Condition- Cellulitis and Erysipelas

Question 1

State the two main causative organisms for cellulitis and erysipelas

Answer 1

Strep pyogenes

Staph aureus

Question 2

List some of the risk factors for developing cellulitis and erysipelas

Answer 2

• Skin trauma: IV cannulateion, cuts, surgery, bites
• Immunocompromised: DM, HIV, steroids, chemo
• Skin infection: tinea, impetigo, prior cellulitis
• Oedema; lymphoedema, venous insufficiency

Question 3

State some of the differences between Cellulitis and Erysipelas

Answer 3

CELLULITIS

• Dermis and subcutaneous (deeper)
• Indistinct borders

ERYSIPELAS

• Epidermis (more superficial)
• Raised, shiny and clearly demarcated

Question 4

Which organisms might have caused this lesion? State some of the characteristic features of it on examination

Answer 4

CELLULITIS- staph aureus, strep pyogenes

• tender
• erythematous
• swollen
• warm
• poorly demarcated borders

Question 5

Which organisms might have caused this lesion? State some of the characteristic features of it on examination

Answer 5

ERYSIPELAS- staph aureus, strep pyogenes

• Erythematous
• Tender
• Swollen
• Warm
• Superficial
• Raised lesion with clearly demarcated borders
• May show systemic signs

Question 6

If a previous IVD used presents with a purulent cellulitic lesion what might you be worried about?

Answer 6

MRSA infection

Suspect if: IVD, hospital contact, contact hx with MRSA, purulent, homosexual

Question 7

List some of the possible consequences of cellulitis infection

Answer 7

• Peri-orbital cellulitis: lid oedema, conjunctival infection
• Orbital cellulitis: vision impairment, limited eye movement. May even spread to brain
• Abscess formation
• Sepsis
• Necrotising fasciitis

Question 8

Which investigations would you conduct on someone with cellulitis?

Answer 8

• Bloods: WCC, FBC, blood culture
• Discharge and MC&S
• Aspiration
• CT/MRI if orbital cellulitis and meningeal involvement suspected

Question 9

How would you manage a patient with cellulitis

Answer 9

• CONSERVATIVE:
  
  • draw around lesion
  • IV fluids
  • Monitor obs
• MEDICAL:
  
  • Oral abx: flucloxacillin + vancomycin (if MRSA suspected)
  • IV abx if severe
• SURGICAL:
  
  • Decompression of peri-orbital cellulitis (SURGICAL EMERGENCY)
  • Abscess management
    
    • Abx
    • Aspiration
    • Incision + Drainage
    • Excision

Question 10

When would a patient with cellulitis need to be admitted in to hospital?

Answer 10

• SEPSIS is suspected:
  
  • High HR
  • High RR
  • Low BP
• Confusion: AVPU or GCS

Question 11

Which condition could have caused the eye-lid oedema?

Answer 11

Peri-orbital cellulitis- infection by strep pyogenes or staph aureus

Question 12

Which classification system can be used for cellulitis as suggested by NICE CKS?

Answer 12

ERON CLASSIFICATION;

1. No systemic issues or uncontrolled co-morbidities
2. Systemically unwell or well but with uncontrolled co-morbidities
3. Significant systemic unwell- high HR, high RR, low BP, confusion
4. SEPSIS or Necrotising Fasciitis