Materiały źródłowe

• #1 Cellulitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549770/

  Cellulitis is a common bacterial skin infection, with over 14 million cases occurring in the United States annually. […] It provides the latest updates on how to accurately diagnose, effectively treat, and manage patients with bacterial cellulitis. […] The learner will know how to discern when cellulitis treatment is appropriate in the outpatient setting with oral antibiotics versus when a patient should be hospitalized and treated with intravenous antibiotics, and how the interprofessional team can best manage patients with cellulitis. […] Cellulitis is diagnosed clinically based on the presence of spreading erythematous inflammation of the deep dermis and subcutaneous tissue. […] Two of the four criteria (warmth, erythema, edema, or tenderness) are required to make the diagnosis.

• #1 Cellulitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cellulitis/diagnosis-treatment/drc-20370766

  Your health care provider will likely be able to diagnose cellulitis by looking at your skin. […] You might need to undergo a blood test or other tests to help rule out other conditions.

• #1 Cellulitis and other bacterial skin infections

  https://www.rch.org.au/clinicalguide/guideline_index/cellulitis_and_skin_infections/

  Cellulitis is a spreading infection of the skin extending to involve the subcutaneous tissues. Many conditions present similarly to cellulitis always consider differential diagnoses. […] The typical presenting features of all skin infections include soft tissue redness, warmth and swelling, but other features are variable. […] Allergic reactions and contact dermatitis are frequently misdiagnosed as cellulitis. If there is itch and no tenderness, cellulitis is unlikely. […] Blood culture is not useful in mild/moderate cellulitis. […] Consider imaging (eg ultrasound) if abscess, deep infection or foreign body suspected. […] Features suggestive of necrotising fasciitis include: severe pain out of keeping with apparent severity of infection, rapid progression, marked systemic features (eg high fever with rigors, tachycardia, tachypnoea, hypotension, confusion, vomiting). […] Consider consultation with local paediatric team when no improvement or deterioration after 24-48 hours of therapy. […] Consider transfer when child requires care above the level of comfort of local hospital.

• #1 Cellulitis Workup: Approach Considerations, Moderate to Severe Cases and Systemic Symptoms, Ultrasonography, CT Scanning, and MRI

  https://emedicine.medscape.com/article/214222-workup

  Generally, no workup is required in uncomplicated cases of cellulitis that meet the following criteria: Limited area of involvement, Minimal pain, No systemic signs of illness (eg, fever, chills, dehydration, altered mental status, tachypnea, tachycardia, hypotension), No risk factors for serious illness (eg, extremes of age, general debility, immunocompromised status). […] Because the bacterial etiology of cellulitis in typical cases is expected to represent streptococcal and, less commonly, staphylococcal infection, additional procedures are also usually unnecessary. However, in more severe disease or unique clinical scenarios, additional procedures may be indicated. […] For serious infections, perform a blood culture, Gram stain, and culture of needle aspiration or punch biopsy specimens to pinpoint the etiology. Blood cultures are only positive in 5%-15% of patients with cellulitis.

• #1 Cellulitis Workup: Approach Considerations, Moderate to Severe Cases and Systemic Symptoms, Ultrasonography, CT Scanning, and MRI

  https://emedicine.medscape.com/article/214222-workup

  The IDSA recommends bloodwork for patients with skin or soft tissue infection (SSTI) who have signs and symptoms of systemic toxicity; such tests include blood cultures, complete blood cell (CBC) with differential, and levels of creatinine, bicarbonate, creatine phosphokinase, and C-reactive protein (CRP). […] The IDSA also recommends considering inpatient admission in the presence of hypotension and/or the following laboratory findings: an elevated creatinine level; an elevated creatine phosphokinase level (2-3 times the upper limit of normal [ULN]); a CRP level 13 mg/L (123.8 mmol/L); a low serum bicarbonate level; or a marked left shift on the CBC with differential. […] If a complicated or deep infection is suspected, imaging studies and/or surgical consultations should be done promptly.

• #1 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  The IDSA recommends considering inpatient admission in patients with hypotension and/or the following laboratory findings: Elevated creatinine level, Elevated creatine phosphokinase level (2-3 times the upper limit of normal), CRP level 13 mg/L (123.8 mmol/L), Low serum bicarbonate level, Marked left shift on the CBC with differential. […] Treatment of cellulitis is as follows: Antibiotic regimens are effective in more than 90% of patients. […] All but the smallest of abscesses require drainage for resolution, regardless of the pathogen. […] In cases of cellulitis without draining wounds or abscess, streptococci continue to be the likely etiology, and beta-lactam antibiotics are appropriate therapy. […] In patients who are allergic to penicillin: clindamycin or a macrolide (clarithromycin or azithromycin). […] For cellulitis involving wounds sustained in an aquatic environment, recommended antibiotic regimens vary with the type of water involved.

• #1 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  Blood cultures should also be done in the following circumstances: Moderate to severe disease (eg, cellulitis complicating lymphedema), Cellulitis of specific anatomic sites (eg, facial and especially ocular areas), Patients with a history of contact with potentially contaminated water, Patients with malignancy who are receiving chemotherapy, Neutropenia or severe cell-mediated immunodeficiency, Animal bites. […] Imaging studies: Ultrasonography may play a role in the detection of occult abscess and direction of care. […] If necrotizing fasciitis is a concern, CT imaging typically is used in stable patients; MRI can be performed, but MRI typically takes much longer than CT scanning. […] Needle aspiration should be performed only in selected patients or in unusual cases, such as in cases of cellulitis with bullae or in patients who have diabetes, are immunocompromised, are neutropenic, are not responding to empiric therapy, or have a history of animal bites or immersion injury.

• #1 Cellulitis Workup: Approach Considerations, Moderate to Severe Cases and Systemic Symptoms, Ultrasonography, CT Scanning, and MRI

  https://emedicine.medscape.com/article/214222-workup

  Gram stain, whether obtained via biopsy or aspiration of the infected area, has a low yield and is unnecessary in most cases, unless purulent material is draining or bullae or abscess is present. […] If recurrent episodes of cellulitis are suspected to be secondary to tinea pedis or onychomycosis, mycologic investigations are advisable. […] Current data suggest that ultrasonography may play a role in the detection of occult abscess and direction of care, especially in an emergency department setting. […] If necrotizing fasciitis is a concern, computed tomographic (CT) imaging is typically used to help rule out this condition in stable patients; magnetic resonance imaging (MRI) can be performed, but MRI typically takes much longer than CT scanning. […] Needle aspiration should be performed only in selected patients, such as in cases of cellulitis with bullae or in patients who are immunocompromised, are neutropenic, are not responding to empiric therapy, or have a history of animal bites or immersion injury.

• #1 Cellulitis Workup: Approach Considerations, Moderate to Severe Cases and Systemic Symptoms, Ultrasonography, CT Scanning, and MRI

  https://emedicine.medscape.com/article/214222-workup

  Aspiration or punch biopsy of the inflamed area may have a culture yield of 2-40% and is of limited clinical value in most cases. […] By contrast, Gram stain and culture following incision and drainage of an abscess yields positive results in more than 90% of cases. […] Dissection of the underlying fascia to assess for necrotizing fasciitis may be determined by surgical consultation or indicated following initial evaluation and imaging studies. […] Skin biopsy is not routine but may be performed in an attempt to rule out a noninfectious entity. […] In cases in which cellulitis is extensive and tissue is no longer viable, debridement may be performed.

• #1 Cellulitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549770/

  The Infectious Disease Society of America practice guidelines recommends against imaging the infected area except in patients with febrile neutropenia. […] Blood cultures are also necessary when a patient has signs of systemic infection. […] Hospitalization with the induction of systemic antibiotics may be necessary for patients who: present with systemic signs of infection, have failed outpatient treatment, are immunocompromised, exhibit rapidly progressing erythema, are unable to tolerate oral medications, or have cellulitis overlying or near an indwelling medical device. […] The clinician should obtain blood cultures if a patient is exhibiting signs of systemic toxicity, has persistent cellulitis despite adequate treatment, has unique exposures such as animal bites or water-associated injuries.

• #1 Cellulitis – Wikipedia

  https://en.wikipedia.org/wiki/Cellulitis

  Cellulitis is most often a clinical diagnosis, readily identified in many people by history and physical examination alone, with rapidly spreading areas of cutaneous swelling, redness, and heat, occasionally associated with inflammation of regional lymph nodes. […] The diagnosis is usually based on the presenting signs and symptoms, while a cell culture is rarely possible. […] It is important to evaluate for co-existent abscess, as this finding usually requires surgical drainage as opposed to antibiotic therapy alone. […] Physicians’ clinical assessment for abscess may be limited, especially in cases with extensive overlying induration, but use of bedside ultrasonography performed by an experienced practitioner readily discriminates between abscess and cellulitis and may change management in up to 56% of cases. […] Use of ultrasound for abscess identification may also be indicated in cases of antibiotic failure. […] Cellulitis has a characteristic „cobblestoned” appearance indicative of subcutaneous edema without a defined hypoechoic, heterogeneous fluid collection that would indicate abscess.

• #1 Cellulitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cellulitis?lang=us

  CT is used to accurately differentiate between superficial cellulitis and deep cellulitis. […] MRI is sensitive for distinguishing cellulitis alone from necrotizing fasciitis and infectious myositis and for showing subcutaneous fluid collections and abscesses. That said, it is seldom required for diagnosing cellulitis and is therefore usually ordered for suspected complications or to rule out alternative diagnoses in cases of an atypical presentation. […] Uncomplicated cellulitis is usually treated conservatively with antibiotics and locally supportive measures.

• #1 Cellulitis Causes, Symptoms, Diagnosis and Treatment – Cura4U

  https://cura4u.com/conditions/cellulitis

  Diagnosis usually depends on the physical examination, but some important investigations include: […] 1- Swab test: To identify the causative organism. […] 2- Biopsy: Skin scrapings can be sent to the laboratory for detailed examination. […] 3- CBC: Complete blood count reveals increased White Blood cells. […] 4-CRP: Increased C-reactive protein in the blood test can indicate infection. […] 5- Culture of blood […] 6- X-ray if the foreign object is under skin or bone.

• #1 Acute cellulitis and erysipelas in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/acute-cellulitis-and-erysipelas-in-adults-treatment

  Patients with skin and soft tissue infection may present with cellulitis, abscess, and other forms of infection. […] Clinical manifestations and diagnosis of cellulitis and erysipelas are discussed separately. […] Effective treatment of cellulitis and erysipelas depends on determining the most likely microorganism causing the infection. […] Examination and clinical features cannot always differentiate erysipelas from cellulitis, so we treat for cellulitis whenever we are uncertain. […] Cellulitis and erysipelas can both cause rapidly progressive and severe illness. […] Initial assessment of these infections should focus on determining the severity of illness and whether hospitalization is indicated. […] Hospitalization or admission to an observational unit is indicated for most individuals who warrant parenteral antibiotics.

• #1 Acute cellulitis and erysipelas in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/acute-cellulitis-and-erysipelas-in-adults-treatment

  The decision to initiate parenteral therapy is typically based on the extent and severity of infection and patient comorbidities. […] For individuals with cellulitis or erysipelas without red-flag conditions, we suggest initial treatment with parenteral antibiotics in the following circumstances: systemic signs of toxicity such as fever, hypotension, or sustained tachycardia. […] The pillars of cellulitis treatment are antibiotic therapy and management of exacerbating conditions, including the point of entry of infection. […] At the time of presentation, selection of empiric antibiotic therapy is based on determining the most likely pathogen. […] Empiric antibiotics for cellulitis should always cover beta-hemolytic streptococci and methicillin-sensitive S. aureus (MSSA), which are the two most common pathogens of cellulitis.

• #1 Cellulitis differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Cellulitis_differential_diagnosis

  Cellulitis should be distinguished from thrombophlebitis, contact dermatitis, insect stings, drug reactions, and arthritis. […] Cellulitis must be differentiated from other causes of lower limb edema like chronic venous insufficiency, acute deep venous thrombosis, lipedema, myxedema, lymphatic filariasis and causes of generalized edema. […] Cellulitis can be promptly diagnosed with an appropriate history and physical exam. Administration of an antibiotic therapy will initiate resolution of the condition in 2-3 days. Differentials have to be thought of only when resolution is not seen. Non-resolution of cellulitis can be due to infection by resistant strains of the bacterium involved. […] There are many dermatological conditions which manifest in manner similar to cellulitis. Careful evaluation of each case, based on accurate history and physical examinations, is very important. […] Cellulitis must be differentiated from other diseases that cause bone pain, edema, and erythema.

• #1 Applying a Clinical Prediction Rule to Distinguish Lower Extremity Cellulitis from Its Mimics | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0900/p309.html

  How can a clinician best determine whether a patient with lower leg erythema has cellulitis? […] Lower extremity cellulitis typically presents with acutely expanding erythema, warmth, edema, and tenderness. […] Studies have shown that about 30% of people admitted to the hospital for treatment of cellulitis are mis-diagnosed, resulting in unnecessary hospitalizations and intravenous antibiotic therapy. […] Dermatology consultation increases diagnostic accuracy for cellulitis and is often used as the criterion standard in cellulitis studies but is not feasible in every patient. […] A study of 73 adults diagnosed clinically with cellulitis in the emergency department found that a temperature difference of 0.85F (0.47C) or more between affected and corresponding unaffected areas, measured by thermal imaging, was 100% sensitive and 50% specific for cellulitis.

• #1 Applying a Clinical Prediction Rule to Distinguish Lower Extremity Cellulitis from Its Mimics | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0900/p309.html

  The seven-point ALT-70 score for cellulitis is a clinical prediction rule developed using a retrospective chart review of 259 patients, of whom 70% had a final diagnosis of cellulitis. […] The ALT-70 clinical prediction rule has been validated prospectively, and it outperformed thermal imaging for the diagnosis of lower extremity cellulitis in the emergency department. […] Given an overall likelihood of cellulitis in this group of 69%, only 9.1% with a score of 0 to 2 had cellulitis, compared with 80.4% with a score of 3 to 7. […] The ALT-70 clinical prediction rule applies only to lower extremity cellulitis and does not apply to patients with surgery in the past 30 days, penetrating trauma, indwelling hardware at the site, burns, diabetic ulcers, abscess, known history of osteomyelitis, or intravenous antibiotic use in the 48 hours before the emergency department visit.

• #1 Factors and clinical prediction score for complication development after cellulitis diagnosis in adult patients | International Journal of Emergency Medicine | Full Text

  https://intjem.biomedcentral.com/articles/10.1186/s12245-024-00646-w

  The resulting prediction score was named the Ramathibodi Necrotizing Fasciitis/Bacteremia (RAMA-NFB) Prediction Score. […] The Area Under ROC of the clinical prediction score showed a predictive power of 82.93% (95% CI, 0.770.89) for complications after a cellulitis diagnosis. […] Our study aimed to develop an initial prediction model that could assist physicians in determining the risk of complication development after diagnosing cellulitis in adult patients. […] The RAMA-NFB Prediction Score shows AuROC 82.93% (with 95% CI, 76.9888.89). This indicates good correlation of the six identified variables (age65 years, Body Mass Index30 kg/m2, diabetes mellitus, elevated body temperature, low systolic blood pressure, and involvement of the lower extremities) to predict complications of bacteremia or necrotizing fasciitis following a diagnosis of cellulitis.

• #1 Periorbital Cellulitis (Preseptal Cellulitis): Treatment

  https://my.clevelandclinic.org/health/diseases/23566-periorbital-cellulitis

  Periorbital cellulitis (preseptal cellulitis) is a bacterial infection that causes swelling in the skin around your eye. […] Preseptal cellulitis could become a more serious condition if the infection spreads beyond the septum, to the deeper layers of skin and other tissues in your eye socket (orbit). This is called orbital cellulitis. […] To diagnose periorbital (preseptal) cellulitis, healthcare provider will examine the area around your childs eye. […] Periorbital cellulitis needs treatment with antibiotics. […] Contact your provider right away when you notice symptoms of periorbital cellulitis. […] You can reduce your childs risk of periorbital cellulitis if you: Clean and disinfect cuts, scrapes and bites right away. […] Preseptal cellulitis wont go away on its own, and it can spread. If it does, it can quickly become more serious and more uncomfortable for your child.

• #1 Orbital Cellulitis – EyeWiki

  https://eyewiki.org/Orbital_Cellulitis

  Orbital cellulitis is an infection of the soft tissues of the eye socket behind the orbital septum, a thin tissue that divides the eyelid from the eye socket. […] The diagnosis of orbital cellulitis is based on clinical examination. The presence of the following signs is suggestive of orbital involvement: proptosis, chemosis, pain with eye movements, ophthalmoplegia, and optic nerve involvement as well as fever, leukocytosis (75% of cases), and lethargy. […] The physical examination should include the following: Best-corrected visual acuity (BCVA). Decreased vision might be indicative of optic nerve involvement or could be secondary to severe exposure keratopathy or retinal vein occlusion. […] The management of orbital cellulitis requires admission to the hospital and initiation of broad-spectrum intravenous antibiotics that address the most common pathogens.

• #1 Orbital Cellulitis – EyeWiki

  https://eyewiki.org/Orbital_Cellulitis

  Admission to the hospital is warranted in all cases of orbital cellulitis. A complete blood count with differential, blood cultures, and nasal and throat swabs should be ordered. […] Computed tomography of the orbit is the imaging modality of choice for patients with orbital cellulitis. Most of the time, CT is readily available and will give the clinician information regarding the presence of sinusitis, subperiosteal abscess, stranding of orbital fat, or intracranial involvement. […] The complications of orbital cellulitis are ominous and include severe exposure keratopathy with secondary ulcerative keratitis, neurotrophic keratitis, secondary glaucoma, septic uveitis or retinitis, exudative retinal detachment, inflammatory or infectious neuritis, optic neuropathy, panophthalmitis, cranial nerve palsies, optic nerve edema, subperiosteal abscess, orbital abscess, central retinal artery occlusion, retinal vein occlusion, blindness, orbital apex syndrome, cavernous sinus thrombosis, meningitis, subdural or brain abscess, and death. […] With prompt recognition and aggressive medical and/or surgical treatment, the prognosis is excellent.

• #1 Upper Limb Cellulitis: Diagnosis, Management,& Complications

  https://www.theplasticsfella.com/upper-limb-cellulitis/

  Upper limb cellulitis is a bacterial infection of the skin and subcutaneous tissue, causing erythema, warmth, and swelling. Diagnosis is clinical and involves imaging. […] Diagnosed clinically, but imaging and laboratory tests may be required to detect abscesses, systemic toxicity, or deep infections. […] Upper limb cellulitis is diagnosed clinically, but imaging and laboratory tests may be required to detect abscesses, systemic toxicity, or deep infections. […] Clinical diagnosis is key. Ultrasound helps differentiate cellulitis from abscesses. Blood cultures are reserved for systemic signs, while CT scans assess deep infections or necrotizing fasciitis.

• #1 Cellulitis – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/cellulitis

  Diagnosis is by appearance; cultures may help, but treatment with antibiotics should not be delayed pending those results. […] Diagnosis of cellulitis is by examination. Contact dermatitis and stasis dermatitis are often misdiagnosed as cellulitis, thus leading to unnecessary antibiotic use. […] Blood cultures are useful to detect or rule out bacteremia in patients who are immunocompromised and in patients who have signs of systemic infection (eg, fever and leukocytosis). […] Culture of involved tissue may be required in patients who are immunocompromised if they are not responding to empiric therapy or if blood cultures do not isolate an organism as well as in patients with cellulitis at the site of certain injuries (eg, animal bite wounds, penetrating injuries). […] Skin and wound cultures (when wounds are present) are generally not indicated in cellulitis because they rarely identify the infecting organism.

• #1 Cellulitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549770/

  If the clinician promptly identifies cellulitis and initiates treatment with the correct antibiotic, patients can expect to notice an improvement in signs and symptoms within 48 hours. […] Without prompt diagnosis and treatment, cellulitis could lead to several complications. […] If the bacterial infection reaches the bloodstream, it could lead to bacteremia. […] Failure to identify and treat bacteremia from cellulitis can lead to endocarditis, an infection of the inner lining (endocardium) of the heart. […] Cellulitis that leads to bacteremia, endocarditis, or osteomyelitis will require a longer duration of antibiotics and possibly surgery.

• #2 Diagnosis and management of cellulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6303460/

  Cellulitis is a frequently encountered condition, but remains a challenging clinical entity. Under and overtreatment with antimicrobials frequently occurs and mimics cloud the diagnosis. Typical presentation, microbiology and management approaches are discussed. […] Making the correct diagnosis is key to management. Non-infectious conditions should be considered. […] Assessment of baseline liver and renal function may be useful for assessing end-organ dysfunction in patients with sepsis and for dosing of antimicrobials. […] Separate studies have concluded that approximately 30% of cellulitis patients are misdiagnosed. […] While the British Society for Antimicrobial Chemotherapy (BSAC) expert panel recommendations and UK Clinical Resource Efficiency Support Team (CREST) guidelines recommend use of the Eron classification of cellulitis in order to grade severity, the lack of a clear definition of systemic sepsis and ambiguous and potentially overlapping categories have hampered its use in clinical practice.

• #2 Cellulitis – Symptoms, Causes, Treatments, & More

  https://www.webmd.com/skin-problems-and-treatments/cellulitis

  Cellulitis Diagnosis […] Often doctors can diagnose cellulitis based on how your skin looks. Your doctor will ask about your symptoms and examine your skin. You might need a blood test to rule out other conditions with similar symptoms. Other procedures could include: […] X-ray. This is used to see if theres a foreign object in your skin or if the bone underneath is possibly infected. […] Bacterial culture. Your doctor will use a needle to remove fluid from the area and send it to the lab.

• #2 Cellulitis

  https://www.nhs.uk/conditions/cellulitis/

  Cellulitis is a skin infection that’s treated with antibiotics. It can be serious if it’s not treated quickly. […] Early treatment with antibiotics can stop cellulitis becoming more serious. […] Cellulitis makes your skin painful, hot and swollen. […] You may also feel unwell and have flu-like symptoms, with swollen, painful glands. […] For mild cellulitis affecting a small area of skin, a doctor will prescribe antibiotic tablets, usually for a week. […] Contact your GP if you do not start to feel better 2 to 3 days after starting antibiotics. […] If cellulitis is severe, you might be referred to hospital for treatment. […] If cellulitis is not treated quickly, the infection can spread to other parts of the body, such as the blood, muscles and bones. […] Cellulitis is usually caused by a bacterial infection. […] The bacteria can infect the deeper layers of your skin if it’s broken, for example, because of an insect bite or cut, or if it’s cracked and dry. […] You cannot catch cellulitis from another person, as it affects the deeper layers of the skin.

• #2 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  The term cellulitis commonly is used to indicate a nonnecrotizing inflammation of the skin and subcutaneous tissues, usually from acute infection. Cellulitis usually follows a breach in the skin, although a portal of entry may not be obvious; the breach may involve microscopic skin changes or invasive qualities of certain bacteria. […] Generally, no workup is required in uncomplicated cases of cellulitis that meet the following criteria: Limited area of involvement, Minimal pain, No systemic signs of illness (eg, fever, altered mental status, tachypnea, tachycardia, hypotension), No risk factors for serious illness (eg, extremes of age, general debility, immunocompromise). […] The Infectious Disease Society of America (IDSA) recommends the following blood tests for patients with skin or soft tissue infection (SSTI) who have signs and symptoms of systemic toxicity: Blood cultures, CBC with differential, Levels of creatinine, bicarbonate, creatine phosphokinase, and C-reactive protein (CRP).

• #2 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  The IDSA recommends considering inpatient admission in patients with hypotension and/or the following laboratory findings: Elevated creatinine level, Elevated creatine phosphokinase level (2-3 times the upper limit of normal), CRP level 13 mg/L (123.8 mmol/L), Low serum bicarbonate level, Marked left shift on the CBC with differential. […] Treatment of cellulitis is as follows: Antibiotic regimens are effective in more than 90% of patients. […] All but the smallest of abscesses require drainage for resolution, regardless of the pathogen. […] In cases of cellulitis without draining wounds or abscess, streptococci continue to be the likely etiology, and beta-lactam antibiotics are appropriate therapy. […] In patients who are allergic to penicillin: clindamycin or a macrolide (clarithromycin or azithromycin). […] For cellulitis involving wounds sustained in an aquatic environment, recommended antibiotic regimens vary with the type of water involved.

• #2 Cellulitis: Definition, Etiology, Diagnosis and Treatment | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/cellulitis-definition-etiology-diagnosis-and-treatment/2006-12

  Diagnosis of cellulitis is generally based on the morphologic features of the lesion and the clinical setting. If drainage or an open wound is present, or there is an obvious entry portal, Grams stain and culture can provide a definitive diagnosis. In the absence of culture findings, the bacterial etiology of cellulitis is difficult to establish. In some cases staphylococcal and streptococcal cellulitis have similar features and are indistinguishable from each other. […] Culture of needle aspirates is not indicated in routine care because the result rarely alters the treatment plan. Even when taken from the lead edge of the inflammation, cultures from needle aspiration and punch biopsy are positive in only 20 percent of cases. […] This suggests that low numbers of bacteria may produce this condition and that the expanding symptomatic area within the skin may be an effect of extracellular toxins or of the mediators of inflammation elicited by the host. In spite of the low yield from aspiration for individual patients, studies have produced findings of import for overall treatment strategies: data from numerous studies, examining both needle aspiration and punch biopsy, indicate that antimicrobial therapy for cellulitis should focus on Gram-positive cocci in immunocompetent hosts, S. aureus and S. pyogenes in particular.

• #2 Cellulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/214222-overview

  Blood cultures should also be done in the following circumstances: Moderate to severe disease (eg, cellulitis complicating lymphedema), Cellulitis of specific anatomic sites (eg, facial and especially ocular areas), Patients with a history of contact with potentially contaminated water, Patients with malignancy who are receiving chemotherapy, Neutropenia or severe cell-mediated immunodeficiency, Animal bites. […] Imaging studies: Ultrasonography may play a role in the detection of occult abscess and direction of care. […] If necrotizing fasciitis is a concern, CT imaging typically is used in stable patients; MRI can be performed, but MRI typically takes much longer than CT scanning. […] Needle aspiration should be performed only in selected patients or in unusual cases, such as in cases of cellulitis with bullae or in patients who have diabetes, are immunocompromised, are neutropenic, are not responding to empiric therapy, or have a history of animal bites or immersion injury.

• #2 Cellulitis: Symptoms, Causes, Treatment and more – DermNet

  https://dermnetnz.org/topics/cellulitis

  How is the diagnosis of cellulitis made? The diagnosis of cellulitis is primarily based on clinical features including a physical exam. Investigations may reveal: Leukocytosis (raised white cell count). Elevated C-reactive protein (CRP) The causative organism, on the culture of blood or of pustules, crusts, erosions or wound. […] Imaging may be performed. For example: Chest X-ray in case of heart failure or pneumonia Doppler ultrasound to look for blood clots (deep vein thrombosis) MRI in case of necrotising fasciitis.

• #2 Cellulitis – Wikipedia

  https://en.wikipedia.org/wiki/Cellulitis

  Cellulitis is most often a clinical diagnosis, readily identified in many people by history and physical examination alone, with rapidly spreading areas of cutaneous swelling, redness, and heat, occasionally associated with inflammation of regional lymph nodes. […] The diagnosis is usually based on the presenting signs and symptoms, while a cell culture is rarely possible. […] It is important to evaluate for co-existent abscess, as this finding usually requires surgical drainage as opposed to antibiotic therapy alone. […] Physicians’ clinical assessment for abscess may be limited, especially in cases with extensive overlying induration, but use of bedside ultrasonography performed by an experienced practitioner readily discriminates between abscess and cellulitis and may change management in up to 56% of cases. […] Use of ultrasound for abscess identification may also be indicated in cases of antibiotic failure. […] Cellulitis has a characteristic „cobblestoned” appearance indicative of subcutaneous edema without a defined hypoechoic, heterogeneous fluid collection that would indicate abscess.

• #2 Cellulitis and other bacterial skin infections

  https://www.rch.org.au/clinicalguide/guideline_index/cellulitis_and_skin_infections/

  Cellulitis is a spreading infection of the skin extending to involve the subcutaneous tissues. Many conditions present similarly to cellulitis always consider differential diagnoses. […] The typical presenting features of all skin infections include soft tissue redness, warmth and swelling, but other features are variable. […] Allergic reactions and contact dermatitis are frequently misdiagnosed as cellulitis. If there is itch and no tenderness, cellulitis is unlikely. […] Blood culture is not useful in mild/moderate cellulitis. […] Consider imaging (eg ultrasound) if abscess, deep infection or foreign body suspected. […] Features suggestive of necrotising fasciitis include: severe pain out of keeping with apparent severity of infection, rapid progression, marked systemic features (eg high fever with rigors, tachycardia, tachypnoea, hypotension, confusion, vomiting). […] Consider consultation with local paediatric team when no improvement or deterioration after 24-48 hours of therapy. […] Consider transfer when child requires care above the level of comfort of local hospital.

• #2 Applying a Clinical Prediction Rule to Distinguish Lower Extremity Cellulitis from Its Mimics | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0900/p309.html

  The seven-point ALT-70 score for cellulitis is a clinical prediction rule developed using a retrospective chart review of 259 patients, of whom 70% had a final diagnosis of cellulitis. […] The ALT-70 clinical prediction rule has been validated prospectively, and it outperformed thermal imaging for the diagnosis of lower extremity cellulitis in the emergency department. […] Given an overall likelihood of cellulitis in this group of 69%, only 9.1% with a score of 0 to 2 had cellulitis, compared with 80.4% with a score of 3 to 7. […] The ALT-70 clinical prediction rule applies only to lower extremity cellulitis and does not apply to patients with surgery in the past 30 days, penetrating trauma, indwelling hardware at the site, burns, diabetic ulcers, abscess, known history of osteomyelitis, or intravenous antibiotic use in the 48 hours before the emergency department visit.

• #2 Factors and clinical prediction score for complication development after cellulitis diagnosis in adult patients | International Journal of Emergency Medicine | Full Text

  https://intjem.biomedcentral.com/articles/10.1186/s12245-024-00646-w

  Our findings demonstrate that by considering a combination of a patients age, BMI, underlying diseases, vital signs, and the location of cellulitis, it is possible to predict the likelihood of complications arising from cellulitis. […] The RAMA-NFB score allows for early decision making in diagnosis, disposition, and treatment.

• #2 Orbital Cellulitis – EyeWiki

  https://eyewiki.org/Orbital_Cellulitis

  Admission to the hospital is warranted in all cases of orbital cellulitis. A complete blood count with differential, blood cultures, and nasal and throat swabs should be ordered. […] Computed tomography of the orbit is the imaging modality of choice for patients with orbital cellulitis. Most of the time, CT is readily available and will give the clinician information regarding the presence of sinusitis, subperiosteal abscess, stranding of orbital fat, or intracranial involvement. […] The complications of orbital cellulitis are ominous and include severe exposure keratopathy with secondary ulcerative keratitis, neurotrophic keratitis, secondary glaucoma, septic uveitis or retinitis, exudative retinal detachment, inflammatory or infectious neuritis, optic neuropathy, panophthalmitis, cranial nerve palsies, optic nerve edema, subperiosteal abscess, orbital abscess, central retinal artery occlusion, retinal vein occlusion, blindness, orbital apex syndrome, cavernous sinus thrombosis, meningitis, subdural or brain abscess, and death. […] With prompt recognition and aggressive medical and/or surgical treatment, the prognosis is excellent.

• #2 Cellulitis: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/cellulitis-treatment

  We dont have a medical test that can diagnose cellulitis. Doctors diagnose it by examining the infected skin and asking questions. […] To get an accurate diagnosis, some patients need: […] While a test cannot tell whether you have cellulitis, testing can tell what germs are causing an infection. […] If you are seeing a doctor other than a dermatologist, you may be sent to a dermatologist. Cellulitis can look like other skin conditions and infections. […] Dermatologists have extensive training in diagnosing the many conditions that can look like cellulitis. An accurate diagnosis is essential to clear your skin condition.

• #2 Cellulitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549770/

  The Infectious Disease Society of America practice guidelines recommends against imaging the infected area except in patients with febrile neutropenia. […] Blood cultures are also necessary when a patient has signs of systemic infection. […] Hospitalization with the induction of systemic antibiotics may be necessary for patients who: present with systemic signs of infection, have failed outpatient treatment, are immunocompromised, exhibit rapidly progressing erythema, are unable to tolerate oral medications, or have cellulitis overlying or near an indwelling medical device. […] The clinician should obtain blood cultures if a patient is exhibiting signs of systemic toxicity, has persistent cellulitis despite adequate treatment, has unique exposures such as animal bites or water-associated injuries.

• #2 Acute cellulitis and erysipelas in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/acute-cellulitis-and-erysipelas-in-adults-treatment

  Indications for MRSA coverage are described above. […] The first step when selecting an initial antibiotic regimen for cellulitis is to determine whether providing coverage beyond beta-hemolytic streptococci and S. aureus is necessary. […] For most patients with cellulitis who don’t have features that warrant specific management, our approach depends on the severity of illness, patient’s immune status, and risk for MRSA. […] In general, our antibiotic recommendations match those of expert guidelines. […] Patients with severe sepsis, rapid administration of empiric broad-spectrum antibiotics is indicated because delay or lack of adequate coverage increases mortality. […] For patients with severe sepsis or high-risk neutropenia, we suggest initial therapy with vancomycin plus cefepime.

• #3 Acute cellulitis and erysipelas in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/acute-cellulitis-and-erysipelas-in-adults-treatment

  For patients with unambiguous erysipelas who do not meet criteria for parenteral antibiotics, empiric oral antibiotics active against beta-hemolytic streptococci should be administered. […] Duration of therapy should be individualized depending on clinical response. […] The duration of therapy for erysipelas is analogous to the duration used for cellulitis. […] Patients with cellulitis or erysipelas typically have symptomatic improvement within 24 to 48 hours of beginning antimicrobial therapy. […] Significant progression of erythema or persistence of systemic symptoms after 24 to 48 hours should prompt a search for possible reasons for treatment failure. […] Recurrent erysipelas and cellulitis are not uncommon occurrences. […] Management of recurrent episodes is the same as the approach for initial episodes. […] Potential tools for prevention of recurrent cellulitis include alleviation of predisposing conditions, antibiotic prophylaxis, and S. aureus decolonization.

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