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2) CELLULITIS.pptx
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- 2. 1) Definition • Cellulitisis commonly used to indicate a non necrotizing inflammation of the dermis and hypodermis related to acute infection that does not involve the fascia or muscles • Characterized by signs of inflammation. 1) Pain 2) . 3) . 4) . 5) .
- 3. 2) Epidemiology • Becausecellulitis is not a reportable disease, the exact prevalence is uncertain. • In a large epidemiological hospital-based study on skin, soft tissue, bone, and joint infections, 37.3% patients were identified as having cellulitis.
- 4. 3) Risk Factors •Race No racial predilection has been noted. • Sex No predilection for either sex is usually reported, although a higher incidence among males has been reported in some studies. • Age Under 5 yrs and above 45 years of age are highly predisposed.
- 5. • Comorbidities - Factorsassociated with an increased risk of infection are the presence of concurrent illness eg, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency, diabetes mellitus, hypertension - Immunosuppression is a major factor in our setting - Intravenous drug abusers are also vulnerable.
- 6. • The presenceof foreign bodies, including indwelling intravenous catheters, external orthopedic pins, and other surgical devices, predisposes to infection in the local area.
- 7. Causative agents • Inimmunocompetent adults, cellulitis is usually due to Streptococcus pyogenes and Staphylococcus aureus. • Patients who are immunocompromised with may develop cellulitis due to infection with other organisms, including gram-negative bacilli (eg, Pseudomonas, Proteus, Serratia, Enterobacter, Citrobacter) anaerobes. • Escherichia coli may be responsible for cellulitis in patients with nephrotic syndrome
- 8. • Cellulitis occurringaround surgical wounds less than 24 hours postoperatively may result from GABHS (Group A beta hemolytic streptococcus) or Clostridium perfringens infection. • Clostridium perfringens produces gas, which may be appreciated on examination as crepitus. • Recurrent cellulitis due to streptococci may be observed in patients with chronic lymphedema • Streptococcal infections are also common in injection drug users.
- 9. 4) Pathogenesis • Cellulitisusually follows a break in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound. • Organisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis. • The vast majority of cases are caused by Streptococcus pyogenes or Staphylococcus aureus.
- 10. • Cellulitis mayrarely result from the metastatic seeding of an organism from a distant focus of infection, especially in immunocompromised individuals. • The incubation period is somewhat organism dependent. • Postoperative cellulitis at the surgical site due to group A beta-hemolytic streptococci may develop rather rapidly. • On the other hand, cellulitis due to staphylococci usually is delayed in onset.
- 11. 5) Clinical presentation HISTORY •The patient may or may not relate an episode of trauma that has preceded their symptoms • If the patient recalls an episode of trauma, the clinician should ask about circumstances surrounding the incident that may elicit clues to a particular etiology.
- 12. • The pastmedical history should focus on the presence of comorbid conditions that increase the risk for cellulitis, the most common of which include diabetes mellitus, HIV infection/AIDS, chronic kidney disease, and chronic liver disease. • The surgical history may include a recent surgery that resulted in wound infection.
- 15. PHYSICAL EXAMINATION • Involvedsites are red, warm, swollen, and painful. • The borders are not elevated or sharply demarcated. • Lymphangitis, regional lymphadenopathy, or both may be present. • Malaise, chills, fever, and systemic toxicity may occur. • In severe cases, patients may develop septic shock. • Local suppuration may follow if therapy is delayed. • Overlying skin may develop areas of necrosis.
- 16. • Cellulitis ismajorly a clinical diagnosis • The most common site is the leg
- 17. LABORATORY WORK UP •Complete blood Count - CBC • C-REACTIVE PEPTIDE – CRP • Erythrocyte sedimentation rate – ESR • Random Blood Sugars – RBS • HIV test • Urinalysis • Urea Electrolyte and Creatinine - UECs • Blood Cultures
- 18. • Skin biopsyis unnecessary, unless a nonbacterial etiology is suspected or in immunocompromised individuals
- 19. IMAGING STUDIES • Ultrasonographymay be helpful in evaluating suppuration at the site and as an aid in guiding needle aspiration. • It can also help rule out deep vein thrombosis mimicking cellulitis. • CT scanning or MRI may be helpful to rule out any underlying fasciitis or osteomyelitis, if suspected.
- 20. 6) Differential Diagnosis •Osteomyelitis • Necrotising fasciitis • Thrombophlebitis • Deep Venous Thrombosis • Angioedema 10 others ???????
- 21. 7) Management • Patientswith mild cases of cellulitis may be treated in an outpatient setting. • Oral agents with activity against staphylococci and streptococci (eg, dicloxacillin or flucloxacillin,, clindamycin, cotrimoxazole, amoxicillin/clavulanate) are usually effective for the treatment of cellulitis in immunocompetent hosts.
- 22. • Severely illpatients and those unresponsive to standard oral antibiotic therapy should be treated with intravenous antibiotics in the hospital. • This is also recommended in immunosuppressed individuals, in those with facial cellulitis, and in any patients with a clinically significant concurrent condition, including lymphedema, malignancy, and cardiac, hepatic, or renal conditions
- 23. Supportive care • Elevatingthe affected limb • Cold compresses • Analgesic medications • Antipyretic medications • Hematinic medications Management of the medical and surgical cormobidities is important.
- 24. • Urgent consultationwith a surgeon should be sought in the setting of; i. crepitus, ii. circumferential cellulitis, iii. necrotic-appearing skin, iv. rapidly evolving cellulitis, v. pain disproportional to physical examination findings, vi. severe pain on passive movement, vii. or other clinical concern for necrotizing fasciitis
- 25. • Circumferential cellulitismay result in compartment syndrome. • Surgical decompression, i,.e, fasciotomy may be necessary. • Cellulitis associated with an abscess requires surgical drainage of the source of infection for adequate treatment.
- 26. 8) Complications • Abscessformations • Necrotizing fasciitis • Osteomyelitis • Chronic ulcer • Septicaemia • Death • NB; CATEGORIZE INTO IMMEDIATE, EARLY, INTERMIDIATE AND LONG TERM COMPLICATIONS
- 27. • Cellulitis generallyis a localized infection. Most patients treated appropriately recover completely. • Mortality is rare (5%) but may occur in neglected cases or when cellulitis is due to highly virulent organisms (eg, P aeruginosa).
- 28.