Cellulitis

Infection of superficial and deep dermis and subcutaneous fat Microbiology (nejm 2004.350:904)

• Streptococcus and Staphylococcus including MRSA (15-74% of purulent skin and soft tissue infections; high-risk groups include athletic teams, military, prison. MSM. communities or families w/ MRSA infections; nejm 2005:355:666)

• Cat bite: P. multocida; dog bite: P. multocida & C. canimorsus

• Penetrating injury: Pseudomonas

• Fish spine: £ rhusiopathiae.V. vulnificus

Clinical manifestations

• Erythema, edema, warmth, pain (rubor, tumor, calor. dolor)

• • Lymphadenitis (proximal red streaking) and regional lymphadenopathy

• P. multocida rapid onset; C. canimorsus -» sepsis w/ symmetric, peripheral gangrene in splenectomized and other immunocompromised Pts

Diagnosis

• Largely clinical diagnosis: blood cx low yield but useful if ©

• Aspirate of bulla or pus from furuncle or pustule may provide dx Treatment

• Antibiotics: penicillinase-resistant PCN or 1st gen. ceph.:

if MRSA suspected -* vanco if hospitalized.TMP-SMX if outPt

• Limb elevation (erythema may get worse after initiation of abx b/c bacterial killing release of inflammatory enzymes)

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