagabine]]
*[[Trauma]]
*[[Varicella]]
*[[Venectomy]]
*[[Vibrio vulnificus]]
*[[Wells syndrome]]
*[[WHIM syndrome]]
}}


* The causative pathogen of cellulitis varies with the anatomical location and the patient’s medical and exposure history.
===Causes Based on Anatomical Location, Medical and Exposure History===
The causative pathogen of cellulitis varies with the anatomical location and the patient’s medical and exposure history.


{| style="border: 2px solid #DCDCDC; font-size: 90%;"
{| style="border: 2px solid #DCDCDC; font-size: 90%;"
Line 40: Line 254:
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Breast surgert with axillary lymph node dissection
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Breast surgert with axillary lymph node dissection
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Ipsilateral arm
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Ipsilateral arm
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Non–group A hemolytic ''[[Streptococcus]]''
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Non–group A [[Streptococcus#Beta-Hemolytic Streptococci|beta-hemolytic]] ''[[Streptococcus]]''
|-
|-
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Harvest of saphenous vein
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Harvest of saphenous vein
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Ipsilateral leg
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Ipsilateral leg
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Group A or non–group A hemolytic ''[[Streptococcus]]''
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | [[Streptococcus#Beta-Hemolytic Streptococci|Beta-hemolytic]] ''[[Streptococcus]]''
|-
|-
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Crepitant or gangrenous cellulitis
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Crepitant or gangrenous cellulitis
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Extremities, Trunk
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Extremities, Trunk
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | ''[[Clostridium]]'' or non–spore-forming [[anaerobe]]s; alone or with ''[[E. coli]]'', ''[[Klebsiella]]'', or ''[[Aeromonas]]''
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | ''[[Clostridium]]'' or non–[[Endospore#Endospore-Forming Anaerobes|spore-forming]] [[anaerobe]]s; alone or with ''[[E. coli]]'', ''[[Klebsiella]]'', or ''[[Aeromonas]]''
|-
|-
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Diabetic foot ulcer
| style="padding: 0 5px; background: #F5F5F5;" align=left valign=top | Diabetic foot ulcer
Line 76: Line 290:


[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Latest revision as of 18:15, 19 February 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Group A streptococcus and [[staphylococcus]are the most common causative agents of cellulitis. These bacteria are part of the normal flora living on the skin.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Less Common Causes

Less common causes of cellulitis include:

  • Gram-negative aerobic bacilli [2]

Causes by Organ System

Cardiovascular Chronic venous insufficiency, coronary artery bypass graft surgery, lymphatic obstruction, lymphedema, peripheral vascular disease
Chemical / poisoning No underlying causes
Dermatologic Acute bacterial dermohypodermatitis, Chediak-Higashi syndrome, dermatitis, erysipelas, hidradenitis suppurativa, insect bites and stings, lymphatic obstruction, lymphedema, non-necrotising cellulitis, paronychia, stasis dermatitis, systemic lupus erythematosus, tattoo, Wells syndrome
Drug Side Effect Belimumab, corticosteroids, luliconazole, oritavancin, panitumumab, pergolide, romidepsin, tiagabine
Ear Nose Throat Deep neck space infections
Endocrine Diabetes mellitus
Environmental Paronychia
Gastroenterologic Chronic liver disease, cirrhosis
Genetic Chediak-Higashi syndrome, Wells syndrome, WHIM syndrome
Hematologic Wells syndrome
Iatrogenic Mastectomy, radiation therapy, radical neck surgery, saphenous vein stripping, venectomy
Infectious Disease Acute bacterial dermohypodermatitis, adenitis, aeromonas hydrophila, animal bite, athlete's foot, beta-hemolytic streptococci, candida albicans, capnocytophaga canimorsus, citrobacter, clostridium perfringens, clostridium, cryptococcus neoformans, deep neck space infections, dermatitis, eikenella corrodens, enterobacter, erysipelas, erysipelothrix rhusiopathiae, fusarium, group A streptococcus, haemophilus influenzae, helicobacter cinaedi, herpes simplex, HIV, mastitis, meningococcus, MRSA, nocardiosis, non-necrotising cellulitis, orbital cellulitis, pasteurella multocida, pasteurella,periorbital cellulitis, peritonsillar abscess, pneumococcus, pseudomonas aeruginosa, quinsy, serratia, staphylococcus aureus, streptobacillus moniliformis, streptococcus agalactiae, streptococcus iniae, streptococcus pneumoniae, streptococcus, varicella, vibrio vulnificus
Musculoskeletal / Ortho No underlying causes
Neurologic Chediak-Higashi syndrome
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic Orbital cellulitis, periorbital cellulitis
Overdose / Toxicity Substance abuse
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte Nephrotic syndrome, systemic lupus erythematosus
Rheum / Immune / Allergy Eosinophilic cellulitis, systemic inflammatory response syndrome, systemic lupus erythematosus, WHIM syndrome
Sexual No underlying causes
Trauma Animal bite, trauma
Urologic No underlying causes
Dental Ludwig's angina, submandibular cellulitis
Miscellaneous Breast implant infections, mastectomy, pelvic lymph node dissection

Causes in Alphabetical Order

Causes Based on Anatomical Location, Medical and Exposure History

The causative pathogen of cellulitis varies with the anatomical location and the patient’s medical and exposure history.

Predisposing factor, anatomical location, and likely etiology of cellulitis[5]
Predisposing Factor Anatomical Location Likely Etiology
Periorbital (preseptal) cellulitis Eyelid and periocular tissues Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes
Buccal cellulitis in children without Hib vaccine Cheek Haemophilus influenzae
Cellulitis complicated by body piercing Ear, nose, umbilicus S. aureus, S. pyogenes
Perianal cellulitis Perineum S. pyogenes
Subcutaneous injection of illicit drugs (“skin popping”) Extremities, neck S. aureus, Streptococcus (group A, B, C, F, G)
Breast surgert with axillary lymph node dissection Ipsilateral arm Non–group A beta-hemolytic Streptococcus
Harvest of saphenous vein Ipsilateral leg Beta-hemolytic Streptococcus
Crepitant or gangrenous cellulitis Extremities, Trunk Clostridium or non–spore-forming anaerobes; alone or with E. coli, Klebsiella, or Aeromonas
Diabetic foot ulcer Dorsum of foot or toes S. aureus, Streptococcus, Enterobacteriaceae, P. aeruginosa, Acinetobacter, or anaerobes
Exposure to salt water at breeches of skin Extremities Vibrio vulnificus
Exposure to fresh water at breeches of skin Extremities Aeromonas hydrophila
Medicinal leech therapy Extremities Aeromonas hydrophila
Working as a butcher, fish or clam handler, veterinarian Fingers Erysipelothrix rhusiopathiae

References

  1. ↑ 1.0 1.1 Fleisher G, Ludwig S (1980). "Cellulitis: a prospective study". Ann Emerg Med. 9 (5): 246–9. PMID 6768328.
  2. ↑ Raff AB, Kroshinsky D (2016). "Cellulitis: A Review". JAMA. 316 (3): 325–37. doi:10.1001/jama.2016.8825. PMID 27434444.
  3. ↑ Gen R, Horasan EŞ, Vaysoğlu Y, Arpaci RB, Ersöz G, Özcan C (2013). "Rhino-orbito-cerebral mucormycosis in patients with diabetic ketoacidosis". J Craniofac Surg. 24 (2): e144–7. doi:10.1097/SCS.0b013e31827c7eb8. PMID 23524816.
  4. ↑ Ajayan P, Krishnamurthy S, Biswal N, Mandal J (2013). "Clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome". Indian Pediatr. 50 (8): 779–81. PMID 23502669.
  5. ↑ Swartz, MN. (2004). "Clinical practice. Cellulitis". N Engl J Med. 350 (9): 904–12. doi:10.1056/NEJMcp031807. PMID 14985488. Unknown parameter |month= ignored (help)

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