Guidelines On The Management Of Cellulitis In Adults

Posted by e-Medical PPT Sunday, September 16, 2012
Cellulitis in adults is a common medical condition taking up a large number of occupied bed
days in Acute hospitals.Inappropriate diagnosis of cellulitis is a problem and would need prospective rather than
retrospective studies to quantify the extent. Cellulitis must be differentiated from lower leg
eczema,oedema with blisters, acute venous problems including deep venous thrombosis
(DVT), thrombophlebitis and liposclerosis, and vasculitis
Cellulitis is a spreading bacterial infection of the dermis and subcutaneous tissues. For the
purposes of these guidelines, erysipelas will be classified as a form of cellulitis rather than a
distinct entity. The most common infective organisms in adults are streptococci (esp. Strep.
pyogenes) and Staph. aureus. Less common organisms include Strep. pneumoniae,
Haemophilus influenzae, Gram-negative bacilli and anaerobes
Necrotizing fasciitis (NF) is a rapidly progressive and destructive soft tissue infection that
involves the subcutaneous tissue and fascia. Skin may initially be spared and presenting signs
of NF are often non-specific and may resemble cellulitis. NF is rare but has a high mortality
of approximately 50%. Clinicians must be alert to the clinical signs of NF as it is essential to
avoid delay in appropriate treatment with antibiotics and urgent surgical exploration and
debridement.
Cellulitis presents as the acute and progressive onset of a red, painful, hot, swollen and tender
area of skin. The edge of the erythema may be well demarcated or more diffuse and typically
spreads rapidly. Constitutional upset with fever and malaise occurs in most cases, and may be
present before the localising signs. Blistering/bullae, superficial haemorrhage into blisters,
dermal necrosis, lymphangitis and lymphadenopathy may occur. The leg is the commonest
site and there may be an identifiable portal of entry, for example, a wound, an ulcer or signs of
tinea infection. Bilateral leg cellulitis is extremely rare.
Complications include fasciitis, myositis, subcutaneous abscesses, septicaemia, post
streptococcal nephritis and death.
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