Cellulitis
Basics
Description
Description
- Acute, spreading erythematous superficial infection of skin and SC tissues:
- Nonpurulent SSTI (skin and soft tissue infection) = uncomplicated cellulitis
- Purulent SSTI = cellulitis with purulent component is covered in “Abscess”
- Extension into deeper tissues can result in necrotizing soft tissue infection
- Progressive spread of erythema, warmth, pain, and tenderness
- Predisposing factors:
- Lymphedema
- Tinea pedis or other toe web abnormalities
- Open wounds
- Pre-existing skin lesion (furuncle)
- Prior trauma or surgery
- Retained foreign body
- Vascular or immune compromise
- Injection drug use
- Recurrent SSTI
Etiology
Etiology
- Uncomplicated cellulitis (nonpurulent SSTI):
- Group A streptococci
- Methicillin-sensitive Staphylococcus aureus (MSSA)
- Methicillin-resistant S. aureus (MRSA)
- Risk factors for Staph infection (MSSA and MRSA):
- Recent hospital or long-term care admission
- Recent surgery
- Children
- Soldiers
- Incarcerated persons
- Athletes in contact sports
- Injection drug use
- Men who have sex with men
- Dialysis treatments and catheters
- History of penetrating trauma
- Additional risk factors for MRSA infection:
- Prior MRSA infection
- MRSA colonization
- Area of high MRSA incidence
- Close contact with MRSA patient
- Extremity cellulitis after lymphatic disruption:
- Nongroup A β-hemolytic streptococci (groups C, B, G)
- Cellulitis in diabetics:
- Can be polymicrobial with S. aureus, streptococci, gram-negative bacteria, and anaerobes, especially when associated with skin ulcers
- Periorbital cellulitis:
- Strep and Staph
- Buccal cellulitis:
- Polymicrobial with anaerobic oral flora, associated with intraoral laceration or dental abscess
- Less common causes:
- Clostridia
- Anthrax
- Pasteurella multocida – common after cat and dog bites
- Eikenella corrodens – human bites
- Pseudomonas aeruginosa:
- Hot-tub folliculitis – self-limited
- Foot puncture wound
- Ecthyma gangrenosum in neutropenic patients
- Erysipelothrix species – saltwater fish, poultry, meat, or hide handlers
- Aeromonas hydrophila – freshwater swimming
- Vibrio species – seawater or raw seafood
Pediatric Considerations
- Facial cellulitis in children:
- Streptococcus pneumoniae
- H. influenzae type B, although incidence significantly declining since introduction of HIB vaccine
- Perianal cellulitis:
- Group A streptococci
- Associated or antecedent pharyngitis or impetigo
- Neonates:
- Group B streptococci
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Citation
Schaider, Jeffrey J., et al., editors. "Cellulitis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307045/all/Cellulitis.
Cellulitis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307045/all/Cellulitis. Accessed December 9, 2024.
Cellulitis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307045/all/Cellulitis
Cellulitis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307045/all/Cellulitis.
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