Cellulitis is an acute inflammation of the skin accompanied by pain, erythema (redness), swelling and local heat.
Cellulitis can be caused by external pathogenic bacteria, but also by the indigenous flora that colonize the skin and its annexes (S.aureus, S.pyogenes). Solutions of continuity are represented by the gateways to bacteria in the skin (cuts, stings, bites, surgical incisions) accompanied by poor hygiene. S.aureus infection spreads on a limited surface (abscess, folliculitis), while S.pyogenes infection is a diffuse inflammation that expands more rapidly, accompanied by fever and satellite adenopathy.
People who have an increased risk of developing cellulitis are those who suffer from some diseases:
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Surgery for collecting fragments of safena vein may be followed by strep cellulitis. Streptococci can produce cellulitis also in patients with chronic lymphedema (elephantiasis). In individuals with diabetes cellulitis is frequently caused by the group B streptococcus and in children, periorbital cellulitis is caused by Haemophilus influenzae; the spreading of H.influenzae infection can be countered by vaccination.
There are other situations in which some bacteria can cause cellulitis, so that these infections occur in typical situations and with a careful history it can be rapidly identified the precise cause. For example, the cellulitis that appears after a cat or dog bite is most commonly caused by Pasteurella multocida, Capnocytophaga canimorsus and Staphylococcus intermedius to which is added a variety of anaerobic microorganisms (including the bite human). Pasteurella species are resistant to nafcillin and dicloxacina but sensitive to quinolones, tetracycline and erythromycin. Infections associated with animal or human bites can be treated successfully by administrating of ampicillin and cefotixina.
...see more Cellulitis pictures: Cellulitis pictures
P.aeruginosa penetrates the skin following a nail trauma (when someone is standing board = 'sweaty shoe syndrome''), three types of bacteria can cause infection: ectima gangrenosum, cellulitis folliculitis and a consecutive penetrating wound. Treatment involves necessarily surgical drainage of purulent collections. Empirically (until the results of antibiogram) an aminoglycoside, a third-generation cephalosporin, a penicillin (semisynthetic) or a fluoroquinolone can be used.
Hospitalized patients and the immunocompromised people (HIV) often suffer from cellulitis provoked by gram-negative bacilli (including P.aeruginosa). In such cases, we recommend performing cultures and antibiograms, as is a multidrug resistant hospital flora.
Of the above, note that the etiology of cellulitis can be established by a medical history, if there is a possibility of continuity, samples for cultures can be taken; in some cases there is difficult to identify the causal agent, as the needle that punctures the center of the lesion will increase the positive value of crops in just one fifth of cases. Lesion size does not correlate with an increased number of bacteria; the inflammation gets worse through the action of microbial toxins or inflammatory mediators of the host.
Cellulitis may be caused by different bacteria, among which the most common are streptococci. They quickly spread to the skin as limiting infection produces enzymes that prevent a piece of tissue. Staphylococcus infection can also cause cellulitis, especially after stings, bites, or wounds.
Bacteria enter the skin through small skin lesions, resulted from scratches, stings, burns or skin diseases (dermatitis). The swelling affected skin is particularly vulnerable.
Frequently cellulitis affects the legs but it can occur in any region of the body. The first symptoms of cellulitis are redness and pain localized on an area of skin involved in this process. A part of the symptoms appear because both by bacteria responsible for infection and by the body's response, in order to stop infection. Infected skin gets swollen and an orange color. Liquid droplets sometimes appear on the portion of skin affected.
In most patients, fever, chills, tachycardia, headache, hypotension and mental confusion install. It is generally observed a general state of malaise. As the infection spreads, it increases the lymph nodes disease (lymphadenitis).
Periorbital cellulitis, known also like preseptal cellulitis is an infection localized into the eyelid and near the eye. Note that it is not the same with orbital cellulitis. The difference between them is that the first one is made in front of the septum, and the second behind it. The principle cause is a break in the eye skin which can facilitate the entering of bacteria.
The first symptoms are swelling, redness, erythema, tenderness, warmth and pain. Severe cases present also fever, shut eye and conjunctival injection. The most appropriate treatment is antibiotic medication, dicloxacillin, cephalexin and clindamycin being the most common substances used for this disease. If not treated, the infection can spread into the blood, causing serious complication.
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Facial cellulitis is a bacterial infection caused by pathogen agents like bacteria. It is mainly characterized by swelling, redness, pain and heat. It can appear due to problems in the lymphatic system, teeth inflammation, middle ear inflammation or even upper respiratory tract infections. Once the patient gets an open wound the bacterium enters the deeper layers of the skin and triggers facial cellulitis. Severe cases may provoke fever, irritability, swollen, warm, tender tongue and chills. Untreated, it can lead to complications. Antibiotics, together with a good care, can cure cellulitis and avoid further recurrence.
Cellulitis of the legs
One of the most common places for cellulitis is on the lower limbs, because they are the most exposed to infection. The causes can be cuts, animal bites, wounds, considered open gates for bacteria from the outside, or even for the own skin flora. Moreover, recent surgeries or invasive procedures are risk factors as well.
The patient will experience redness, warmer skin areas, swelling and pain. The doctor will effectuate a medical exam and order blood tests in order to confirm the diagnosis. If positive, antibiotics will be administered orally or IV, depending on the severity of the case. Also, it is recommended to keep the affected limb elevated and to apply cold compresses to reduce the pain.
Cellulitis antibiotic treatment may be administered intravenously, orally or by application of special creams that have an antibiotic composition. The type of treatment used is decided depending on the severity of infection and its location.
...read more about Periorbital cellulitis treatment: Periorbital cellulitis treatment
In case of a rapid dissemination of infection bacteraemia may occur (presence of bacteria in blood) and sepsis (body's response to this syndrome due to systemic infection). Facial cellulitis can spread to the brain, causing meningitis. Other rare complications occurring in people with cellulitis are thrombophlebitis (inflammation and infection veins) and gangrene (tissue necrosis). People with certain chronic diseases such as diabetes, peripheral arthritis, or compromised immune systems are prone to complications. Also these cases are more frequent to become recurrent.
Normally, cellulitis is not contagious. The bacteria enter the skin through a gateway (as mentioned before: wounds, cuts, animal bites). On the other hand, it is possible to contact cellulitis from someone else by coming in direct contact with persons who already have an infection like this, if they have open sores. Here are some tips that can help you stay away of cellulitis: Avoid skin lesions by wearing appropriate protective equipment. If you still get hurt, wash the wound with soap and water and watch it some days until it heals. Some wounds have an increased risk of infection - animal bites, stings, wounds deep in the dust penetrated, burns or frostbites. Also, thorough cleansing of skin and personal hygiene is very important respect. Notice early signs of infection of the skin: if an area is red, hot and painful, it is likely to need treatment.
General health state and controlling chronic diseases play an important role. A healthy body is able to fight more easily against the multiplication of bacteria, while a weak body is prone to infections.
Cellulitis in children
Due to the fact that children are move active than the adults, they tend to get hurt easily. They also play with animals or in open areas, where pathogen agents are in plenty. Once a bruise, cut or animal bite appears on the skin surface, any bacterium from the outside can enter the skin and produce cellulitis, especially streptococci or staphylococci.
You will then observe a red surface, more intense than the one from a scratch or a rash, accompanied by swelling and tenderness. It is urgent to bring your child to the doctor so that adequate antibiotics can be administered. Complications like arthritis or kidney inflammation can occur if not treated properly. Be aware that even if the symptoms disappear, the cure must be taken for completely, to avoid a possible recurrence.
Even if cellulitis is more frequently produce by streptococci, other bacteria like staphylococci can be the cause of this disease. Staphylococci are a large family of bacteria, including also Methicillin-resistant Staphylococcus aureus. Once arrived in the tissue under the skin, it causes a big number of soft tissue infections, including cellulitis.
The symptoms are similar to any other type of cellulitis, but the treatment is substantially different. MRSA is resistant to usual antibiotics used in those cases (cephalexin, for example). Glycopeptide antibiotics like teicoplanin and vancomycin are able to treat it. Severe cases, when the bacterium doesn't respond to those drugs, are treated with linezolid, daptomycin or tigecycline.