Cellulitis/Erysipelas/Necrotising Fasciitis/TSS Flashcards
Common aetiology of cellulitis/erysipelas
- Commonly: Staph aureus, Group A beta-haemolytic strep (GABHS) - esp. erysipelas
Difference between cellulitis and erysipelas
- Erysipelas: upper dermis and superficial lymphatics
- Cellulitis: deeper dermis & subcut fat
Common features of cellulitis/erysipelas
- May have site indicating portal of entry e.g. eczematous, burn, laceration (but often not seen)
- More commonly lower extremities
- Erythema, oedema, warmth
- Itch and tenderness
- +/- exudate/crusting
- Erysipelas has well-defined border
How can you tell between peri-orbital and orbital cellulitis?
Orbital cellulitis involves ophthalmoplegia
Abx for cellulitis/erysipelas
• Flucloxacillin, cephalexin
DDx for cellulitis/erysipelas
- Impetigo
- SSSS
- Necrotising fasciitis
- Allergic reaction/contact dermatitis
What is necrotising fasciitis?
Rapidly spreading infection of deep layer of superficial fascia, characterised by necrosis of subcutaneous tissue
Most common cause of necrotising fasciitis?
• Group A strep (+/- toxic shock) in healthy children (staph aureus is possible)
Main clinical pearl for necrotising fasciitis
• Constitutional unwellness out of proportion to cutaneous signs – soft tissue swelling + violaceous or bluish vesicles and bullae.
Mx for necrotising fasciitis
- Urgent surgical referral for radical debridement
- Supportive therapy (consider Hyperbaric O2)
- IV antibiotics (fluclox, clinda)
What is TSS caused by?
Due to toxin produced byS. aureusor Group A streptococcus
How does TSS usually occur?
- Tampon use
- skin and soft tissue infections
What are key features of TSS?
- Macular rash
- Hypotension
- Soft tissue necrosis/fever
