Clinical
Presentation
the physical examination
should first focus on the area of concern. Nonpurulent cellulitis is associated
with 4 cardinal signs of infection: erythema, pain, swelling, and warmth.
Several physical examination findings may help the clinician identify the most
likely pathogen and assess the severity of the infection, thereby facilitating
appropriate treatment. Those findings include the following:
·
The involved
site(s)is/are red, hot, swollen, and tender
·
Regional lymphadenopathy
is present
·
Malaise, chills, fever,
and toxicity are present
Cellulitis characterized by
violaceous color and bullae suggests more serious or systemic infection with
organisms such as V. vulnificus
·
Lymphangitic spread (red
lines streaking away from the area of infection), crepitus, and hemodynamic
instability are indications of severe infection, requiring more aggressive
treatment
signs/symptoms of potentially severe deep
soft-tissue infection (Note: these frequently appear later in the course of
necrotizing infections), which necessitate emergent surgical evaluation[2] :
·
Violaceous bullae
·
Cutaneous hemorrhage
·
Skin sloughing
·
Skin anesthesia
·
Rapid progression
·
Gas in the tissue
Generally, no workup is
required in uncomplicated cases of cellulitis that meet the following criteria:
·
Limited area of
involvement
·
Minimal pain
·
No systemic signs of
illness (eg, fever, chills, dehydration, altered mental status, tachypnea,
tachycardia, hypotension)
·
No risk factors for
serious illness (eg, extremes of age, general debility, immunocompromised
status)
- In mild cases of cellulitis
treated on an outpatient basis, dicloxacillin, amoxicillin, and cephalexin
are all reasonable choices
- Clindamycin or a macrolide
(clarithromycin or azithromycin) are reasonable alternatives in patients
who are allergic to penicillin
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