Cellulitis

• What are the three types of lower respiratory tract infections (LRTI)?

  1. Community-acquired pneumonia
  2. Hospital-acquired pneumonia (> 48 hours after hospital admission)
  3. Aspiration pneumonia
• What are the common causes of pneumonia?

  Pneumococcal (strep pneumonia) -> affects all ages; more common in elderly, alcoholics & post-splenectomy

  Staph aureus -> can complicate influenza infection, more common in IV drug users

  Pseudomonas -> common in bronchiectasis, CF & HAP
• What are some less common offenders in pneumonia?

  Klebsiella -> occurs in elderly, immunocompromised, diabetics & alcoholics

  Mycoplasma pneumonia -> erythema multiforme rash, neurological symptoms

  Legionella -> colonises water tanks < 60C; often after recent travel; associated diarrhoea, hypo Na, hepatitis; can test for urinary antigen
• What are the signs and symptoms of pneumonia?

  Cough

  Purulent sputum

  Chest pain

  Wheeze

  Haemoptysis

  Coarse crackles

  Reduced air entry

  Pleural rub
• What are the definitions of cellulitis and erysipelas?

  • Erysipelas: Painful, shiny light-red swelling of a defined area of skin, often with lymphatic involvement.
  • Cellulitis: Dark red, less well-defined swelling involving deeper layers and possibly lymphatics.
• What are the common causative organisms of cellulitis?

  Staph aureus

  Strep pyogenes

  Strep pneumoniae

  Haemophilus influenzae
• What are the signs & symptoms of cellulitis?


  Fever

  Usually localised area of inflammation

  Nearly always unilateral

  Lymphangitis

  Vesicles/bullae

  Cutaneous haemorrhage
• What is the diagnosis of cellulitis?


  Clinical diagnosis

  Bloods (only if unwell)
• What is the management of cellulitis?


  Oral flucloxacillin (IV if systemically unwell)
• What are the Inx of cellulitis?


  Obs

  Full Hx & examination

  Wound swab

  Bloods (FBC, U&Es, CRP, cultures)
• What are the DDx of cellulitis?


  DVT

  Varicose or venous stasis eczema

  Erysipelas

  Superficial thrombophlebitis

  Necrotising fasciitis

  Septic arthritis
• What are the RFs of cellulitis?


  Any disruption of skin integrity

  Venous insufficiency & peripheral vascular disease

  Obesity

  Skin breaks

  Lymphoedema

  Previous cellulitis

  Surgery to lower limb

  Tinea pedis

  Skin conditions that affect the dermis

  T2DM

  IVDU

  Alcoholism

  Immunosuppression

  Pregnancy
• What are the signs & symptoms of cellulitis?


  Usually unilateral, commonly on shins

  Erythema

  Warmth

  Tenderness

  Swelling

  Fever

  Malaise

  Nausea
• What are the possible complications of cellulitis?


  Systemic infection

  Subcutaneous abscess formation

  Myositis

  Fasciitis

  Death
• What is the classification of cellulitis?

  Eron classification

  Class I

  • No signs of systemic toxicity & pt has no uncontrolled comorbidities

  Class II

  • Pt is EITHER systemically unwell OR systemically well with a comorbidity that may complicate or delay resolution of infection

  Class III

  • Pt has significant systemic upset or unstable comorbidities - may interfere with response to treatment or a limb-threatening infection due to vascular compromise

  Class IV

  • Pt has sepsis syndrome or a severe life-threatening infection (necrotizing fasciitis)
• What is the general management of cellulitis?


  Mark area of erythema -> to detect spreading

  Elevate leg (if possible)

  Consider paracetamol/ibuprofen for pain or fever

  Oral Abx (IV if unwell) -> usually flucloxacillin or co-amoxiclav