W#15 Pathophysiology replies

POST # 1 DANIKA

The purpose of this initial post is to discuss the pathophysiology, common presenting symptoms, diagnosis, and treatment of cellulitis. Cellulitis is an acute infection of the dermis and subcutaneous layers of the skin frequently occurring in the lower extremities (VanMeter & Hubert, 2018). The condition can also be called erysipelas, but this term usually refers to superficial cellulitis of the face or extremities with lymphatic involvement (Sullivan & de Barra, 2018). Cellulitis occurs when bacteria break the skin barrier and enter the soft tissue (Spelman & Baddour, 2020). Gram positive cocci like Streptococcus spp and Staphylococcus aureus are the most common causes of cellulitis (Sullivan & de Barra, 2018). Predisposing factors include a skin barrier break (ulcer, wound, abrasion, insect bite, IV drug injection site), edema, obesity, and immunosuppression (Spelman & Baddour, 2020). Venous stasis, increased blood sugar, poor nutrition, and immunosuppression decrease wound healing. Common presenting symptoms include redness, swelling, pain, and heat at the affected area as the body’s immune response is activated (Sullivan & de Barra, 2018). Cellulitis may present with purulent drainage while erysipelas is nonpurulent. Both cellulitis and erysipelas are almost always unilateral. Systemic effects like fever, chills, and headache may be present (Spelman & Baddour, 2020). 

Diagnosis is based upon the previously mentioned clinical manifestations. If there is purulent drainage, a culture swab should be obtained to identify the bacteria (Spelman & Baddour, 2020). Antibiotic treatment is usually directed at Streptococcus spp and Staphylococcus aureus. A S. aureus infection is more likely to have pus (Sullivan & de Barra, 2018). Patients will be treated with empiric antibiotic therapy, most commonly oral cephalexin or IV cefazolin (Spelman & Baddour, 2019). Patients with systemic effects should receive IV antibiotic treatment (Spelman & Baddour, 2019). Spelman & Baddour (2019) note that worsening erythema might occur after antibiotic initiation and this is not to be confused with treatment failure. Increased local inflammation is due to the enzymes released by pathogens during destruction (Spelman & Baddour, 2019). It is important to optimize treatment by elevating the affected area and managing edema, blood sugar, and vascular disease (Sullivan & de Barra, 2018). 

Clinical Infectious Diseases has provided “Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America” and includes both screening and treatment guidelines (Stevens et al., 2014).

https://academic.oup.com/cid/article/59/2/e10/2895845

 References

Spelman, D., & Baddour, L. (2019). Cellulitis and skin abscess in adults: Treatment. Retrieved August 10, 2020, from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/cellulitis-and-skin-abscess-in-adults-treatment?search=cellulitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Spelman, D., & Baddour, L. (2020). Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis. Retrieved August 10, 2020, from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/cellulitis-and-skin-abscess-epidemiology-microbiology-clinical-manifestations-and-diagnosis?search=cellulitis

Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J., Gorbach, S. L., . . . Wade, J. C. (2014). Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 59(2), E10-E52. doi:10.1093/cid/ciu296

Sullivan, T., & de Barra, E. (2018). Diagnosis and management of cellulitis. Clinical medicine (London, England), 18(2), 160–163. https://doi.org/10.7861/clinmedicine.18-2-160