Tuesday, December 25, 2012

Arm Cellulitis images



Dermatlas



See extensive images on skin infections and conditions:

Skinsight



This image comes from an excellent site for information on lymphedema.  Cellulitis can result in damage to the lymphatics, thus triggering what is referred to as secondary lymphedema.

Lymphedema Therapy

see also:  Arm Lymphedema



MRSA Abscess and Surrounding Cellulitis in Right Arm of Patient


Washington.edu





Cellulitis

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Tuesday, September 11, 2012

Cellulitis--epidemiological and clinical characteristics.


Cellulitis--epidemiological and clinical characteristics.


2012


Source

Clinic for Infectious Diseases, Clinical Center of University of Sarajevo, Bosnia and Herzegovina. melica74@gmail.com

Abstract


INTRODUCTION: 

Cellulitis is acute skin infection and/or infection of subcutaneous tissue, mostly caused by Streptococcus pyogenes and Staphylococcus aureus. Clinical preview is usually obvious and enough for diagnosis. Tretment is antimicrobial therapy. In recurrent cases a prophylaxis is very often needed.





OBJECTIVES:

Analysis some of the epidemiological and clinical characteristics of cellulitis.

PATIENTS AND METHODS:

Retrospective analysis of medical documentation of patients with clinical preview of cellulitiswho were hospitalized in Clinic for infective diseases of Clinical Center of University of Sarajevo in last three years.

RESULTS:

In period of three years 123 patients were hospitalized with clinical preview of cellulitis in the broadest sense of the word. In 123 of cellulitises, 35/123 (28.45%) were erisipelases-superficial type and 88/123 (71,55%) were deep cellulitises. Men were more affected 56,09%, average of age was 50.22 years. Before hospitalization patients had ambulance treatment in average of 5.12 days, and hospitalization was long in average of 13.33 days. Risk factors wich contributes to the disease were found in 71.54% of cases. Due to localisation, skin disorders on lower limb were the most frequent 71.56%,cellulitis of upper limb were found in 12.19%, head and/or neck in 13.08%, trunk in 3.25%. Repetition of disease were found in 4.8% in patients wtih risk factors. Bacteremic isolats were confirmed in 27.64% of cases. In all patients empirical antibiotic treatment were started, in the 62.60% the first choice of medicine was antibiotic from the group of lincosamides.

CONCLUSION:

Cellulitis is very serious disease that can be prevented.

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Monday, March 12, 2012

Variability of antimicrobial prescribing in patients with acute cellulitis.

Variability of antimicrobial prescribing in patients with acute cellulitis.


Mar 2012

Source

Acute Medical Unit, York Teaching Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK.

Abstract


PURPOSE:

Clinical guidelines concerning treatment of infection are incorporated into prescribing formularies and antimicrobial stewardship policies. The extent to which these influence prescribing is uncertain. In this study, we sought to examine antimicrobial prescribing patterns in patients with cellulitis.


METHODS:

Consecutive adults admitted to hospital due to acute cellulitis between 2008 and 2010 were studied. Data collected were clinical and laboratory markers of sepsis, antimicrobial agent, route of administration, number of i.v. dosages, duration of antimicrobial treatment, and hospital length of stay. Three groups were defined by prescribing that was (i) identical to formulary, (ii) modified appropriately due to microbiological data or prior drug allergy, and (iii) nonformulary prescribing. Comparisons were made between groups using Mann-Whitney tests.


RESULTS:

There were 306 patients: 167 men (54.6%), median age 66 (range 18-100) years. Prescribing was consistent with formulary recommendations in 253 (82.7%), modified appropriately in 24 (7.8%), and nonformulary in 29 (9.5%). Median [interquartile range (IQR)] duration of hospital stay was 5 (3-8), 7 (5-9, P = 0.026), and 7 (5-14, P = 0.0006) days, and overall duration of antimicrobial therapy was 12 (9-16), 13 (8-15), and 15 (12-19, P = 0.0479) days, respectively. No differences were observed in clinical or laboratory markers of sepsis.


CONCLUSIONS:

Prescribing patterns accorded with prevailing guidelines in the majority of patients. Nonetheless, there was nonformulary prescribing in 10% of patients, and this could not be explained by clinical or laboratory measures of disease severity. Further work is needed to explore the factors that contribute to nonformulary prescribing in this group of patients.


SpringerLink

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Sunday, October 11, 2009

How Cracked heels can let killer bacteria invade your body

How Cracked heels can let killer bacteria
invade your body


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 .


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

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Saturday, December 15, 2007

Approach to the patient with presumed cellulitis.

Approach to the patient with presumed cellulitis.

Semin Cutan Med Surg. 2007

Kroshinsky D, Grossman ME, Fox LP.
Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY.


Dermatologists frequently are consulted in the evaluation and management of the patient with cellulitic-appearing skin. For routine cellulitis, the clinical presentation and patient symptoms are usually sufficient for an accurate diagnosis. However, when the clinical presentation is somewhat atypical, or if the patient fails to respond to appropriate therapy for cellulitis because of routine bacterial pathogens, the differential diagnosis should be rapidly expanded. We discuss the approach to the patient with presumed cellulitis, with an emphasis on the differential diagnosis of cellulitis in both the immunocompetent and immunucompromised patient.

PMID: 18070684 [PubMed - in process]

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Saturday, November 10, 2007

Defining Cellulitis

Defining Cellulitis

Skinmed. 2007 Nov-Dec

Lawrence Charles Parish, MD; Joseph A. Witkowski, MD

Exactly what does cellulitis mean? How many consultation requests state that the patient has cellulitis, when, in fact, it was stasis dermatitis from which the patient suffered? Leider and Rosenblum, 1 considered the 20th-century lexicographers for dermatology, wrote:

Cellulitis literally means inflammation (-itis) of the little cells (cellul-). What is really meant, of course, is diffuse inflammation of parenchyma without necrosis or sharp localization of pus.

The definition given by the Microsoft Word dictionary is less precise but more limiting as describing cellulitis as “infection and inflammation of the tissues beneath the skin.”We have traditionally considered cellulitis to be inflammation in the dermis with both redness and induration present. No purulent opening can be seen; when there is a portal for pus, a furuncle or boil would be the diagnosis.

Cellulitis and Erysipelas

The terms cellulitis and erysipelas connote a diffusely spreading bacterial infection, excluding such walled-off lesions as the abscess, furuncle, and carbuncle (ie, not a boil). The pathology of erysipelas ( Figure 1 ) should be limited to the upper portions of the dermis, while cellulitis ( Figure 2 , Figure 3 ) seeks the lower portions of the dermis and the subcutaneous tissue. Because the clinical pictures often blend, many Northern European physicians use the term erysipelas to include both erysipelas and cellulitis. Unfortunately, both terms get bantered about in the United States, creating a continuing state of confusion. There seems to be a movement to discard the concept of erysipelas entirely. 2–5

Both conditions represent the results of pyogenic infections due to such bacterium as β-hemolytic streptococcus, group A, B, C, or G. Sometimes Staphyloccocus aureus is implicated in cellulitis, while Haemophilus influenzae type b can cause childhood cellulitis. Rarer causes of cellulitis include Aeromonas hydrophila, 6 Vibrio alginolyticus, 7 and Pasteurella multocida. 8 Erysipelas, once called phlegmona diffusa, and cellulitis can develop due to Pseudomonas aeruginosa, Streptococcus pneumoniae, Serratia marcescens, 9 and Campylobacter jejuni, particularly in immunocompromised patients.

Clinical manifestations can include tenderness and malaise with the addition of chills and/or fever. There can be induration and pitting edema as a result of the rapid spread of the infection. Lymphangitis may also appear in the vicinity of the erythema. Chronic attacks of cellulitis may lead to elephantiasis. 10

Dissecting cellulitis, also known by the more cumbersome term perifollicutis capitis abscedens et suffodiens ( Figure 4 ), only partially meets the criteria for cellulitis. While there is induration, erythema, and edema, there are also accompanying pustular openings and subsequent crusting.

Nonbacterial Cellulitis

If the definition of cellulitis denotes bacterial origin, then several diseases are as misnamed as is pyogenic granuloma, which has no overt bacterial origin. These include recurrent preseptal cellulitis, which appears to be a factitial entity not due to bacteria, and breast cellulitis, also called isolated erythema of the breast, that does not have a bacterial cause. 11 Cervical carcinoma may metastasize to the skin, producing red induration, at which point it is termed cellulitis-like cutaneous metastasis. To add to the confusion, eosinophilic cellulitis, also called Wells syndrome, has a cellulitic component without bacteria being involved 12 ; sometimes a viral etiology is even suggested.

Unnecessary Confusion

A clinical presentation of erythema and induration may be found in both stasis dermatitis, for example, and cellulitis. Because these signs are present, this does not make the cutaneous findings of venous insufficiency an infectious disease. Similarly, oozing and crusting superimposed on dusky, erythematous skin suggest bacterial superinfection, but they do not create the picture of cellulitis ( Figure 5 ).

Conclusions

Cellulitis is a specific sign with recognized etiologies. The word should not have its meaning diluted by extensions of its definition, nor should cellulitis be used inappropriately.

Clinical manifestations can include tenderness and malaise with the addition of chills and/or fever. There can be induration and pitting edema as a result of the rapid spread of the infection. Lymphangitis may also appear in the vicinity of the erythema. Chronic attacks of cellulitis may lead to elephantiasis.
10

Dissecting cellulitis, also known by the more cumbersome term perifollicutis capitis abscedens et suffodiens ( Figure 4 ), only partially meets the criteria for cellulitis. While there is induration, erythema, and edema, there are also accompanying pustular openings and subsequent crusting.

Nonbacterial Cellulitis


If the definition of cellulitis denotes bacterial origin, then several diseases are as misnamed as is pyogenic granuloma, which has no overt bacterial origin. These include recurrent preseptal cellulitis, which appears to be a factitial entity not due to bacteria, and breast cellulitis, also called isolated erythema of the breast, that does not have a bacterial cause. 11 Cervical carcinoma may metastasize to the skin, producing red induration, at which point it is termed cellulitis-like cutaneous metastasis. To add to the confusion, eosinophilic cellulitis, also called Wells syndrome, has a cellulitic component without bacteria being involved 12 ; sometimes a viral etiology is even suggested.

Unnecessary Confusion


A clinical presentation of erythema and induration may be found in both stasis dermatitis, for example, and cellulitis. Because these signs are present, this does not make the cutaneous findings of venous insufficiency an infectious disease. Similarly, oozing and crusting superimposed on dusky, erythematous skin suggest bacterial superinfection, but they do not create the picture of cellulitis (
Figure 5 ).

Conclusions


Cellulitis is a specific sign with recognized etiologies. The word should not have its meaning diluted by extensions of its definition, nor should cellulitis be used inappropriately.

References


1 Leider M, Rosenblum M. A Dictionary of Dermatological Words, Terms and Phrases. New York, NY: McGraw-Hill; 1968.
2 Grosshans EM. The red face: erysipelas. Clin Dermatol. 1993;11:307–313.
3 Lazzarini L, Conti E, Tositti G, et al. Erysipelas and cellulitis: clinical and microbiological spectrum in an Italian tertiary care hospital. J Infect. 2005;51:383–389.
4 Parish LC, Jungkind DL. Systemic antimicrobial therapy for skin and skin structure infections: comparison of fleroxacin and ceftazidime. Am J Med. 1993;94:166S–173S.
5 Witkowski JA, Parish LC. Bacterial skin infections: management of common streptococcal and stapylococcal lesions. Postgrad Med. 1982;72:166–168, 171–173, 176–178 passim.
6 Mathur MN, Patrick WG, Unsworth IP, et al. Cellulitis owing to Aeromonas hydrophilia: treatment with hyperbaric oxygen. Aust N Z J Surg. 1995;65:367–369.
7 Lee SY, Chuang YC, Young CD. Extensive cellulitis with septic shock caused by Vibrio vulnificus infection-a case report with review of literature. Kansenshogaku Zasshi. 1991;65:1484–1487.
8 Bradaric N, Milas I, Luksic B, et al. Erysipelas-like cellulitis with Pasteurella multocida bacteremia after a cat bite. Croat Med J. 2000;41:446–449.
9 Bornstein PF, Ditto AM, Noskin GA. Serratia marcescens cellulitis in a patient on hemodialysis. Am J Nephrol. 1992;12:374–376.
10 Bonnetblanc JM, Bedane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003;4:157–163.
11 Miller SR, Mondry T, Reed JS, et al. Delayed cellulitis associated with conservative therapy for breast cancer. J Surg Oncol. 1998;67:242–245.
12 Chung CL, Cusack CA. Wells syndrome: an enigmatic and therapeutically challenging disease. J Drugs Dermatol. 2006;5:908–911.

SKINmed: Dermatology for the Clinician. 6;6:261-263 (November/December 2007)


LeJacq

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