Cellulitis resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Synonyms and keywords:

Overview

Causes

Life Threatening Causes

No known life-threatening causes are included.

Common Causes

The cellulitis is bacterial in origin caused by invasion of bacteria through the skin barrier. The common causes are:

Diagnosis

Shown below is an algorithm summarizing the diagnosis of cellulitis according to the Infectious Diseases Society of America guidelines.

Patients presents with clinical symptoms suggestive of cellulitis, i.e.

erythema
edema
warmth
swollen regional lymph nodes
involvement of one limb.

Perform compression Doppler ultrasound of the limb and D-dimers level

Positive

Negative

likely Deep venous thrombosis (DVT)

DVT unlikely. High clinical suspicion for cellulitis

Assess levels of inflammatory markers

Raised ESR, CRP and leukocytosis

Does patient have any signs of rapidly progressive or systemic infection?

Body temperature>101.5 degrees Fahrenheit, chills, headache, and fatigue
Signs of sepsis. i.e. hypotension and heart rate>100bpm
Patient develops rapidly progressive symptoms like bullae, vesicles, petechiae, crepitus
Patient has low immunity (i.e. infants and elderly patients)

Perform the following tests:

Debridement of wound with culture of the specimen
Blood culture
Radiographic tests to evaluate deep tissue infection

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Is the cellulitis having a purulent discharge?

Yes

No

Are there any of the following clinical signs?

Systemic toxicity (fever, hypotension, and tachycardia)
Presence of an indwelling device (pacemaker, vascular graft)
Patient is on extremes of age
Major comorbid conditions

Yes

No

Initiate intravenous antibiotic therapy. The coverage of the micro-organisms is determined by:

Oral or peri-rectal ulcers
Pressure ulcer with draining abscess
Necrosis of overlying skin

Yes

No

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Do's

The content in this section is in bullet points.

Don'ts

The content in this section is in bullet points.

References