Cellulitis laboratory tests
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-In-Chief: Aditya Govindavarjhulla, M.B.B.S.
Overview
With changing trends in medicine, recommended lab investigations are changing. Blood cultures and blood counts are the mainstay for the treatment and prognosis. Other blood tests like ESR and CRP help in prognosis.Levels of ESR and CRP at admission may predict the severity and duration of hospitalization.[1]
Lab Work Up
Blood Tests
- Total blood count increases. Leukocytosis is seen is most of the cases but in few toxin mediated cellulitis leucopenia may be observed.
- ESR and CRP can be used as prognostic indicators.New recommendations are more favorable towards the use of CRP compared to ESR.[2]
- If repeated infections of cellulitis are occurring Diabetes should be ruled out. Fasting blood sugars will help in this.
Cultures
- Cultures can be taken from Wounds, Pus & Blood. Blood cultures are positive only in few cases of mild infection/ community acquired cellulitis.[3] Blood cultures are significant when systemic spread occurs.
- In cases of abscess, gram staining and cultures of drained fluid may be helpful in further management of the condition.
- In cases of repeated cellulitis of foot, fungal infections have to be ruled out.Skin scrapings will be helpful for the diagnosis.
- Imaging may be considered when
- Bone involvement in suspected.
- Foreign body in-situ is one of the differential.
Depending on the site involved imaging may be required. In cases of orbital cellulits ct scan is needed to differentiate between pre/post septal cellulitis.
Ultrasound
- It can be used in cases of occult abscesses.
- It useful in aspiration of pus in children and reduces hospital stay.[4]
CT and MRI
- In cases of deep abscess or occult abscess, in cases of orbital cellulitis to differentiate pre/post septal CT scan is quite useful tool.
- Soft tissue involvement is seen in cases of untreated or in rapidly spreading progressing cellulitis. MRI can be of great value in such cases.
Drug Resistance
- Microbial resistance to drugs is a very common and serious problem.[5] In cases of non resolution, severe infections leading to hospitalization drug sensitivity has to be tested.
References
- ↑ Lazzarini L, Conti E, Tositti G, de Lalla F (2005). "Erysipelas and cellulitis: clinical and microbiological spectrum in an Italian tertiary care hospital". J Infect. 51 (5): 383–9. doi:10.1016/j.jinf.2004.12.010. PMID 16321649.
- ↑ http://dermatology.jwatch.org/cgi/content/full/2011/318/1
- ↑ Perl B, Gottehrer NP, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM (1999). "Cost-effectiveness of blood cultures for adult patients with cellulitis". Clin Infect Dis. 29 (6): 1483–8. doi:10.1086/313525. PMID 10585800.
- ↑ Chao HC, Lin SJ, Huang YC, Lin TY (2000). "Sonographic evaluation of cellulitis in children". J Ultrasound Med. 19 (11): 743–9. PMID 11065262. Unknown parameter
|month=ignored (help) - ↑ http://www.nejm.org/doi/full/10.1056/nejmoa043252