Cellulitis

Question 1

Define Cellulitis?

Answer 1

Acute non-purulent spreading infection of the subcutaneous tissue, causing overlying skin inflammation

Question 2

What is the aetiology of Cellulitis?

Answer 2

Often results from:

• Penetrating Injury
• Local Lesions (e.g. insect bits)
• Fissuring (e.g. anal fissures)

This allows pathogenic bacteria to enter the skin

Question 3

What are the most common organisms that enter the skin in Cellulitis?

Answer 3

Streptococcus Pyogenes
Staphylococcus Aureus
Beware of MRSA

Question 4

What is Cellulitis of the orbit (orbital Cellulitis) is usually caused by?

Answer 4

Haemophilus Influenzae

Question 5

What are the risk factors for Cellulitis?

Answer 5

Skin Break
Poor Hygeine
Poor Vascularisation of tissue (e.g. due to diabetes mellitus)

Question 6

What is the epidemiology of Cellulitis?

Answer 6

Very Common

Question 7

What are the general history features of Cellulitis?

Answer 7

History of cut, scratch or injury

Question 8

What are the presenting symptoms of Periorbital Cellulitis?

Answer 8

Painful swollen red skin around the eye

Question 9

What are the presenting symptoms of Orbital Cellulitis?

Answer 9

Painful or limited eye movements, visual impairment

Question 10

What are the signs of Cellulitis caused by Lesion on physical examination?

Answer 10

Erythema
Oedema
Warm tender indistinct margins
Pyrexia - may suggest systemic spread

Question 11

What is important to remember with Cellulitis on physical examination?

Answer 11

Exclude the presence of an abscess (aspirate if pus suspected)

Question 12

What are the signs of Periorbital Cellulitis on physical examination?

Answer 12

Swollen Eye Lids

Conjuctival Infection

Question 13

What are the signs of Orbital Cellulitis on physical examination?

Answer 13

Proptosis
Impaired visual acuity and eye movements
Test for RAPD, visual acuity and colour vision

Question 14

What bloods would you do for Cellulitis?

Answer 14

WCC

Blood Culture

Question 15

What investigation would you do for discharge for Cellulitis?

Answer 15

Sample and send for MC&S

Question 16

When do we do an Aspiration for Cellulitis?

Answer 16

If pus is suspected

Question 17

When do we do a CT/MRI for Cellulitis?

Answer 17

If orbital Cellulitis is suspected (helps assess posterior spread of infection)

Question 18

What is the medical management plan for Cellulitis?

Answer 18

Oral penicillins (e.g. flucloxacillin) or tetracyclines are effective 
If hospital-acquired - treat empirically based on local guidelines and change depending on the sensitivity of cultured organisms

Question 19

What is the surgical management plan for Cellulitis?

Answer 19

Orbital decompression may be needed in orbital cellulitis (EMERGENCY)

Question 20

What do we do for an Abscess in Cellulitis?

Answer 20

Aspirate
Incision and drainage
Excised completely

Question 21

What are the possible complications of Cellulitis?

Answer 21

Sloughing of overlying skin
Orbital Cellulitis - may cause permanent loss of vision, spread to the brain, abscess formation, meningitis, cavernous sinus thrombosis