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Lower limb cellulitis

Definition and Epidemiology

  • Cellulitis is a common bacterial skin infection involving the deeper layers of the skin and subcutaneous tissues.
  • Lower limbs are frequently affected.
  • Common in all age groups but higher incidence in elderly and immunocompromised individuals.

Pathophysiology

  • Typically caused by Streptococcus and Staphylococcus species, including MRSA.
  • The bacteria enter through breaks in the skin (cuts, abrasions, ulcers, athlete’s foot).
  • Risk factors include skin breaches, lymphoedema, obesity, diabetes, and chronic venous insufficiency.

Clinical Features

  • Acute onset of erythema, swelling, warmth, and tenderness of the affected area.
  • Systemic symptoms may include fever, chills, and malaise.
  • Skin may appear tight, glossy, and blistered in severe cases.
  • Lymphangitis and regional lymphadenopathy may be present.

Diagnosis

  • Primarily clinical, based on history and examination.
  • Laboratory tests (CBC, CRP, ESR) may show raised inflammatory markers.
  • Blood cultures and swabs from any open wounds to identify causative organisms, particularly in severe or recurrent cases.

Management

  • Mild to Moderate Cases:
    • Oral antibiotics (e.g., flucloxacillin, or erythromycin/clindamycin for penicillin-allergic patients).
    • Elevating the affected limb and analgesia for symptom relief.
  • Severe Cases:
    • Intravenous antibiotics (e.g., IV flucloxacillin, or vancomycin in cases of suspected MRSA).
    • Consider hospital admission for systemic symptoms or rapid progression.
  • Recurrent Cellulitis:
    • May require prophylactic antibiotics.
    • Address underlying risk factors (e.g., skin care, compression therapy for oedema).

Complications

  • Abscess formation, necrotising fasciitis, sepsis.
  • Chronic lymphoedema due to damage of lymphatic vessels.
  • Recurrent episodes, particularly in individuals with chronic risk factors.

Prognosis

  • Generally good with appropriate antibiotic treatment.
  • Chronic or recurrent cellulitis may develop in patients with predisposing factors.

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