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Cellulitis is an inflammatory condition involving the deeper layers of the skin – dermis and subcutaneous tissue. It tends to almost always occur due to a bacterial infection. Cellulitis tends to arise in the periphery of the body, more commonly on the legs and less frequently in the arms. Most cases are associated with impaired immune defences and poor circulation. Although cellulitis is easily treated with antibiotics, it is a serious medical condition that can quickly progress and lead to complications and even death.
What causes cellulitis?
Causes of Cellulitis
The bacteria most commonly involved are streptococci and staphylococci. Cellulitis caused by methicillin-resistant Staphylococcus aureus (MRSA) may need more aggressive treatment. Less commonly, other types of bacteria such as Hemophilus influenzae, Pneumococcus, and Clostridium species may also cause cellulitis. Some of the bacteria responsible for cellulitis may be harmless strains normally present on the skin, in the nasal cavity or the mouth. Others may be transferred from the environment, water, or other contaminated objects. However, cellulitis is not contagious. Treatment of cellulitis is with antibiotics.
Risk Factors
Although cellulitis may develop following an injury to the skin or around a surgical wound, in some cases there may not be any apparent break in the skin. Microabrasions of the skin due to dry skin may also serve as an entry point for the bacteria causing cellulitis. Insect and spider bites can also transmit the bacteria.
Chronic edema or swelling of the leg and pre-existing skin conditions such as athlete’s foot, impetigo, or eczema may be risk factors for cellulitis. Similarly, conditions such as diabetes, obesity, chronic kidney disease, chronic liver disease, and pregnancy may be predisposing factors in the development of cellulitis. Immunocompromised individuals such as those with HIV/AIDS or on chemotherapy may be more likely to develop cellulitis. Injection of illicit drugs may lead to cellulitis.
What are the symptoms of cellulitis?
Signs and Symptoms of Cellulitis
The organisms responsible for cellulitis usually enter through a break in the skin. It reaches the deeper layers and multiply there, thus giving rise to symptoms of cellulitis. The typical features of inflammation may be seen in cellulitis, such as pain, warmth, redness and swelling of the affected area. The skin may be stretched and tight with a glossy appearance. Malaise, chills, fever and enlarged lymph nodes may be present.
Cellulitis may be complicated by abscess (accumulation of pus) formation. Blisters on the skin surface and abscess may be seen at the site. Long red streaks may indicate involvement of the lymphatic system. Cellulitis may be confused with erysipelas, which is a more superficial skin infection, with well-demarcated, slightly raised borders. It can occur in any part of the body but is most commonly seen on the lower leg and arms. Infection on the face may spread quickly and lead to meningitis, a very dangerous complication of cellulitis.
Picture of cellulitis of the leg from Wikimedia Commons
Complications of Cellulitis
If left untreated, cellulitis can lead to serious complications, particularly in patients with diabetes, cancer, and those with decreased immunological status. Complications may include blood or bone infections, shock, meningitis, lymphangitis, endocarditis and gangrene.
How is cellulitis diagnosed?
Diagnosis of Cellulitis
The clinical history and physical examination will usually point to the diagnosis. Tests may include a :
- Complete blood count (CBC)
- Blood culture
- Culture of fluid or pus drained from the affected area
How is cellulitis treated?
Treatment of Cellulitis
Appropriate antibiotics may be given orally or by intravenous injection. Treatment for 7 to 10 days usually ensures total recovery. Longer treatment may be necessary if the condition is very severe and in immunocompromised individuals. Drainage of the abscess, if present, is usually necessary.
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