Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Common invasive nonsuppurative infection of connective tissue• Diffuse inflammation in the absence of findings indicating necrotizing infection• Usually appears on an extremity• A surgical wound, puncture, skin ulcer, or patch of dermatitis is usually identifiable as a portal of entry• Most often caused by group A streptococci and S aureus +++ Epidemiology + • Often occurs in susceptible patients, eg, alcoholics with postphlebitic leg ulcers• Cellulitis due to gram-negative bacterial infection (Proteus mirabilis and Klebsiella) may develop in immunocompromised patients +++ Symptoms and Signs + • Brawny red or reddish-brown area of edematous skin• Advances rapidly from its starting point, and the advancing edge may be vague or sharply defined• Moderate or high fever is almost always present• Warm, erythematous, edematous area• Painful spreading inflammation of the skin• Nonelevatated, poorly defined, advancing margins• Lymphangitis arising from cellulitis produces red, warm, tender streaks 3-4 mm wide leading from the infection along lymphatic vessels +++ Laboratory Findings + • Most cases are caused by streptococci or staphylococci, but other bacteria have been involved• Bacteria are difficult to obtain for culture• Blood cultures positive only 2% of the time• Needle aspiration yields positive cultures only 20-40% of the time• Leukocytosis +++ Imaging Findings + • Radiographs may reveal nonspecific edematous soft tissue + • Thrombophlebitis• Contact dermatitis• Chemical inflammation due to drug injection• Hemorrhagic bullae and skin necrosis suggests necrotizing fasciitis +++ Rule Out + • Must be distinguished from necrotizing infection + • Complete history and physical exam• History of open wound, break in skin, puncture• Swab may be taken from lesion for culture +++ When to Admit + • High fever, spreading inflammation, failure of oral antibiotic regimen• Cellulitis of the face, hand, orbits, periorbital region + • Therapy should consist of rest, elevation, warm packs, and a PO or IV antibiotic• Warm packs may be used to elevate subcutaneous tissue temperature• Treatment is predominantly nonoperative +++ Surgery +++ Indications + • If there is progression to necrotizing infection• Abscesses require drainage +++ Medications + • Penicillins or first-generation cephalosporins given IV +++ Treatment Monitoring + • If a clear response has not occurred in 12-24 hours, an abscess should be suspected or consider the possibility that the causative agent is a gram-negative rod or resistant organism• Patient must be examined once daily or more often to detect a hidden abscess masquerading within or under an area of cellulitis +++ Complications + • Sepsis +++ References ++Corwin ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.