Materiały źródłowe

• #1 Cellulitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19114

  Cellulitis is characterized by erythema, warmth, edema, and tenderness to palpation resulting from cytokine and neutrophil response from bacteria breaching the epidermis. […] The cytokines and neutrophils are recruited to the affected area after bacteria have penetrated the skin leading to an epidermal response. This response includes the production of antimicrobial peptides and keratinocyte proliferation and is postulated to produce the characteristic exam findings in cellulitis. […] Group A Streptococci, the most common bacteria to cause cellulitis, can also produce virulence factors such as pyrogenic exotoxins (A, B, C, and F) and streptococcal superantigen that can lead to a more pronounced and invasive disease.

• #2 Cellulitis – UF Health

  https://ufhealth.org/conditions-and-treatments/cellulitis

  Cellulitis is a common skin infection caused by bacteria. It affects the middle layer of the skin (dermis) and the tissues below. Sometimes, muscle below the skin can be affected. […] Staphylococcus and streptococcus bacteria are the most common causes of cellulitis. […] Normal skin has many types of bacteria living on it. When there is a break in the skin, these bacteria can cause a skin infection. […] Cellulitis is a deep infection of the skin, usually accompanied by generalized (systemic) symptoms such as fever and chills. The area of redness increases in size as the infection spreads.

• #3 Cellulitis: Practice Essentials, Background, Pathophysiology

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

  Cellulitis usually follows a breach in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound. In some cases, there is no obvious portal of entry and the breach may be due to microscopic changes in the skin or invasive qualities of certain bacteria. Organisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis. […] The vast majority of cases of cellulitis are likely caused by Streptococcus pyogenes and, to a lesser degree, by Staphylococcus aureus. In rare cases, cellulitis results from the metastatic seeding of an organism from a distant focus of infection, especially in immunocompromised individuals. Distant seeding is particularly common in cellulitis due to S pneumoniae (pneumococcus) and marine Vibriospecies. Neisseria meningitidis, Pseudomonas aeruginosa, Brucella species, and Legionella species have also been reported as rare causes of cellulitis resulting from hematogenous spread.

• #4 Cellulitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762

  Cellulitis is caused when bacteria, most commonly streptococcus and staphylococcus, enter through a crack or break in the skin. […] The incidence of a more serious staphylococcus infection called methicillin-resistant Staphylococcus aureus (MRSA) is increasing. […] Cellulitis can occur anywhere on the body, but the most common location is the lower leg. Bacteria are most likely to enter broken, dry, flaky or swollen skin, such as through a recent surgical site, cuts, puncture wounds, ulcers, athlete’s foot or dermatitis. […] Untreated cellulitis might lead to bacteremia, endocarditis, osteomyelitis, toxic shock syndrome or sepsis. Rarely, the infection can spread to the deep layer of tissue called the fascial lining. Necrotizing fasciitis is an example of a deep-layer infection. It’s an extreme emergency. […] Recurrent episodes of cellulitis may damage the lymphatic drainage system and cause chronic swelling of the affected limb.

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

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

  Cellulitis is acute bacterial infection of the skin and subcutaneous tissue most often caused by streptococci or staphylococci. […] The skin barrier is usually compromised. […] Streptococci cause diffuse, rapidly spreading infection because enzymes produced by the organism (streptokinase, DNase, hyaluronidase) break down cellular components that would otherwise contain and localize the inflammation. […] Methicillin-resistant S. aureus (MRSA-USA300) is the predominant community strain of MRSA in the United States (community-associated MRSA [CA-MRSA]). […] Patients who are immunocompromised may become infected by opportunistic organisms, including gram-negative bacteria (such as Proteus, Serratia, Enterobacter, or Citrobacter), anaerobic bacteria, and Helicobacter and Fusarium species.

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

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

  Bacteria breach the skin barrier, triggering an inflammatory cascade, with high-risk groups including IV drug users, diabetics, and immunocompromised patients. […] Bacteria penetrate the dermis and subcutaneous tissue via a disrupted skin barrier, bypassing the protective role of the epidermis. […] The infection triggers an acute inflammatory cascade with cytokine release, leading to vasodilation, edema, and neutrophil infiltration in the deep dermis and subcutaneous layers.

• #7 What you need to know about cellulitis – ProHealth Prolotherapy Clinic

  https://prohealthclinic.co.uk/blog/cellulitis/

  Cellulitis, a common bacterial skin infection, occurs when Staphylococcus aureus or strep bacteria enter the skin through any break. That results in the entry of the bacteria releasing several chemicals to invade the affected area, spread rapidly and reproduce. The body activates the process of inflammation to get rid of the bacteria and nullify their effects on the body by reaching the deeper layers. […] The process of inflammation begins with increased blood flow to the area that has been affected. Next, the capillaries of that area become leaky, and the neutrophils enter the tissue affected by the bacteria. More cell mediators, such as cytokines, also reach the site of infection to control the spread of the bacteria and its harmful toxins. […] These cells produce antimicrobial proteins to destroy the organism. The most common bacteria that cause Cellulitis Group A Streptococci. These bacterial organisms release exotoxins, making it more difficult for the body to eradicate them from the body.

• #8 Cellulitis | Concise Medical Knowledge

  https://www.lecturio.com/concepts/cellulitis/

  Bacteria enter disrupted skin barrier: […] Invasion of dermis and subcutaneous tissue triggers cytokine release, recruiting neutrophils and other inflammatory cells to the site. […] Intrinsic bacterial factors allow the pathogen to evade initial host defenses, leading to erythema, pain, and local swelling (edema). […] If the pathogen overcomes the immune defenses, further spread (deeper and/or contiguous infection and bacteremia) occurs. […] Reduced control of infection occurs in: Decreased tissue vascularity and oxygenation, Increased peripheral fluid stasis, Poor ability to combat infections.

• #9 Cellulitis: Causes, Treatment, Types, Symptoms & Antibiotics

  https://www.emedicinehealth.com/cellulitis/article_em.htm

  Cellulitis is a common infection of the skin and the soft tissues underneath the skin. Bacterial skin infections and soft tissue infections occur when bacteria invade broken or normal skin and start to spread under the skin and into the soft tissues. Infection results in inflammation, which is a process in which the body reacts to the bacteria. Inflammation may cause swelling, redness, pain, and/or warmth. […] Bad circulation from poor vein function or peripheral arterial disease is a common cause of cellulitis. […] Staph bacteria are a common cause of cellulitis. […] Almost any organ system can be infected by S. aureus. Most frequently, S. aureus strains first infect the skin and its structures (for example, sebaceous glands, hair follicles) or invade damaged skin (cuts, abrasions). Sometimes the infections are relatively limited (such as a sty, boil, furuncle, or carbuncle), but other times they may spread to other skin areas (causing cellulitis, folliculitis, or impetigo). Unfortunately, these bacteria can reach the bloodstream (bacteremia) and end up in many different body sites, causing infections (wound infections, abscesses, osteomyelitis, endocarditis, pneumonia) that may cause severe harm or even be fatal.

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

  https://dermnetnz.org/topics/cellulitis

  Cellulitis is a common bacterial skin infection of the lower dermis and subcutaneous tissue. It results in a localised area of red, painful, swollen skin, and systemic symptoms. Left untreated, cellulitis can be life-threatening. […] The most common bacteria causing cellulitis are Streptococcus pyogenes (two-thirds of cases) and Staphylococcus aureus (one third). Rare causes of cellulitis include: […] Other forms of skin injury that may increase bacterial exposure and cellulitis infection include surgical wounds and insect bites. […] Cellulitis may be associated with lymphangitis and lymphadenitis, which are due to bacteria within lymph vessels and local lymph glands. A red line tracks from the site of infection to nearby tender, swollen lymph glands. […] The management of cellulitis is becoming more complicated due to rising rates of methicillin-resistant Staphylococcus aureus (MRSA) and macrolide- or erythromycin-resistant Streptococcus pyogenes. […] Patients with recurrent cellulitis may benefit from chronic suppressive antibiotic treatment with low-dose penicillin V or erythromycin, for one to two years.

• #11 Cellulitis – Skin Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/skin-disorders/bacterial-skin-infections/cellulitis

  Cellulitis is most commonly caused by Streptococcus and Staphylococcus bacteria. Streptococci spread rapidly in the skin because they produce enzymes that hinder the ability of the tissue to confine the infection. […] A strain of Staphylococcus that is resistant to previously effective antibiotics has become a more common cause of cellulitis. This strain is called methicillin-resistant Staphylococcus aureus (MRSA). […] Bacteria usually enter through small breaks in the skin that result from scrapes, punctures, surgery, burns, fungal infections (such as athlete’s foot), animal bites, and skin disorders. […] Certain types of bacteria can cause cellulitis when skin damaged by injuries (such as cuts) is immersed in water. […] People whose immune system is weakened may be susceptible to bacteria that do not usually cause infections.

• #12 Cellulitis: Practice Essentials, Background, Pathophysiology

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

  Immunocompromised hosts may become infected from nontraditional cellulitis organisms, including gram-negative rods (eg, Pseudomonas, Proteus, Serratia, Enterobacter, Citrobacter), anaerobes, and others (eg, Helicobacter cinaedi, Fusarium species). Although fungi (eg, Cryptococcus) and herpes simplex virus may also cause cellulitis, these causes are rare. […] Pneumococci may cause a particularly malignant form of cellulitis that is frequently associated with tissue necrosis, suppuration, and bloodstream invasion. Two distinct syndromes are recognized: the first is marked by involvement of the extremities in patients with diabetes or substance abuse, and the second is marked by involvement of the head, neck, and upper torso in patients with systemic lupus erythematosus, nephrotic syndrome, or hematologic disorders.

• #13 Cellulitis: Practice Essentials, Background, Pathophysiology

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

  Certain host factors predispose to severe infection. The elderly and individuals with diabetes mellitus are at risk for more severe disease. In addition, patients with diabetes, immunodeficiency, cancer, venous stasis, chronic liver disease, peripheral arterial disease, and chronic kidney disease appear to be at higher risk for recurrent infection because of an altered host immune response. Local control of immune function through interleukin-driven neutrophil recruitment, protective action of antimicrobial peptides, and the integrity of the cutaneous barrier have significant effects on the hosts defense against infection. […] Cellulitis due to lymphatic obstruction or venectomy may be caused by nongroup A streptococci (ie, groups B, C, and G). Postvenectomy status following saphenous vein stripping can also result in cellulitis.

• #14 Cellulitis: current insights into pathophysiology and clinical management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29219814/

  Cellulitis is a bacterial skin and soft tissue infection which occurs when the physical skin barrier, the immune system and/or the circulatory system are impaired. […] Diabetes, obesity and old age are associated with defects in all of these areas and as a result are major predisposing factors for cellulitis. […] Recent evidence on diagnostic strategies is discussed, the importance of which is underscored by findings that venous insufficiency, eczema, deep vein thrombosis and gout are frequently mistaken for cellulitis. […] Relapses occur frequently due to a high prevalence of risk factors associated with cellulitis in combination with the occurrence of persistent post-inflammatory lymphatic damage. […] Lastly, we identify knowledge gaps which, if addressed, will advance our understanding of the pathophysiology of cellulitis and improve its clinical management.

• #15 About Cellulitis | Lymphoedema Support Network – LSN

  https://www.lymphoedema.org/cellulitis/about-cellulitis/

  Cellulitis is a sudden, non contagious infection of the skin, characterised by redness, swelling and heat, with associated pain and tenderness. […] People with lymphoedema are particularly susceptible to cellulitis because the lymphatic system is damaged or overloaded and does not function adequately to fight infection. […] The infection may enter via a break in the skin, such as a scratch or insect bite or through a pre-existing wound or ulcer, or through an area of skin inflammation, e.g. athlete’s foot, eczema or dermatitis. […] Treatment of cellulitis in lymphoedema is very important, not only because the sufferer may become very ill, but because lymph drainage routes risk being damaged further. This may cause the swelling to worsen and lead to permanent skin changes, such as tissue thickening.

• #16 Cellulitis – Skin Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/skin-disorders/bacterial-skin-infections/cellulitis

  The first symptoms of cellulitis are redness, pain, and tenderness over an area of skin. These symptoms are caused both by the bacteria themselves and by the body’s attempts to fight the infection. […] As the bacterial infection spreads, nearby lymph nodes may become enlarged and tender (lymphadenitis), and the lymphatic vessels may become inflamed (lymphangitis). […] Prompt treatment with antibiotics can prevent the bacterial infection from spreading rapidly and reaching the blood and internal organs. […] If doctors suspect methicillin-resistant Staphylococcus aureus (MRSA) infection, such as when pus is draining from under the skin, when other serious symptoms develop, or if MRSA is a common cause of cellulitis in the community, treatment may include antibiotics such as trimethoprim with sulfamethoxazole, clindamycin, or doxycycline by mouth.

• #17 Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic P | IJGM

  https://www.dovepress.com/recurrent-cellulitis-who-is-at-risk-and-how-effective-is-antibiotic-pr-peer-reviewed-fulltext-article-IJGM

  Cellulitis originates when pathogenic bacteria enters the subcutaneous tissues through the dermal barrier. The risk is accentuated by dermal pathology, such as fungal foot infections and ulcers. […] Lymphatic dysfunction is likely to be the main pathology associated with recurrent cellulitis. […] Lymphatic abnormalities have been found in 77% to 87% of patients with lower limb cellulitis in lymphoscintigraphy scans four weeks after recovery from cellulitis. […] Any other condition that impairs lymphatic drainage and function can also predispose to recurrent cellulitis. […] Systemic pathology such as immunodeficiency and cancer can additionally increase the risk of cellulitis. […] The inflammation in cellulitis can lead to tissue damage and fibrosis, subsequently affecting interstitial flow, systemic response to infection and bacterial and toxin clearance.

• #18 Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic P | IJGM

  https://www.dovepress.com/recurrent-cellulitis-who-is-at-risk-and-how-effective-is-antibiotic-pr-peer-reviewed-fulltext-article-IJGM

  Where interstitial flow is reduced in severe and repeated infections, it will result in lymphatic insufficiency further impairing immune function. […] This inflammatory response in cellulitis is suspected to be driven by inflammatory modulators and bacterial toxins rather than bacterial load. […] Reducing the duration and severity of cellulitis is likely to reduce the risk of future recurrence.

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

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

  The use of alternative medications for severe acute bacterial skin and skin structure infection (ABSSSI) with S. aureus (including MRSA) are based on availability, ease of administration, adverse effect profile, and cost. […] Most cellulitis resolves quickly with antibiotic therapy. […] Serious but rare complications include severe necrotizing subcutaneous infection and bacteremia with metastatic foci of infection. […] Recurrences in the same area are common, sometimes causing serious damage to the lymphatics, chronic lymphatic obstruction, and lymphedema.

• #20 Clinical Guidance for Group A Streptococcal Cellulitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/cellulitis.html

  Occasionally: Cellulitis can result in bacteremia. […] Rarely: Cellulitis can result in deep tissue infections, such as Infective endocarditis, Osteomyelitis, Septic thrombophlebitis, Suppurative arthritis. […] Early identification and management of superficial skin lesions is also key to cellulitis prevention.

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

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

  Risk factors include skin abnormalities (eg, trauma, ulceration, fungal infection, other skin barrier compromise due to preexisting skin disease), which are common among patients with chronic venous insufficiency or lymphedema. […] Most cellulitis is nonpurulent. However, cellulitis sometimes is accompanied by one or more pustules, furuncles, or abscesses with or without purulent drainage or exudate and is referred to as purulent. […] Clinical features suggestive of MRSA or complicated infection (high-risk symptoms) include the following: Pain disproportionate to physical findings, Cutaneous hemorrhage, Bullae, Skin sloughing, Skin anesthesia, Rapid progression, Tissue gas, Signs of systemic toxicity (fever or hypothermia, tachycardia, hypotension, delirium). […] Cellulitis can recur in patients with risk factors such as tinea pedis, obesity, venous insufficiency, edema, and atopic dermatitis.

• #22 Cellulitis – Skin Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/skin-disorders/bacterial-skin-infections/cellulitis

  Symptoms of cellulitis usually disappear after a few days of antibiotic therapy. […] When cellulitis affects the same site repeatedly, especially the leg, lymphatic vessels may be damaged, causing permanent swelling of the affected tissue. […] Cellulitis can develop again in people who have risk factors such as athlete’s foot, obesity, damage to leg veins that prevents blood from flowing normally (venous insufficiency), swelling (edema), and atopic dermatitis (eczema).

• #23 Cellulitis and Diabetes: Causes and Implications

  https://familymedicineaustin.com/things-that-increase-your-risk-for-cellulitis-diabetics/

  Bacteria invade your skin when it is damaged or cracked. […] If microorganisms enter the layers of skin, anybody can have a potentially severe skin infection. […] The immune response is the mechanism through which the body manages infection. […] When the immune system is weakened, the ability to regulate infection is reduced, allowing bacteria to multiply and cause damage. […] The first is connected to diabetic problems. […] Diabetic neuropathy (nerve damage) is a frequent diabetic consequence that causes you to lose feeling, particularly in your feet. […] The second way diabetes raises the risk of cellulitis is that elevated blood sugar, which is a characteristic of diabetes, impairs immune function, allowing bacterium and other infectious microbes to proliferate. […] Pre-existing skin problems like athletes foot allow skin germs to reach greater depths of the skin and produce infection.

• #24 Clinical and Molecular Hepatology

  https://www.e-cmh.org/m/journal/view.php?number=1469

  Cellulitis is a common infection in patients with liver cirrhosis. […] Cellulitis in compensated cirrhosis is different from that of decompensated patients regarding microorganisms, pathogenesis, and prognosis. […] Poor liver function in decompensated patients may increase the risk of developing infection which may be due to defect in bactericidal activity of immunoglobulin, decreased opsonic and neutrophil functions, complement deficiency, or reduced number of Kupffer cells and fibronectin levels. […] Gram negative cellulitis were seen in decompensated cirrhosis possibly due to increased bacterial translocation and intestinal overgrowth which establishing gram negative bacteremia that result either in primary septicemia or localized infections like cellulitis. […] The current study reported that in-hospital mortality rate among cirrhotic patients with cellulitis was (27.3%) that much higher than that shown in previous studies.

• #25 Cellulitis and Diabetes: Causes and Implications

  https://familymedicineaustin.com/things-that-increase-your-risk-for-cellulitis-diabetics/

  Lymphedema is a chronic disorder that causes swelling. […] This condition increases your chances of acquiring cellulitis and so in diabetes when there is cellulitis. […] Once germs infiltrate the skin and soft tissue, the lymphatic fluid provides an ideal environment for them to proliferate. […] Anything that generates a breach in the skin, such as a cut or abrasion, provides a chance for skin germs to infiltrate deeper. […] This leads blood to pool and build up in the legs, causing discomfort, swelling, and, in severe instances, open sores. […] Because these lesions are open places through which bacteria may readily infiltrate the deep layers of the skin, they render persons with venous insufficiency particularly susceptible to cellulitis and so in the case of diabetes.

• #26 Skin and soft tissue infections – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/skin-and-soft-tissue-infections/

  Cellulitis: local infection of the deep dermis and subcutaneous tissue. […] In both erysipelas and cellulitis, the most common point of entry for the pathogen is a small skin lesion (e.g., interdigital tinea pedis). […] Beta-hemolytic streptococci: mostly group A Streptococcus (S. pyogenes). […] GAS is the most common cause of nonpurulent skin and soft tissue infections (i.e., erysipelas, cellulitis). […] Entry is commonly via a minor skin injury; erysipelas can consequently spread via superficial lymphatic vessels. […] Aerobic and anaerobic, gram-positive and gram-negative bacteria are frequently isolated. […] Both monomicrobial and polymicrobial causes are common. […] Polymicrobial: wide variety; of aerobic and anaerobic pathogens, often of intra-abdominal or genitourinary origin (E. coli, Bacteroides spp.).

• #27 Cellulitis vs. Erysipelas: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/cellulitis-vs-erysipelas

  Cellulitis and erysipelas result from bacteria that get into the skin. While its not always possible to determine how bacteria enter your skin, they often do so through an opening like a cut, oozing rash, or open sore. Abrasions, burns, and surgical wounds are all prone to infection from these bacteria. […] Group A Streptococcus is also the most common cause of cellulitis, but Staphylococcus aureus is also a common cause. […] Cellulitis typically occurs on the lower legs and feet but can occur anywhere on your body. This infection causes your skin to look dark red or purple. Unlike erysipelas, a cellulitis infection has soft borders that arent well-defined. […] Since cellulitis affects the inner layers of your skin, it may generate pus. Pain and swelling are common. Fever is less common but may also occur.

• #28 Skin and soft tissue infections – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/skin-and-soft-tissue-infections/

  Monomicrobial: commonly group A Streptococcus (S. pyogenes), Peptostreptococcus spp., S. aureus. […] The only way to definitively establish the causative pathogen is by obtaining a deep tissue culture (i.e., during surgical exploration). Clinical features alone are not reliable enough to distinguish between pathogens. […] Necrotizing fasciitis first spreads along the fascia before spreading to the superficial cutaneous tissue. Local findings may, therefore, be unremarkable, with patients experiencing a disproportionate level of pain. […] Red flags that suggest necrotizing deep tissue infection include the presence of crepitus, bullous lesions, skin necrosis, pain out of proportion to examination, and signs of systemic toxicity (especially altered mental status). […] Superficial wound cultures may not accurately represent the pathogens found in deep tissue and should not be used to guide management. […] Necrotizing soft tissue infections are a surgical emergency. Expedite and prioritize surgical exploration for diagnostic confirmation and debridement as much as possible!

• #29 Bacterial Etiology and Risk Factors Associated with Cellulitis and Purulent Skin Abscesses in Military Trainees | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165491

  Military trainees are at high risk for skin and soft-tissue infections (SSTIs). […] Although Staphylococcus aureus is associated with purulent SSTI, it is unclear to what degree this pathogen causes nonpurulent cellulitis. […] To inform effective prevention strategies and to provide novel insights into SSTI pathogenesis, we aimed to determine the etiology of SSTI in this population. […] Results suggest that atypical bacteria may play an important role in nonpurulent cellulitis pathogenesis. […] Herein we report our findings from a prospective observational study aimed at discerning SSTI-specific risk factors as well as detailed characterization of the microbiology of both purulent and nonpurulent SSTI using a high-throughput sequencing strategy in addition to standard microbiology and serology.

• #30 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  Most SSTIs occur de novo, or follow a breach in the protective skin barrier from trauma, surgery, or increased tissue tension secondary to fluid stasis. […] In one prospective study, beta-hemolytic streptococcus was found to cause nearly three-fourths of cases of diffuse cellulitis. […] MRSA infections are characterized by liquefaction of infected tissue and abscess formation; the resulting increase in tissue tension causes ischemia and overlying skin necrosis. […] Lymphatic and hematogenous dissemination causes septicemia and spread to other organs (e.g., lung, bone, heart valves). […] Diabetic lower limb infections, severe hospital-acquired infections, necrotizing infections, and head and hand infections pose higher risks of mortality and functional disability.

• #31 Bacterial Etiology and Risk Factors Associated with Cellulitis and Purulent Skin Abscesses in Military Trainees | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165491

  Although small quantities of both streptococci and S. aureus sequences were recovered from most leading edge aspirate specimens, the most abundant species was the soil bacterium Rhodanobacter terrae. […] This possibility has yet to be confirmed but should be investigated further in the future. […] Thus, while both infections are SSTI and share overlapping clinical characteristics, they differ in etiology and likely in pathogenesis.

• #32 Patient education: Skin and soft tissue infection (cellulitis) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/skin-and-soft-tissue-infection-cellulitis-beyond-the-basics/print

  Cellulitis is an infection of the skin and underlying soft tissue. The infection is usually caused by bacteria, such as staphylococci („Staph”) or streptococci („Strep”); these commonly live on the skin or inner surface of the nose or mouth among healthy people. […] Such breaks in the skin allow bacteria to enter and grow, causing infection. […] Cellulitis treatment includes antibiotics as well as treatment of any underlying condition that led to the skin infection. […] Most people with cellulitis are treated with an antibiotic that is taken by mouth for 5 to 14 days. The „best” antibiotic depends upon an evaluation by your health care provider as to the likely bacterial cause of cellulitis in your case. […] If the infection is severe, you may need to be hospitalized and treated with antibiotics given through a vein (intravenously, or IV).

• #33 Clinical and Molecular Hepatology

  https://www.e-cmh.org/m/journal/view.php?number=1469

  So, it seems that advanced hepatic cirrhosis, its related complications and aggressive cellulitis sequelae that may progress to septic shock and death have major prognostic importance in this group of patients. […] Prolonged hospital stay, higher MELD-Na score, complicated cellulitis, septic shock and recurrence of cellulitis were risk factors of in-hospital mortality of cirrhotic patients with cellulitis. […] Early diagnosis and optimal treatment of cellulitis is a crucial step in the management of those high risk patients.

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