Cellulitis
Cellulitis is "an acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions." [1] The condition has been known from antiquity; generations of medical students learned its signs as rubor, tumor, calor, dolor or "reddened, swollen, warm to the touch, and painful." The presence of broken skin in the inflamed area is a further warning, but there may be no obvious wound.
The most common organisms are:[2]
- Staphylococcus aureus
- Streptococcus pyogenes (group A strept)
Differential diagnosis to rule out life-threatening conditions, such as deep venous thrombosis, compartment syndrome and gangrene, is essential; a presentation of the common signs of cellulitis needs urgent, if not emergent, evaluation.
Treatment
Clinical practice guidelines for treatment are available.[3] According to the 200 guidelines, which state that staphylococcus aureus is very uncommon: "Suitable agents include dicloxacillin, cephalexin, clindamycin, or erythromycin, unless streptococci or staphylococci resistant to these agents are common in the community."
Cellulitis is sometimes self-limiting, but will sometimes need antibiotic therapy and sometimes surgical debridement and drainage.
If levofloxacin is used for treatment, 5 days is as effective as 10 days.[4] However, levoflaxacin is ineffective against methicillin-resistant Staphylococcus aureus.
References
- ↑ Anonymous (2024), Cellulitis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Chira, S; L G Miller (2009-08-03). "Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review". Epidemiology and Infection: 1-5. DOI:10.1017/S0950268809990483. ISSN 0950-2688. PMID 19646308. Retrieved on 2009-09-01. Research Blogging.
- ↑ Stevens DL, Bisno AL, Chambers HF, et al. (November 2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin. Infect. Dis. 41 (10): 1373–406. DOI:10.1086/497143. PMID 16231249. Research Blogging.
- ↑ Hepburn, Matthew J; David P Dooley, Peter J Skidmore, Michael W Ellis, William F Starnes, William C Hasewinkle (2004-08-09). "Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis". Archives of Internal Medicine 164 (15): 1669-1674. DOI:10.1001/archinte.164.15.1669. ISSN 0003-9926. PMID 15302637. Retrieved on 2009-09-01. Research Blogging.