Monday, December 12, 2005

Crepitant Anaerobic Cellulitis

Crepitant Anaerobic Cellulitis

Nonclostridial and clostridial cellulitides have a similar clinical picture and are discussed together under the term, crepitant anaerobic cellulitis. Crepitant anaerobic cellulitis appears as a necrotic soft tissue infection with abundant connective tissue gas. The condition usually occurs after local trauma in patients with vascular insufficiency of the lower extremities. Multiple aerobic and anaerobic organisms have been isolated, including Bacteroides species, Peptostreptococcus species, Clostridium species, and members of the family Enterobacteriaceae. Crepitant anaerobic cellulitis can be differentiated from more serious soft tissue infections by the abundance of soft tissue gas, lack of marked systemic toxicity, gradual onset, less severe pain, and absence of muscle involvement.



Anaerobic cellulitis:

- due to clostridial species usually occurs in pts who have devitalized subcutaneous tissues;

- anaerobid cellulitis necrotizing fascitis is a clostridial infection of ischemic tissue, usually occuring after several days, in an inadequately debrided wound;

- clostridium perfringens and other clostridial species thrive in dirty or inadequately debrided wounds;

- clostridial cellulitis occurs after inadequately debrided trauma when bacteria proliferate in already necrotic tissue;

- incubation period may be delayed for 1-2 days, however, once the infection begins it may spread rapidly;

- typically there will be crepitus caused by gas in the tissues, but systemic symptoms, local pain, and blebs are not seen;

- there is a thin foul discharge from flat blebs of the skin without systemic signs of toxicity; - gas formation is foul smelling and abundant, but there remains no actual muscle invasion;

- diagnosis of clostridial myonecrosis has an unfavorable prognosis; - gram-stained smear of discharge usually shows PMNs and numerous large, blunt gram-positive bacilli; - diff dx:
- Bacteroides infection:

- this type of cellulitic infection is distinguished from clostridial infection by the presence of systemic toxicity and bullae, and by the presence of gram negative bacteria on the gram stain;




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