Cellulitis: Difference between revisions
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==Treatment== | ==Treatment== | ||
[[Cellulitis medical therapy|Medical therapy]] | [[Cellulitis surgery|Surgical options]] | [[Cellulitis primary prevention|Primary prevention]] | [[Cellulitis secondary prevention|Secondary prevention]] | [[Cellulitis cost-effectiveness of therapy|Financial costs]] | [[Cellulitis future or investigational therapies|Future therapies]] | [[Cellulitis medical therapy|Medical therapy]] | [[Cellulitis surgery|Surgical options]] | [[Cellulitis primary prevention|Primary prevention]] | [[Cellulitis secondary prevention|Secondary prevention]] | [[Cellulitis cost-effectiveness of therapy|Financial costs]] | [[Cellulitis future or investigational therapies|Future therapies]] | ||
==Causes== | ==Causes== | ||
Revision as of 14:15, 27 January 2012
For patient information click here
| Cellulitis | |
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| Infected left shin | |
| ICD-10 | L03 |
| ICD-9 | 682.9 |
| DiseasesDB | 29806 |
| MeSH | D002481 |
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Cellulitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Cellulitis On the Web |
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American Roentgen Ray Society Images of Cellulitis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes
Differentiating Cellulitis
Complications & Prognosis
Diagnosis
History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics
Treatment
Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies
Causes
Cellulitis is caused by a type of bacteria entering by way of a break in the skin. This break need not be visible. Group A streptococcus and staphylococcus are the most common of these bacteria, which are part of the normal flora of the skin but cause no actual infection until the skin is broken. Predisposing conditions for cellulitis include insect bite, animal bite, pruritic skin rash, recent surgery, athlete's foot, dry skin, eczema, burns and boils, though there is debate as to whether minor foot lesions contribute.
The appearance of the skin will help a doctor make a diagnosis. The doctor may also suggest blood tests, a wound culture or other tests to help rule out a blood clot deep in the veins of the legs. Cellulitis in the lower leg is characterized by signs and symptoms that may be similar to those of a clot occurring deep in the veins, such as warmth, pain and swelling.
This reddened skin or rash may signal a deeper, more serious infection of the inner layers of skin. Once below the skin, the bacteria can spread rapidly, entering the lymph nodes and the bloodstream and spreading throughout the body.
In rare cases, the infection can spread to the deep layer of tissue called the fascial lining. Necrotizing fasciitis, also called by the media "flesh-eating bacteria", is an example of a deep-layer infection. It represents an extreme medical emergency.
Risk factors
The elderly and those with weakened immune systems are especially vulnerable to contracting cellulitis. Diabetics are more susceptible to cellulitis than the general population because of impairment of the immune system; they are especially prone to cellulitis in the feet because their disease causes impairment of blood circulation in their legs leading to their having foot ulcers that commonly become infected. Cellulitis is also a common complication of obesity.
Immunosuppressive drugs, HIV, and other illnesses or infections that weaken the immune system are also factors that make infection more likely. In addition, chickenpox and shingles often result in blisters which break, providing a gap in the skin through which bacteria can enter. Lymphedema, which causes swelling on the arms and/or legs, can also put an individual at risk.
Diseases that affect blood circulation in the legs and feet, such as chronic venous insufficiency and varicose veins, are also risk factors for cellulitis.
Cellulitis is also extremely prevalent amongst dense populations sharing hygiene facilities and common living quarters. Military installations which require communal showers provide such an environment, as it is prevalent among many recruits going through boot camp.
Diagnosis
Cellulitis is most often a clinical diagnosis, and local cultures do not always identify the causative organism. Blood cultures usually are positive only if the patient develops generalised sepsis. Conditions that may resemble cellulitis include deep vein thrombosis, which can be diagnosed with a compression leg ultrasound, and stasis dermatitis, which is inflammation of the skin from poor blood flow.
Incubation
Cellulitis can develop in as little as twenty-four hours or can take days to develop.
Duration
In many cases, cellulitis takes less than a week to disappear with antibiotic therapy. However, it can take months to resolve completely in more serious cases, and can result in severe debility or even death if untreated. If it is not properly cured it may appear to improve but can resurface again even after months and years.
Treatment
Antibiotics - typically a combination of intravenous and oral antibiotics are administered. Bed rest and elevation of affected limbs is also recommended. Drink plenty of fluids as well - at least 8 glasses of water a day.
Prevention
Good hygiene and good wound care lower the risk of cellulitis. Any wounds should be cleaned and dressed appropriately. Changing bandages daily or when they become wet or dirty will reduce the risk of contracting cellulitis. Medical advice should be sought for any wounds which are deep, dirty or if there is concern about retained foreign bodies.
Cellulitis in horses
Horses may acquire cellulitis, usually secondary to wound (which can be extremely small and superficial) or to a deep-tissue infection, such as an abscess or infected bone, tendon sheath, or joint. Cellulitis from a superficial wound will usually create less lameness (grade 1-2 out of 5) than that caused by septic arthritis (grade 4-5 lameness). The horse will exhibit inflammatory edema, producing a hot, painful swelling. this swelling differs from stocking up in that the horse will not display symmetrical swelling in 2 or four legs, but only in one leg.
This swelling begins near the source of infection, but will eventually continue downward the leg. In some cases, the swelling will also travel upward. Treatment includes cleaning the wound and caring for it properly, the administration of NSAIDs, such as phenylbutazone, cold hosing, applying a sweat wrap or a poultice, and mild exercise. Veterinarians may also perscribe antibiotics. Recovery is usually quick and the prognosis is very good if the cellulitis is secondary to skin infection.
References
- King, Christine, BVSc, MACVSc, and Mansmann, Richard, VDM, PhD. "Equine Lameness." Equine Research, Inc. 1997. Pages 548-549.
- MFMER. 'Cellulitis'. 3 July 2002. Mayo Foundation for Medical Education and Research. 30 Oct. 2003 [2].
- NLM. 'Group A streptococcal infections'. 2002. National Library of Medicine. 30 Oct. 2003 > .
- Pankey, George A. "Approach to rashes and infections of the skin and subcutaneous tissues." Textbook of internal medicine. 2nd ed. 2 vols. Philadelphia: J. B. Lippincott Company, 1992.
- Cellulitis Overview (with picture).