Florid osseous dysplasia: report of a case presenting acute cellulitis.

Florid osseous dysplasia: report of a case

presenting acute cellulitis

Med Oral Patol Oral Cir Bucal. 2009 Sep

Pitak-Arnnop P, Dhanuthai K, Chaine A, Bertrand JC, Bertolus C.

Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany. poramate.pitakarnnop@gmail.com

In this review, we examined a 45-year-old Asian man who had been diagnosed with florid osseous dysplasia (FOD) of the mandible and acute perimandibular cellulitis. This presentation occurred after a history of off-and-on swellings of the jaw and multiple treatments received at another hospital. An aggressive resection of the jaw was planned; however, the patient denied the treatment and came to our clinic to seek a second opinion. The patient was successfully treated by conservative surgery and antibiotic treatment with preservation of the jaw integrity and the mandibular neurovascular canal. Intraoperatively, a piece of a calcified mass was removed and submitted for histopathological examination. The specimen showed woven bone and densely sclerotic mass of calcified materials exhibiting reversal lines and inflammatory cell infiltration of the connective tissue. The definitive diagnosis was FOD with a secondary infection. Treatments for FOD were discussed.

Full Text: Med Oral Patol Oral

Campylobacter fetus cellulitis in an immunocompromised patient: case report and review of the literature.

Campylobacter fetus cellulitis in an immunocompromised patient:

case report and review of the literature

Acta Clin Belg. 2009 Jul-Au

Ausselet N, Huang D, Vandercam B, Yombi JC.

Department of internal medicine, infectious and tropical diseases, Saint Luc University hospital, Bruxelles.

Campylobacter fetus is an opportunist Gram-negative bacillus. The most frequent clinical manifestation is bacteriemia but it can also be responsable for soft tissue infections, endovascular infections, meningitis, peritonitis and thrombophlebitis. Campylobacter fetus cellulitis has been described, but rarely identified in subcutaneous puncture samples. We report a case of an immunocompromised patient with Campylobacter fetus bacteriemia associated with a soft tissue infection whose subcutaneous puncture also revealed the bacteria.

PMID: 19810424 [PubMed - in process]

How Cracked heels can let killer bacteria invade your body

How Cracked heels can let killer bacteria

invade your body

By ALICE GREBOT

Last updated at 10:20 AM on 06th October

One night as Chris Banting was undressing for bed, he was surprised

when his wife Helen pointed out to him that the back of his right calf was

a worrying scarlet colour.

'It was strange because I wasn't in any discomfort at all,' says Chris, 62.

'If you have an infection, you think you'd be in pain or running a temperature,

but I felt fine.'

It was November 2007 and the busiest time of the year in his job as a charity

fundraising manager, but he decided it was something he should get checked

out.

In fact, Chris was suffering from cellulitis - a serious bacterial infection of the

skin.

Left untreated, the bacteria can spread through the body and cause potentially

fatal blood poisoning or an infection of the muscle, bone or heart valve.

Around 70,000 people are hospitalised with it every year.

Cellulitis - not to be confused with cellulite - affects the deep layer of skin

known as the dermis, and sometimes the layer of fat and soft tissues beneath.

Initially, it causes the skin to become sore, red and swollen.

Though it commonly affects the lower legs, it can occur on any part of the body.

Dr Nick Lowe, consultant dermatologist and spokesperson for the

British Skin Foundation, explains that we all have bacteria living on our skin.

Usually this doesn't cause any harm, but if the skin is damaged by an ulcer, cut,

graze or insect bite, or even if it is simply cracked through conditions such as

eczema, the bacteria can get in, causing an infection.

Nail infections or ingrown toenails can also be a source.

'When this happens, the infected area becomes inflamed, tender, red and

often hot,' says Dr Lowe.

'It may also blister. The infection is usually accompanied by symptoms of feeling

generally unwell, including fever and nausea.'

Those with weakened immune systems are particularly vulnerable, as their bodies

lack the strength to fight off the infection.

Other risk factors include diabetes, as it often causes poor blood supply to the skin,

which may lead to ulcers that can serve as an entry point for bacteria.

Athlete's foot can also make you more prone to cellulitis, as this may cause the skin to

crack.

A severe case of cracked heels could make you more vulnerable, too. As can

lymphedema - a condition that causes swelling in a part of the body because of fluid

build-up under the skin.

However, cellulitis can occur without a wound, when bacteria enters through

the lymphatic system.

The speed at which the symptoms manifest themselves depends on the

health of the infected patient.

'In a very healthy person, symptoms may take up to a week to appear,' says Dr Lowe.

'But in the elderly or those with weakened immune systems, symptoms can come

on rapidly, in just a day or two.

'This is why prompt diagnosis-and treatment with antibiotics is vital, before the

infection spreads.'

When Chris Banting discovered the angry rash on his leg, he made an appointment

at an out- of-hours clinic near his home in Bristol.

The doctor diagnosed cellulitis and gave Chris a prescription for antibiotics.

'He told me the most likely point of entry for the bacteria that had caused

my cellulitis had been cracks on the soles of my feet,' says Chris.

'I'd had athlete's foot since I was a teenager, and on top of a recent attack, which I'd

been treating with an anti-fungal cream, had developed a secondary fungal

infection that had caused the cracks.

'I'd heard cellulitis can potentially kill you, but that didn't even enter my head

then. My wife had been through the same thing, and although she'd spent a week

in hospital, she'd been cured, so I thought I'd take the antibiotics and I'd be fine.'

Generally, a course of antibiotics is enough to clear up the infection, but despite

the prompt diagnosis, his symptoms got progressively worse.

Just two days later, he had developed a huge blister on his right calf, around

one-and-a-half inches deep and the diameter of a grapefruit.

'I'd never seen anything like it,' says Chris. 'It seemed to have come out of

nowhere.

'Worse still, the stuff leaking out of it looked like some kind of machine oil.

It was revolting!'

Chris went straight to his GP, who took one look at his leg and told him he

needed to go to hospital.

'She explained the infection had gone beyond the stage when oral

antibiotics would help, and that I'd need to be admitted for intravenous

antibiotics,' he says.

'It was all rather dramatic and happened very quickly.'

Chris was admitted to the Bristol Royal Infirmary.

'One of the first things the doctors did was to draw on my leg with a

marker pen around the outline of the infected skin, so they could keep

track of whether it was spreading or not,' says Chris.

'It would seem it can spread rapidly in some instances - but luckily mine

stayed roughly the same.'

Thankfully, within a couple of days, Chris's infection began to dwindle

(his athlete's foot was also effectively treated).

He remained in hospital for a week and was then released to the care

of his GP surgery, where he went daily for ten days to have his dressings

changed.

Now the only lasting sign he ever suffered from cellulitis is a patch of

discoloured skin extending from behind the knee to the ankle bone.

Though he's recovered, Chris could well suffer a recurrence. Around

one-third of people develop cellulitis again within three years.

'Once you've had cellulitis, you're more likely to get it again - and in

the same area,' says Dr Lowe.

'This is because the infection can damage the lymph channels in the

area, so they become less efficient at filtering out germs.

Therefore, you need to be scrupulous about skin cleansing and keeping

your skin moisturised, to prevent it drying out and cracking.'

Meanwhile, Chris is thankful for the first-class treatment he received -

and to his wife for spotting the symptoms in the first place.

'If she hadn't, goodness knows what could have happened,' he says.

Mail Online

For additional information:

Cellulitis

Complications of Cellulitis and Lymphangitis

Prevention of Cellulitis

What is Cellulitis?

What is Cellulitis?

Written by Amanda Wattson, MD
Saturday, 10 October 2009

Cellulitis is an infection of the skin and the layer of tissue under the skin.

What is going on in the body?

Cellulitis most often develops on the legs but can be seen on the face and on any other skin

on the body. It tends to affect a fairly large area of skin. Cellulitis is usually due to an infection

of the skin with bacteria, but it may also be caused by a fungus.

What are the causes and risks of the infection?

Cellulitis is usually caused by a break in the skin that becomes infected with bacteria or

fungi. It can occur in wounds caused by injury and in surgical wounds. It can also occur when

there is no obvious break in the skin.

Risk factors for cellulitis include the following:

- recent surgery
- diabetes
- recent chickenpox infection

-immunodeficiency disorder, in which the body's infection-fighting mechanisms are impaired.

People with AIDS, for example, have a significant risk of cellulitis.

- impaired circulation, such as peripheral arterial disease, which limits blood flow to the legs

and arms.

- chronic use of steroids

What are the treatments for the infection?

For mild, superficial infections, oral antibiotics, such as cephalexin or dicloxacillin, are often

used. Over-the-counter pain medication, such as ibuprofen or acetaminophen, can be used

as needed to relieve discomfort. For more severe infections, individuals may need intravenous

(IV) antibiotics, such as oxacillin or nafcillin.

Cellulitis may get worse even with treatment, especially in people with diabetes. In these

cases, more aggressive treatment may be needed. This may include surgery to remove dead

skin or even bone.

What are the side effects of the treatments?

Antibiotics and over-the-counter pain medications may cause upset stomach, rash, or allergic

reactions. Surgery may cause bleeding, new infections, or allergic reaction to anesthesia.

What happens after treatment for the infection?

In most cases, cellulitis goes away after treatment. If treatment is successful, people can

usually return to normal activities.

How is the infection monitored?

The healthcare provider will examine the area of cellulitis regularly to assess healing. In

some cases, special X-ray tests may be used if a deeper infection is suspected. Any new

or worsening symptoms should be reported to the healthcare provider.

24 Medica

Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review

Staphylococcus aureus is the most common

identified cause of cellulitis: a systematic review

Epidemiol Infect. 2009 Aug 3

Chira S, Miller LG.

Alpert Medical School at Brown University, Providence, RI, USA.

Correspondence:

^c1 Author for correspondence: L. G. Miller, M.D., M.P.H., Division of Infectious Diseases, Harbor–UCLA Medical Center, 1000 W Carson St, Bin 466, Torrance, CA 90509, USA. (Email: lgmiller@ucla.edu)

SUMMARY:

We utilized Medline to perform a systematic review of the literature to quantify the aetiology of cellulitis with intact skin. Of 808 patients with cellulitis, 127-129 (15.7-16.0%) patients had positive needle aspiration and/or punch biopsy cultures from intact skin. Of the patients with positive cultures, 65 (50.4-51.2%) had cultures positive for Staphylococcus aureus, 35 (27.1-27.6%) for group A streptococcus, and 35-37 (27.1-29.1%) for other pathogens. The most common aetiology of cellulitis with intact skin, when it can be determined, is S. aureus, outnumbering group A streptococcus by a ratio of nearly 2:1. Given the increasing incidence of community-associated methicillin-resistant S. aureus infections, our findings may have critical therapeutic implications.

Cambridge

Necrotizing fasciitis and myonecrosis "synergistic necrotizing cellulitis" caused by Bacillus cereus.

Necrotizing fasciitis and myonecrosis

"synergistic necrotizing cellulitis"

caused by Bacillus cereus.

J Dermatol. 2009 Jul

Sada A, Misago N, Okawa T, Narisawa Y, Ide S, Nagata M, Mitsumizo S.

Division of Dermatology, Department of Internal Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga 849-8501, Japan. Email: sadaasu@cc.saga-u.ac.jp

Our patient was a 37-year-old man with diabetes mellitus and hepatopathy as underlying diseases. Swelling, erythema and pain appeared in the left upper limb on the day before the initial examination. On examination, diffuse purpura was noted on the left upper limb, and, as it rapidly extended to the left upper trunk, emergency surgery was performed. Intraoperatively, gas-producing necrosis was observed not only in subcutaneous tissues but also from the fascia to muscle tissues, and the condition resembled clostridial gas gangrene. However, as the culturing of samples from the lesion yielded Bacillus cereus, a diagnosis of necrotizing fasciitis and myonecrosis (synergistic necrotizing cellulitis) due to B. cereus was made. While the patient developed a serious condition due to sepsis and disseminated intravascular coagulation, he could be saved by early debridement and intensive treatment with an appropriate selection of antibiotics.

Wiley InterScience

Emergency department management of home intravenous antibiotic therapy for cellulitis

Emergency department management of home intravenous antibiotic therapy for cellulitis

Emergency Medicine Journal 2005;22:715-717; doi:10.1136/emj.2004.018143
© 2005 BMJ Publishing Group Ltd and the College of Emergency Medicine.

M Donald1, N Marlow2, E Swinburn1, M Wu3
1 Royal North Shore Hospital, Sydney, Australia2 Northern Sydney Health, Sydney, Australia3 Mona Vale Hospital, Australia

Correspondence to:Correspondence to: Dr M J Donald Royal North Shore Hospital, St Leeward’s, Sydney, NSW, Australia; mikedonald25@hotmail.com

Objectives: To evaluate the safety and efficacy of using intravenous cephazolin as a first line antibiotic for the treatment of cellulitis in a supervised outpatient programme.

Methods: This study was a retrospective analysis and included all patients who attended the emergency department (ED) of a university affiliated hospital in Sydney over the period of 1 year and who satisfied the following inclusion criteria: (a) age >16 years, (b) presented with acute cellulitis, and (c) were suitable for home intravenous antibiotic therapy according to APAC guidelines.

Results: In total, 124 patients were included, of whom 53 (42.7%) presented directly to the ED and 71 (57.3%) were referred by their general practitioner. Of these 124 patients, 75 (60.5%) were men and 49 (39.5%) were women. Age range was 16–97 years. There were 82 (66.2%) presentations of cellulitis of the lower limb, 30 (24.2%) of the upper limb, 9 (7.2%) of the face and 3 (2.4%) of the torso. Cephazolin 2 g twice daily was given to 123 (99.2%) of the patients, and one patient (0.8%) received ceftriaxone 2 g once daily. In total, 105 patients (84.7%) were treated successfully and 19 (15.3%) were re-admitted. Four of the unsuccessful treatment group required incision and drainage of abscesses. The mean duration of intravenous therapy was 6.24 days. One patient developed diarrhoea. There were no other complications attributable to therapy.

Conclusion: Low re-admission rates verify the efficacy of cephazolin 2 g twice daily in treating cellulitis in the home environment. Benefits are multiple and include economic savings and reduced risk of nosocomial infection.

Abbreviations: APAC, Acute/Post Acute Care; ED, emergency department; HIH, hospital in the home

Keywords: Cellulitis; cephazolin; department; emergency

Ermergency Medicine Journal

Continuous-infusion oxacillin for the treatment of burn wound cellulitis.

Continuous-infusion oxacillin for the treatment of burn wound cellulitis.
Surg Infect (Larchmt). 2009 Feb

Schuster KM, Wilson D, Schulman CI, Pizano LR, Ward CG, Namias N.
Section of Trauma, Surgical Critical Care and Surgical Emergencies, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA. kevin.schuster@yale.edu

BACKGROUND: Burn cellulitis is an infection of the unburned skin at the margin of a burn wound or graft donor site, typically caused by group A beta-hemolytic streptococci and Staphylococcus aureus. beta-Lactam antibiotics exhibit time-dependent killing and, because of their narrow spectrum, minimize bacterial resistance. We therefore use continuous-infusion oxacillin in the treatment of burn cellulitis.

METHODS: Patients at a regional burn center who were treated for burn cellulitis from January 2003 to December 2005 were included. Charts were reviewed for all pertinent data regarding the antibiotic treatment methods and outcomes. Successful treatment was defined as resolution of physical findings, fever, and leukocytosis and intravenous antibiotic cessation.

RESULTS: Thirty-seven patients were treated for burn cellulitis, 26 (70%) of whom were treated initially with continuous-infusion oxacillin. Other initial antibiotics were chosen because of concomitant infections, penicillin allergy, or development of cellulitis during treatment with a beta-lactam antibiotic. Oxacillin treatment was successful in 19 patients (73%). Success required an average of 5.16 days, with 1.53 days required for fever resolution and 0.89 days for resolution of leukocytosis. Seven patients who did not respond rapidly were switched to intravenous vancomycin an average of 2.4 days after starting oxacillin, leading to a 100% success rate. There were no deaths, and only one suspected case of allergic reaction to oxacillin. In eleven patients treated with other antibiotics, the success rate was 75%. Success with these drugs required a longer treatment course of 6.45 days. Leukocytosis resolved significantly more slowly at 4.45 days (p = 0.02), and fever resolution was also slower at 3.18 days.

CONCLUSIONS: Continuous-infusion oxacillin was successful in the treatment of 73% of patients, a success rate that might have been higher with clinical patience, and leukocytosis resolved faster than with other antibiotics. Failure of continuous-infusion oxacillin can be managed without clinical consequence by conversion to intravenous vancomycin.

MaryAnn Liebert Publications

Fungal foot infection, cellulitis and diabetes: a review.

Fungal foot infection, cellulitis and diabetes: a review.
Diabet Med. 2009 May

Bristow IR, Spruce MC.
School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK. ib@soton.ac.uk

AIMS: To review the current evidence for the presence of fungal foot infection (tinea pedis and toenail onychomycosis) as a risk factor for the development of cellulitis within the lower limb, particularly for those individuals with diabetes.

METHODS: A structured review of medline, embase and cinahl databases was undertaken to identify publications investigating fungal foot infection as a risk factor for the development of cellulitis.

RESULTS: Sixteen studies were identified. Eight studies adopted a case-control methodology, with the remainder being cross-sectional surveys. The majority of studies established the presence of tinea infection by clinical rather than established microbiological methods. Although the majority of papers suggested a link, only two case-control studies employed microbiological diagnosis to demonstrate that fungal foot infection was a risk for the development of lower limb cellulitis, particularly when infection was located between the toes. There were insufficient data to suggest that fungal foot infection posed an increased risk to patients with diabetes.

CONCLUSION: There is some evidence to suggest that fungal infection of the foot is a factor in the development of lower limb cellulitis, but further robust research is needed to confirm these findings and quantify the risk that fungi pose, particularly to the diabetic foot. Meanwhile, improved surveillance and treatment of tinea infections on the foot by healthcare professionals should be encouraged to reduce potential complications.

Wiley InterScience

Florid osseous dysplasia: report of a case presenting acute cellulitis.

Florid osseous dysplasia: report of a case presenting acute cellulitis.

Med Oral Patol Oral Cir Bucal. 2009 Sept

Pitak-Arnnop P, Dhanuthai K, Chaine A, Bertrand JC, Bertolus C.
Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany. poramate.pitakarnnop@gmail.com

In this review, we examined a 45-year-old Asian man who had been diagnosed with florid osseous dysplasia (FOD) of the mandible and acute perimandibular cellulitis. This presentation occurred after a history of off-and-on swellings of the jaw and multiple treatments received at another hospital. An aggressive resection of the jaw was planned; however, the patient denied the treatment and came to our clinic to seek a second opinion. The patient was successfully treated by conservative surgery and antibiotic treatment with preservation of the jaw integrity and the mandibular neurovascular canal. Intraoperatively, a piece of a calcified mass was removed and submitted for histopathological examination. The specimen showed woven bone and densely sclerotic mass of calcified materials exhibiting reversal lines and inflammatory cell infiltration of the connective tissue. The definitive diagnosis was FOD with a secondary infection. Treatments for FOD were discussed.

Med Oral

Oral tacrolimus treatment for refractory eosinophilic cellulitis.

Oral tacrolimus treatment for refractory eosinophilic cellulitis.
Clin Exp Dermatol. 2009 Jun
Ohtsuka T.
Department of Dermatology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.

A 72-year-old man presented with a 1-month history of a rash. The eruption had previously been successfully treated with oral corticosteroids (prednisolone 30 mg/day) and antihistamines on two previous occasions, but recurred several days after stopping treatment. On examination, multiple, indurated, round to annular erythematous plaques were found on the trunk and limbs. Histological examination revealed interstitial oedema, a dense infiltrate of eosinophils in the dermis, and flame figure formation. These results led us to the diagnosis of eosinophilic cellulitis. Treatment with oral corticosteroids (prednisolone 15 mg/day) was unsuccessful. Four weeks after the start of oral tacrolimus 1 mg/day, the eruption completely resolved.

WileyInterScience

Recurrent Cellulitis in a Case of Aagenaes Syndrome.

Recurrent Cellulitis in a Case of Aagenaes Syndrome.
Clin Pediatr (Phila). 2009 Jun
Dang S, Sigal Y, Davies D.

Aagenaes syndrome, also called Lymphedema Cholestasis Syndrome (LSC 1), is a form of idiopathic familial intrahepatic cholestasis associated with lymphedema of the lower extremities. It is named after the Norwegian pediatrician Oyestein Aagenaes, who described the syndrome in 1968. The presence of lymphedema is likely the predisposing factor for development of recurrent infections in such patients.1 Recurrent cellulitis as such has never been described in the literature with Aagenaes syndrome. This case highlights recurrent cellulitis as one of the potential complications of Aagenaes syndrome.

Sage Journals