Dr Neha Bansal

Definition of cellulitis: It is acute suppurative inflammation of the connective tissue layer in the subcutaneous tissues. (1) It is painful and erythematous with poorly demarcated borders. (2)

Age groups affected: Cellulitis is more common in the elderly and immunocompromised patients, especially diabetics (2). However, it is increasingly being observed in the neonates and small children. A previously broken skin (due to trauma, surgical wound, previous fungal infections, IV Catheters or ulcers) predisposes to the infection

Clinical Features: Patients present with fever and painful, red, swelling of the subcutaneous tissue of the body part. The most common body parts affected are legs and the digits followed by face, feet, hands and torso. Signs of inflammation are present like warmth, redness and swelling. Children most often present with periorbital or orbital cellulitis with underlying sinusitis due to Hib infection. (2) Perianal Cellulitis is most often implicated with Group A streptococcus and occurs almost exclusively in toddlers and young children. (2,5)

Organisms causing cellulitis: Most common organisms implicated are Staphylococcus aureus, Streptococcus pyogenes, hemophilus influenza type b, Prevotella spp, B fragilis group and Clostridium species.(3,4)However usually infection is polymicrobial that includes anaerobic bacteria and isolation of a single organism is often not possible.(2)Hib is most common cause of periorbital and orbital cellulitis. (4)

Diagnosis: The diagnosis is mostly clinical and the sometimes the local wound cultures or blood cultures can help identifying the causative organism. The patient also has elevated WBCs.

Treatment of cellulitis: Oral Therapy is sufficient in cases with minor infection. However, large infection requires intravenous treatment. Antibiotics like amoxicillin-clavulanate or first-generation cephalosporin are effective first line agents. However, Ceftriaxonemay also be used. (2) Antibiotics should be given for at least 3-10 days depending on the extent of the disease. (2)

Supportive therapy like analgesics, cool compress, along with immobilization helps in early recovery. In case the patient is unresponsive to therapy, a second or third generation cephalosporin must be considered. (2)Recurrent and extensive disease may require surgical intervention. (2)

REFERENCES

1.		Ann Van den Bruel, Bert Aertgeerts, Rudi Bruyninckx, Marc Aerts and Frank Buntinx .Signs and symptoms for diagnosisof serious infections in children:a prospective study in primary care. British Journal of General Practice 2007; 57: 538-546.
2.		Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002 Jul 1;66(1):119-24. Review.
3.		Itzhak Brook. Aerobic and anaerobic microbiology of infections after trauma in children. J Accid Emerg Med 998;15:162-167
4.		Ambati BK, Ambati J, Azar N, Stratton L, SchmidtEV. Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination. Ophthalmology 2000;107:1450-3.
5.		Rasi A, Pour-Heidari N Association between Plaque-Type Psoriasis and Perianal Streptococcal Cellulitis and Review of the Literature Archives of Iranian Medicine, Volume 12, Number 6, 2009: 591 - 594.