The risk of cellulitis in cirrhotic patients: a nationwide population-based study in taiwan.

Oct 2012

Lin MN, Tsai CC, Hung TH, Tsai CC.

Source

Department of Family Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan. ; Tzu Chi University School of Medicine, Chiayi, Taiwan.

Abstract

BACKGROUND/AIMS:

Cellulitis is a common infectious disease. However, the risk of cellulitis in cirrhotic patients is not well established, and whether liver cirrhosis is a risk factor for cellulitis remains unknown. This study evaluated the relationship between cellulitis and liver cirrhosis.

METHODS:

The National Health Insurance Database, which was derived from the Taiwan National Health Insurance program, was used to identify patients. The study group consisted of 39,966 patients with liver cirrhosis, and the comparison group consisted of 39,701 randomly selected age- and sex-matched patients.

RESULTS:

During the 3-year follow-up period, 2,674 (6.7%) patients with liver cirrhosis developed cellulitis, and 1,587 (4.0%) patients without liver cirrhosis developed cellulitis. Following a Cox's regression analysis adjusted for age, sex, and underlying medical disorders, the cirrhotic patients demonstrated a greater risk for the occurrence of cellulitis than the non-cirrhotic patients during the 3-year period (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.55 to 1.77; Additionally, cirrhotic patients with complications also had a greater risk for the occurrence of cellulitis than those patients without complications (HR, 1.23; 95% CI, 1.14 to 1.33; ).

CONCLUSIONS:

We conclude that cirrhotic patients have a greater risk of cellulitis than non-cirrhotic patients.

NIH

Dermatitis and Cellulitis in Leopard Geckos (Eublepharis macularius) Caused by the Chrysosporium Anamorph of Nannizziopsis vriesii.

Nov 2012

Toplon DE, Terrell SP, Sigler L, Jacobson ER.

Source

College of Veterinary Medicine, Veterinary Medical Hospitals, Gainesville, Florida.

Abstract

An epizootic of ulcerative to nodular ventral dermatitis was observed in a large breeding colony of 8-month to 5-year-old leopard geckos (Eublepharis macularius) of both sexes. Two representative mature male geckos were euthanized for diagnostic necropsy. The Chrysosporium anamorph of Nannizziopsis vriesii (CANV) was isolated from the skin lesions, and identification was confirmed by sequencing of the internal transcribed spacer region of the rRNA gene. Histopathology revealed multifocal to coalescing dermal and subcutaneous heterophilic granulomas that contained septate fungal hyphae. There was also multifocal epidermal hyperplasia with hyperkeratosis, and similar hyphae were present within the stratum corneum, occasionally with terminal chains of arthroconidia consistent with the CANV. In one case, there was focal extension of granulomatous inflammation into the underlying masseter muscle. This is the first report of dermatitis and cellulitis due to the CANV in leopard geckos.

PubMed

Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit.

Nov 2012

Volz KA, Canham L, Kaplan E, Sanchez LD, Shapiro NI, Grossman SA.

Source

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. Electronic address: kvolz@bidmc.harvard.edu.

Abstract

BACKGROUND: 

Emergency department observation units (EDOU) are often used for patients with cellulitis to provide intravenous antibiotics followed by a transition to an oral regimen for discharge. Because institutional regulations typically limit EDOU stays to 24 hours, patients lacking a clinical response within this period will often be subsequently admitted to the hospital for further treatment.

OBJECTIVE:

 The aim of this study was to determine the rate of hospital admission and characteristics predictive of admission in patients with cellulitis who are initially placed in an ED observation unit.

METHODS:

A retrospective cohort study of patients placed into EDOU with a diagnosis of skin infection was conducted. Age, sex, history of diabetes mellitus, immunosuppression, intravenous drug use, location of cellulitis, presence of abscess, laboratory infectious markers, vital signs, and outpatient antibiotic treatment were recorded. The primary outcome was a hospital admission due to failure to respond to treatment within the 24-hour observation time window. Significant variables on univariate analysis were used to create a multivariate analysis, which identified predictive characteristics.

RESULTS:

 Four hundred six patient charts were reviewed, with 377 meeting inclusion criteria; the inpatient admission rate from EDOU was 29.2%. Using logistic regression techniques, we created a model of independent predictors for need of admission after 24 hours: cellulitis of the hand (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.9), measured temperature higher than 100.4°F (OR, 2.5; 95% CI, 1.1-5.5), and lactate greater than 2 (OR, 3.1; 95% CI, 1.3-7.3) were predictive of failure of ED observation.

CONCLUSIONS:

 Patients with cellulitis placed into ED observation status were more likely to fail an observation trial if they had an objective fever in the ED, an elevated lactate, or a cellulitis that involved the hand.

PubMed

Recurrent Helicobacter cinaedi Cellulitis and Bacteremia in a Patient with Systemic Lupus Erythematosus.

2012

Kikuchi H, Asako K, Tansho S, Ueda T, Koshio O, Ubagai T, Asahara M, Kawakami S, Ono Y.

Source

Department of Microbiology and Immunology, Teikyo University School of Medicine, Japan.

Abstract

A 31-year-old woman who had developed systemic lupus erythematosus at 17 years of age was admitted to the hospital for suspected cellulitis in the lower extremities. A blood culture performed upon admission to the hospital detected Helicobacter cinaedi (H. cinaedi), which was also isolated in blood and fecal cultures obtained on the 42nd hospital day. Bacterial translocation of H. cinaedi present in the intestines may have led to the development of recurrent bacteremia and cellulitis. In cases such as this, appropriate antibiotics therapy might be needed for more than one month. Moreover, H. cinaedi, a cause of emerging infections, requires a long period of time to grow; therefore it is important to extend the culture duration when the presence of this bacterium is suspected.

Internal Medicine

Tuberculous cellulitis in a patient with chronic kidney disease and polymyalgia rheumatica.

Nov 2012

Daido-Horiuchi Y, Kikuchi Y, Kobayashi S, Fujii T, Oshima S, Kondo T.

Source

Department of Internal Medicine, Mishuku Hospital, Japan.

Abstract

An 89-year-old man with advanced renal failure, polymyalgia rheumatica and a past history of tuberculosis was admitted with a high fever. Erythema and swelling appeared in the femoral region. Since the cellulitis failed to respond to antibiotic therapy, a skin biopsy was performed. The specimen showed the presence of epithelioid cell granuloma and panniculitis. Acid-fast organisms were found on Ziehl-Neelsen staining. A polymerase chain reaction test of tuberculosis was positive. Although a diagnosis of miliary tuberculosis was suggested, examinations of a bone marrow biopsy and fundoscopy revealed normal results. The patient's symptoms improved following treatment with isoniazid, rifampicin and ethambutol. This case represents an unusual presentation of tuberculous cellulitis in an immunocompromised patient.

Internal Medicine

Ambient Ozone and Emergency Department Visits for Cellulitis

Mieczysław Szyszkowicz,^1,* Eugeniusz Porada,¹ Gilaad G. Kaplan,² and Brian H. Rowe^3,4

Author information ► Article notes ► Copyright and License information ►

Objectives were to assess and estimate an association between exposure to ground-level ozone and emergency department (ED) visits for cellulitis. All ED visits for cellulitis in Edmonton, Canada, in the period April 1992–March 2002 (N = 69,547) were examined. Case-crossover design was applied to estimate odds ratio (OR, and 95% confidence interval) per one interquartile range (IQR) increase in ozone concentration (IQR = 14.0 ppb). Delay of ED visit relating to exposure was probed using 0- to 5-day exposure lags. For all patients in the all months (January–December) and lags 0 to 2 days, OR = 1.05 (1.02, 1.07). For male patients during the cold months (October–March): OR = 1.05 (1.02, 1.09) for lags 0 and 2 and OR = 1.06 (1.02, 1.10) for lag 3. For female patients in the warm months (April–September): OR = 1.12 (1.06, 1.18) for lags 1 and 2. Cellulitis developing on uncovered (more exposed) skin was analyzed separately, observed effects being stronger. Cellulitis may be associated with exposure to ambient ground level ozone; the exposure may facilitate cellulitis infection and aggravate acute symptoms.

NIH

Risk Factors for Community-associated Methicillin-resistant Staphylococcus Aureus Cellulitis - and the Value of Recognition

Objectives

To identify the risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) cellulitis.

Methods

A review of risk factors for CA-MRSA skin and soft tissue infection in previously published literature was first performed. A retrospective cohort study was then conducted in a teaching ambulatory-care clinic of a tertiary medical center in Honolulu, Hawai‘i.

Results

Of 137 cases with cellulitis diagnosed from January 2005 to December 2007, MRSA was recovered from 85 (62%) of patients who presented with either abscesses or skin ulcers. The recovery of MRSA was significantly associated with obesity (p=0.01), presence of abscesses (p=0.01), and lesions involving the head and neck (p=0.04). Independent risk factors by multivariate logistic regression analysis included the presence of abscesses [adjusted odds ratio (aOR) 2.72; 95% confidence interval (CI) 1.27–5.83; p=0.01] and obesity (aOR 2.33; 95% CI 1.10–4.97; p =0.03). Patients with CA-MRSA were less likely to receive an appropriate antibiotic (p=0.04) and were more likely to require antibiotic change at evaluation in one week (p=0.04) compared with patients infected with non-MRSA bacteria.

Conclusions

The presence of abscesses and obesity were significantly associated with CA-MRSA cellulitis. Empiric therapy with antibiotics active against MRSA should be guided by these risk factors.

NIH

Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the U.K. Dermatology Clinical Trials Network’s PATCH II trial

2012

U.K Dermatology Clinical Trials Network's PATCH Trial Team

Background

Cellulitis (erysipelas) of the leg is a common, painful infection of the skin and underlying tissue. Repeat episodes are frequent, cause significant morbidity and result in high health service costs.

Objectives

To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes.

Methods

Double-blind, randomized controlled trial including patients recently treated for an episode of leg cellulitis. Recruitment took place in 20 hospitals. Randomization was by computer-generated code, and treatments allocated by post from a central pharmacy. Participants were enrolled for a maximum of 3 years and received their randomized treatment for the first 6 months of this period.

Results

Participants (n = 123) were randomized (31% of target due to slow recruitment). The majority (79%) had suffered one episode of cellulitis on entry into the study. The primary outcome of time to recurrence of cellulitis included all randomized participants and was blinded to treatment allocation. The hazard ratio (HR) showed that treatment with penicillin reduced the risk of recurrence by 47% [HR 0·53, 95% confidence interval (CI) 0·26–1·07, P = 0·08]. In the penicillin V group 12/60 (20%) had a repeat episode compared with 21/63 (33%) in the placebo group. This equates to a number needed to treat (NNT) of eight participants in order to prevent one repeat episode of cellulitis [95% CI NNT(harm) 48 to ∞ to NNT(benefit) 3]. We found no difference between the two groups in the number of participants with oedema, ulceration or related adverse events.

Conclusions

Although this trial was limited by slow recruitment, and the result failed to achieve statistical significance, it provides the best evidence available to date for the prevention of recurrence of this debilitating condition.

Complete article:  NIH

Coexistence of dermal sinus tract, dermoid cyst, and encephalocele in a patient presenting with nasal cellulitis.

Nov 2012

Karandikar M, Yellon RF, Murdoch G, Greene S.

Source

Departments of Neurosurgery and.

Abstract

Dermoid cysts, encephaloceles, and dermal sinus tracts represent abnormalities that develop during the process of embryogenesis. The elucidation of the precise timing of formation for these malformations has remained elusive at the molecular level of study. Yet, clinical experience has demonstrated that these malformations do not all occur in the same patient, suggesting a shared pathway that goes awry at distinct points for different patients, resulting in 1 of the 3 malformations. Herein the authors describe a case in which all 3 malformations were present in a single patient. This is the first description in the English literature of a sincipital encephalocele occurring with a dermoid cyst and a dermal sinus tract.

PubMed

Nasty infection lands tourist in hospital

Nasty infection lands tourist in hospital

Oct 2012


A small pimple that festered with cellulitis cut a southern motorcycle tour short but the Australian tourists left Dunedin yesterday thankful for travel insurance and the advice to seek medical attention quickly.
Gold Coast resident Kay Henry said she and husband Jack had for three years planned a motorcycle trip around the deep South with two Dunedin friends.

When the couple, both in their early 60s, rented the three-wheeled motorcycle in Christchurch for their 12-day trip, Mrs Henry noticed a small spot on her upper left leg.

After a night in Fairlie, she stopped to swim in a Tekapo hot-pool and that night in Wanaka saw the spot was redder but believed rubbing from motorcycle leggings had created the irritation, Mrs Henry said.

However, when they reached Te Anau on Labour Day she began feeling hot and shivery despite her temperature being normal, she said.

The couple believed the sore was a spider bite and laughed at the irony of an Australian being bitten by a spider in New Zealand.

But fellow biker and friend Gordon Hunt, from Belleknowes, recognised the skin infection and urged prompt medical attention.

A Te Anau doctor confirmed it was cellulitis, prescribed oral antibiotics and they continued their holiday.

Despite some soreness, she felt fine, she said.

However, on Wednesday while visiting Cosy Nook, near Orepuki, the pain was "raging" so they headed for Southland Hospital in Invercargill, she said.

The doctor told her the motorcycling was over, gave her intravenous antibiotics and admitted her to hospital.

The next morning, a nurse cut each side of the hard white boil on her leg to release the "poison". But when it continued to fester, a doctor operated in the afternoon, she said.

She finally left hospital on Sunday and was driven to Dunedin.

She began bleeding again yesterday and was stitched up in Dunedin Hospital before flying to Christchurch. Mr Henry rode the motorcycle.

Their flight home to the Gold Coast today had been upgraded to business class so she could stretch out her leg, she said.

The couple had nearly forgone buying insurance because they were only travelling to New Zealand, she said.

"Thank God we did."

Mr Henry said he had never heard of cellulitis and was thankful Mr Hunt knew about the skin infection.

"If we hadn't had Gordon there to say 'don't muck around with this,' who knows what would have happened?"

Southern District Health Board vascular surgeon Andre van Rij said cellulitis was very common and very severe infections could cause kidney failure, the loss of affected limbs and death.

Some bacteria could spread very rapidly, within a few hours, Prof van Rij said.

Otago Daily News



What is cellulitis?

• A spreading bacterial infection of the skin and the tissue beneath.

• The bacteria enters small breaks in the skin but can occur in skin that is not obviously injured.

• Usually develops on the legs but can occur anywhere.

• Symptoms are redness, pain and tenderness of the skin.

• Infected skin becomes hot, slightly swollen and blisters with fluid may appear.

• Most people feel mildly ill with fever, chills, rapid heart rate, headache, low blood pressure and confusion.

Postoperative infections in obstetrics and gynecology.

Dec 2012

Jaiyeoba O.

Source

Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina.

Abstract

Postoperative infection is the most commonly seen complication of surgery in obstetrics and gynecology. The use of antibiotic prophylaxis has greatly decreased though not completely eliminated this adverse outcome. Postoperative infections include wound cellulitis, wound abscess, endomyometritis, pelvic cellulitis, and pelvic abscess. Infections usually manifest as fever and greater than normal postoperative pain. Refractory fevers maybe because of septic pelvic vein thrombophlebitis or maybe noninfectious in origin. Broad-spectrum antibiotics should be initiated as soon as possible when diagnosis of postoperative infection is made; most patients will respond to treatment within 24 to 48 hours when appropriate antibiotics are selected.

Clinical Obstetrics and Gynecology

Imaging in infections of the head and neck.

Nov 2012

Hegde AN, Mohan S, Pandya A, Shah GV.

Source

Department of Radiology, Singapore General Hospital, Block 4, Level 1, Outram Rd, Singapore 169608. Electronic address: amogh77@yahoo.co.in.

Abstract

Infections of the head and neck vary in their clinical course and outcome because of the diversity of organs and anatomic compartments involved. Imaging plays a central role in delineating the anatomic extent of the disease process, identifying the infection source, and detecting complications. The utility of imaging to differentiate between a solid phlegmonous mass and an abscess cannot be overemphasized. This review briefly describes and pictorially illustrates the typical imaging findings of some important head and neck infections, such as malignant otitis externa, otomastoiditis bacterial and fungal sinusitis, orbital cellulitis, sialadenitis, cervical lymphadenitis, and deep neck space infections.

Elsevier

Sonography first for subcutaneous abscess and cellulitis evaluation.

Sonography first for subcutaneous abscess and cellulitis evaluation.

Oct 2012

1. Srikar Adhikari, MD, RDMS and 
2. Michael Blaivas, MD

1. Author Affiliations

   1. Department of Emergency Medicine, University of Arizona Medical School, Tucson, Arizona USA (S.A.); and Department of Emergency Medicine, Northside Hospital Forsyth, Cumming, Georgia USA (M.B.).

   1. Address correspondence to Michael Blaivas, MD, Department of Emergency Medicine, Northside Hospital Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30040-1147 USA. E-mail:mike@blaivas.org
   Sonography is an ideal imaging modality for evaluation of pathologic soft tissue conditions. High resolution and the ability to perform dynamic testing such as compressing structures allow for accurate differentiation between potentially confusing physical findings. Traditionally, clinicians assumed that any area of the skin that was erythematous and showed swelling potentially harbored an abscess. Incision and drainage has long been the standard of care in such cases and was often used as a diagnostic procedure. However, studies have confirmed anecdotal clinical evidence that the physical examination is often incorrect. In fact, not only was incision and drainage being performed unnecessarily, in some cases, needed procedures were missed after failure to recognize the presence of an abscess. With the recent spread of sonography into clinical practice, multiple descriptions of point-of-care sonography use in suspected soft tissue infections have been published. Some have even noted that blind incision and drainage, once thought to be harmless, could lead to serious potential complications because not all red swollen structures should be cut with a scalpel. This article reviews clinical scenarios in which point-of-care soft tissue sonography is useful in suspected skin infections and describes pathologic findings and commonly accepted scanning approaches.
   Journal of Ultrasound

The use of ultrasonography in diagnosis and management of superficial fascial space infections.

May 2012

Mukhi PU, Mahindra UR.

Source

Department of Oral and Maxillofacial Surgery, S.M.B.T Dental College and Hospital, Amrutnagar, Sangamner, Maharashtra, India.

Abstract

Aims and Objectives: To evaluate the role of ultrasonography as a diagnostic aid to differentiate cellulitis from abscess; and efficacy of ultrasound-guided surgical drainage of superficial abscesses in the maxillofacial region. 

Materials and Methods: a total of 26 patients with acute facial swellings were included in the study. Clinical examination confirmed the presence of space infection. Ultrasonographic examination of the swelling was then performed. If ultrasound images showed no collection and only thickness of subcutaneous tissue and muscle involved were increased, then the diagnosis was made as cellulitis. When collection was identified, diagnosis was made as abscess. Dimensions of abscess cavity, amount of pus collected, and depth of the center of the abscess cavity from the skin surface were recorded. Pus evacuation was then prime consideration either by needle aspiration or by incision and drainage. The amount of collection recorded on ultrasonography was compared with that drained at the time of surgery. 

Results: of 26 patients, 14 patients were diagnosed with cellulitis and the remaining 12 patients with abscesses in the maxillofacial region. Five of 12 cases of abscess were managed with ultrasound-guided needle aspiration; rest seven cases underwent the incision and drainage procedure. Clinical specificity (69.23%) was found to be poorer than ultrasound specificity (100 %), both clinical and ultrasound showed the same percentage of sensitivity (92.30%) 

Conclusions: from our experience we can conclude that ultrasonography is an inexpensive and non-invasive diagnostic technique that should be used to supplement clinical examination in patients with superficial fascial space infection.

PubMed