Cellulitis

Introduction

What is cellulitis?:

It is an acute suppurative inflammation of the connective tissue layer of the subcutaneous tissues¹. It is painful and erythematous with poorly demarcated borders². Age groups affected: It is more common in the elderly and immunocompromised patients, especially diabetics². However, it is increasingly being observed in neonates and small children. A previously broken skin (due to trauma, surgical wound, previous fungal infections, IV Catheters or ulcers) predisposes it to the infection The most common organisms implicated in cellulitis are Staphylococcus aureus, Streptococcus pyogenes, Hemophilus influenza type b, Prevotella spp, B fragilis group, and Clostridium species^3,4. However, infection is usually polymicrobial which also includes anaerobic bacteria, and isolation of a single organism is often not possible². Hib is the most common cause of periorbital and orbital cellulitis⁴.

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 the 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.

Diagnosis

The diagnosis is mostly clinical and sometimes the local wound cultures or blood cultures can help to identify the causative organism. The patient also has elevated WBC count.

Treatment

Oral therapy is sufficient in cases with minor infections. However, a large infection requires intravenous treatment. Antibiotics like amoxicillin-clavulanate or first generation cephalosporin are effective first-line agents. However, Ceftriaxone may also be used². Antibiotics should be given for at least 3-10 days depending on the extent of the disease². Supportive therapy like analgesics, cool compression, along with immobilization helps in early recovery. In case the patient is unresponsive to therapy, a second or third-generation cephalosporin must be considered². The recurrent and extensive disease may require surgical intervention².