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Cellulitis                  SX  |  RX    |     Cellulitis2008.pdf                                                                                                                      

Cellulitis is an infection of the skin and subcutaneous tissue.      Images of Cellulitis    

Erysipelas is a clinical variant of cellulitis, is characterized by well-demarcated erythema, tenderness, and swelling, & discrete raised border.  Erysipelas usually affects the face, or the extremities.     Images of Erysipelas  

Facial Cellullitis & Erysipelas is suggested by a well-demarcated raised border cellulitis of the face.  Both preseptal & orbital cellulitis cause marked eyelid inflammation & swelling.  However, decreased visual acuity, decreased extraoccular eye movement, marked chemosis, pain on eye movement, or significant axial proptosis indicates orbital cellulitis, which can permanently damage the optic nerve as well as extend centrally and cause cavernous sinus thrombosis.

Image of Facial Erysipelas  

Necrotizing Cellulitis is a subset of soft-tissue infections marked by frank cutaneous & subcutaneous necrosis yet lacking involvement of fascial planes.  Its systemic toxicity is less than that of its more lethal cousin necrotizing fasciitis.
In immunocompetent hosts, GAS, Clostridium (gas forming anaerobes), Vibrio (seawater injury or seafood), Aeromonas spp. (outdoor freshwater injuries) may be the pathogens.  Gas-forming anaerobes, such as clostridia, Bacteroides, and peptostreptococci; Klebsiella & E.Coli can also produce a crepitant cellulitis.
In immunocompromised patients Pseudomonas aeruginosa can cause a cellulitis that may have a necrotizing component, ecthyma gangrenosum (EG).

SX:
It is marked by redness, tenderness, swelling, and a poorly defined border.  Fever, leukocytosis, lymphangitis, regional lymphadenopathy, hematogenous dissemination, and focal abscesses or bullae may accompany these infections.

Organisms:  
Overall, Group A beta-hemolytic streptococci (GAS), Strep. pyogenes, and Staphyloccal aureus account for most cellulitis.  Less common pathogens include group B, C, & G streptococci, Strep.pneumoniae, H.influenze, & Yersinia enterocolitica.  Other pathogens include enteric Gram-negative rods, Pseudomonas spp., & anaerobes.

   

RX:

For possible or proven MRSA Cellulitis:

PO Clindamycin 300-450 mg q6-8h, Trimethoprim-sulfamethoxazole (Bactrim/Septra-DS) 1 tab bid, or doxycycline (Vibramycin) or Minocycline 100 mg bid.
Rifampin has excellent activity against MRSA (not to be used alone due to rapid development of resistance) and may be used in combination with the other antibiotics.

* Fluoroquinolones should NOT be used to treat skin & soft tissue infections due to MRSA due to frequent resistant to Ciprofloxacin.

IV Vancomycin 30 mg/kg/24 hour in 2 divided doses (max not to exceed 2 g/24h).

IV Linezolid 600 mg q12h or daptomycin 4 mg/kg once daily.


For Nonfacial Cellulitis & Erysipelas:

For Facial Cellulitis & Erysipelas:

For Hand Cellulitis:

For Necrotizing Soft-Tissue Infections:

Ref:
Current Therapy in Adult Medicine 4th Ed, 1997 - Jerome Kassierer & Harry Greene II

     


2008