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PubMed2006

Dissecting cellulitis treated with the long-pulsed Nd:YAG laser.

BACKGROUND: Dissecting cellulitis is a chronic inflammatory scalp condition characterized by pustular nodules, sinus tract formation, and resultant cicatricial alopecia. Current treatments are of limited efficacy. OBJECTIVE: This report explored treating dissecting cellulitis with the long-pulsed Nd:YAG laser to determine the capabilities and limitations of this modality with respect to: (1) reducing pus formation; (2) enabling the termination of systemic treatments; (3) investigating the side-effect profile including dyspigmentation and scarring alopecia; and (4) terminating the disease process. METHODS: This observational study followed four patients with long-standing dissecting cellulitis through consecutive treatments with the long-pulsed Nd:YAG laser without epidermal cooling. RESULTS: One year after initiating laser treatment, patients achieved decreased pus formation, a reduced reliance on systemic treatments, and a controlled or terminated disease process without dyspigmentation. Three patients had regrowth of terminal hairs in treatment sites. CONCLUSION: The long-pulsed Nd:YAG laser is effective in attenuating the progression of dissecting cellulitis without appreciable adverse cutaneous side effects. This is a pilot study, and more patients must be treated in other trials to verify these findings.

Adult↗
PubMed1996

Escherichia coli cellulitis in broiler chickens: clonal relationships among strains and analysis of virulence-associated factors of isolates from diseased birds.

Thirty-nine Escherichia coli isolates from broiler chickens with cellulitis were serotyped and analyzed for clonal relationships by multilocus enzyme electrophoresis. The isolates were further characterized with respect to hemagglutination (HA); serum resistance; antibiotic susceptibility; production of aerobactin, colicin V, and hemolysin; expression of K1 or K5 capsule; sensitivity to cloacin DF13 after treatment with diphenylamine; expression of iron-regulated outer membrane proteins; and virulence in 1-day-old chickens. In addition, the isolates were examined for the presence of DNA sequences related to F1A (fim) and P (pap) fimbriae, aerobactin synthesis (iuc) and transport (iut), hemolysin operon hly, and TraT lipoprotein-induced serum resistance (traT). Only 38.4% of the isolates were typeable with standard O antisera, and of these, serogroups O25 and O78 were the most frequently observed. Multilocus enzyme electrophoresis, based on 20 enzymes, resolved 17 electrophoretic types, forming seven clusters. Isolates from four of these clusters fell into E. coli clone complexes that have been previously reported to be commonly associated with avian colibacillosis. All isolates expressed two to five iron-regulated outer membrane proteins, were resistant to serum and cloacin DF13, and possessed DNA sequences homologous to fim and iuc/iut. Most isolates (72%) were positive for traT, and a majority produced colicin V and aerobactin (92 and 82%, respectively). Assays for the presence of fim and pap DNA sequences, for HA, and for virulence gave variable results but suggest that cellulitis isolates may express F1A and/or other mannose-resistant HA fimbriae different from P and may be virulent in 1-day-old chickens. Our results support the hypothesis that cellulitis in broilers in many cases is caused by E. coli clones identical to other pathogenic avian E. coli strains. Certain clones may be specific to cellulitis, because 25% of the isolates tested belong to clusters not related to known clone complexes.

Animals↗
PubMed1997

Murine model of recurrent group G streptococcal cellulitis: no evidence of protective immunity.

Despite the well-known tendency of cellulitis due to beta-hemolytic streptococci to recur, little is known regarding the mechanisms of human immunity to this infection. We established cellulitis in mice by using a strain of group G streptococcus (1750) originally isolated from the bloodstream of a patient with acute cellulitis. This strain, which has been studied extensively in our laboratory, expresses M protein structurally and functionally analogous to that of group A streptococci, and we have cloned and sequenced the gene encoding this protein (emmMG1). Mice injected with 5 x 10(7) CFU of strain 1750 developed nonlethal necrotic skin and soft tissue infections that healed spontaneously after 14 to 16 days. After healing, the mice were repetitively reinoculated three times with the same challenge dose of 1750. Lesion size did not decrease in severity, size, or time to healing after repetitive challenge. The maximum lesion size and tissue concentration of microorganisms increased between the first and fourth challenges. Pretreatment of 1750 cells with opsonic antisera to MG1 diminished neither the maximum lesion size nor the time course of evolution of the lesions. Thus, in the mouse model used here, there was no evidence of acquired protective immunity to experimentally induced cellulitis.

Animals↗
PubMed2003

Dilemmas when managing cellulitis.

Cellulitis is commonly seen in primary care. It is also a common reason for hospital admission accounting, for example, for around 3% of emergency medical consultations at one UK district general hospital. Here, we review the management of cellulitis, and try to resolve some common dilemmas: whether a patient with cellulitis should be treated in hospital; which antibacterial to use; whether it should be given orally or parenterally; and whether patients with recurrent cellulitis should take prophylactic antibacterials.

Anti-Bacterial Agents↗
PubMed2005

Emergency department management of home intravenous antibiotic therapy for cellulitis.

OBJECTIVES: To evaluate the safety and efficacy of using intravenous cephazolin as a first line antibiotic for the treatment of cellulitis in a supervised outpatient programme. METHODS: This study was a retrospective analysis and included all patients who attended the emergency department (ED) of a university affiliated hospital in Sydney over the period of 1 year and who satisfied the following inclusion criteria: (a) age >16 years, (b) presented with acute cellulitis, and (c) were suitable for home intravenous antibiotic therapy according to APAC guidelines. RESULTS: In total, 124 patients were included, of whom 53 (42.7%) presented directly to the ED and 71 (57.3%) were referred by their general practitioner. Of these 124 patients, 75 (60.5%) were men and 49 (39.5%) were women. Age range was 16-97 years. There were 82 (66.2%) presentations of cellulitis of the lower limb, 30 (24.2%) of the upper limb, 9 (7.2%) of the face and 3 (2.4%) of the torso. Cephazolin 2 g twice daily was given to 123 (99.2%) of the patients, and one patient (0.8%) received ceftriaxone 2 g once daily. In total, 105 patients (84.7%) were treated successfully and 19 (15.3%) were re-admitted. Four of the unsuccessful treatment group required incision and drainage of abscesses. The mean duration of intravenous therapy was 6.24 days. One patient developed diarrhoea. There were no other complications attributable to therapy. CONCLUSION: Low re-admission rates verify the efficacy of cephazolin 2 g twice daily in treating cellulitis in the home environment. Benefits are multiple and include economic savings and reduced risk of nosocomial infection.

Adolescent↗
PubMed1991

Necrosis and sloughing of skin associated with limb cellulitis in four cows and a calf: predisposing causes, treatment and prognosis.

Four cows and a calf with non-suppurative limb cellulitis were observed subsequently to suffer skin necrosis and sloughing in the affected limbs, either on or distal to the metacarpus or metatarsus. In comparison with six cows with suppurative Corynebacterium pyogenes limb cellulitis, topical therapy or the cases with skin necrosis and sloughing was adequate and the prognosis was good, when compared with the rigorous systemic therapy applied to the cows with suppurative cellulitis, some of which died. The skin necrosis and sloughing resulting from limb cellulitis seemed to be encouraged by the paucity of tissue between the skin and the bone, by the poor vascularity of the area, and by the causative bacteria.

Administration, Topical↗
PubMed1994

MR imaging in acute infectious cellulitis.

PURPOSE: To describe magnetic resonance (MR) imaging findings in acute infectious cellulitis and assess its value for the diagnosis of severe necrotizing forms. MATERIALS AND METHODS: Spin-echo (SE) T1- and T2-weighted imaging was performed in 36 patients with acute infectious cellulitis. T1-weighted SE images obtained after injection of a paramagnetic contrast agent were also obtained when an abscess was suspected on precontrast images. Sixteen patients underwent surgical débridement, along with fascial and muscle biopsy. RESULTS: Distinct MR imaging features were found in patients with necrotizing soft-tissue infections, that is, hyperintense signal on T2-weighted images at the deep fasciae, poorly defined areas of hyperintense signal on T2-weighted images within muscles, and peripheral enhancement on contrast material-enhanced T1-weighted images. In nonnecrotizing cellulitis, signal intensity abnormalities were seen only in the subcutaneous fat. CONCLUSION: The precise extent of acute cellulitis and the presence of necrotizing soft-tissue infections can be determined with MR imaging, particularly on T2-weighted images.

Abdominal Muscles↗
PubMed1992

Serratia marcescens cellulitis in a patient on hemodialysis.

Serratia marcescens is an infrequent cause of cellulitis with only 5 reported cases. Four of the 5 patients were immunocompromised. Additionally, the cellulitis usually occurred at a site contiguous with a wound. We report a case of S. marcescens cellulitis in a patient with end-stage renal disease on chronic hemodialysis. The initial presentation was a soft tissue infection that progressed to septic shock. Ultimately, the patient responded to antibiotics and surgical debridement of infected tissue. This case serves as a reminder to consider infections due to gram-negative bacilli as a cause of cellulitis in immuno-compromised patients regardless of the presentation.

Abscess↗
PubMed2006

The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department.

OBJECTIVES: To evaluate the effect of diagnostic soft-tissue ultrasound (US) on management of emergency department (ED) patients with clinical cellulitis. METHODS: This was a prospective observational study in an urban ED of adult patients with clinical soft-tissue infection without obvious abscess. The treating physician's pretest opinions regarding the need for further drainage procedures and the probability of subcutaneous fluid collection were determined. Emergency sonologists then performed US of the infected area, and the effect on management plan was recorded. RESULTS: Ultrasound changed the management of patients with cellulitis in 71/126 (56%) of cases. In the pretest group that was believed not to need further drainage, US changed the management in 39/82 (48%), with 33 receiving drainage and 6 receiving further diagnostics or consultation. In the pretest group in which further drainage was believed to be needed, US changed the management in 32/44 (73%), including 16 in whom drainage was eliminated and 16 who had further diagnostic interventions. US had a management effect in all pretest probabilities for fluid from 10% to 90%. CONCLUSIONS: Soft-tissue US changes physician management in approximately half of patients in the ED with clinical cellulitis. US may guide management of cellulitis by detection of occult abscess, prevention of invasive procedures, and guidance for further imaging or consultation.

Abscess↗
PubMed2003

Aztreonam treatment of Pasteurella multocida cellulitis and bacteremia.

OBJECTIVE: To report a case of Pasteurella multocida cellulitis and bacteremia treated successfully with aztreonam. CASE SUMMARY: An 81-year-old white man with multiple antibiotic allergies was admitted with severe cellulitis of the left arm and bacteremia due to P. multocida. The patient was treated for 14 days with aztreonam and had complete resolution of the infection. DISCUSSION: To our knowledge, this is the first published case describing successful treatment of P. multocida cellulitis and bacteremia with aztreonam. Antimicrobials recommended for use in P. multocida infections include penicillin, ampicillin, amoxicillin, second- and third-generation cephalosporins, tetracyclines, fluoroquinolones, and trimethoprim/sulfamethoxazole. There is very little information in the current literature regarding the activity of aztreonam toward P. multocida. CONCLUSIONS: This case demonstrates the potential use of aztreonam for P. multocida cellulitis and bacteremia in those instances where antibiotics of choice cannot be given.

Aged↗
PubMedDate not supplied

Virulence factors of Escherichia cofi from cellulitis or colisepticemia lesions in chickens.

This study was designed to compare virulence factors of cellulitis-derived Escherichia coli to colisepticemic E. coli in order to clarify whether E. coli associated with cellulitis comprise a unique subset of pathogenic E. coli. Isolates were tested for serotype, capsule, aerobactin production, colicin production, the presence of the iss gene, and serum resistance. Untypable isolates made up the greatest percentage of each group. Serotypes O2 and O78 were the most commonly identified among both groups of isolates. No statistical differences in the distribution of aerobactin or colicin production, capsule, or iss gene were observed between groups. Cluster analysis showed that 90% of the E. coli isolates had greater than 42% livability in serum-resistance tests. No separation of colisepticemic vs. cellulitis E. coli isolates was observed on the basis of SR. Colicin production by E. coli was highly correlated with serum resistance (P = 0.0029). These data suggest that cellulitis E. coli have virulence traits similar to those of colisepticemic E. coli.

Animals↗
PubMed1998

Differentiation of necrotizing fasciitis and cellulitis using MR imaging.

OBJECTIVE: This study was performed to evaluate the diagnostic value of MR imaging in differentiating necrotizing fasciitis from cellulitis. MATERIALS AND METHODS: Spin-echo T1-weighted, T2-weighted, and contrast-enhanced T1-weighted spin-echo sequences were performed in 15 patients with clinically suspected necrotizing fasciitis. In two other patients, only unenhanced imaging was performed. The MR imaging results were correlated with the surgical findings in 11 cases, with autopsy in one case, and with the clinical outcome in five cases. RESULTS: Cellulitis was diagnosed when subcutaneous thickening with fluid collections was revealed on T2-weighted images and when subcutaneous tissue or superficial fascia or both showed contrast enhancement. For the diagnosis of necrotizing fasciitis, imaging revealed additional involvement of deep fasciae with fluid collections, thickening, and enhancement after contrast administration. According to these criteria, we found 11 cases of necrotizing fasciitis and six of cellulitis. MR imaging identified all 11 cases of necrotizing fasciitis correctly when compared with the surgical findings. One false-positive case of cellulitis was overstaged and was thought to be necrotizing fasciitis. Contrast-enhanced T1-weighted sequences delineated abscesses and areas of necrosis more clearly than T2-weighted sequences did, but showed no additional lesions. CONCLUSION: When no deep fascial involvement is revealed with MR imaging, necrotizing fasciitis can be excluded. However, because its sensitivity exceeds its specificity, MR imaging tends to overestimate the extent of deep fascial involvement. Therefore, the therapeutic regimen should be based on a combination of clinical findings and MR imaging.

Adult↗
PubMed1989

The etiology of bacterial cellulitis as determined by fine-needle aspiration.

Bacterial cellulitis is a common problem, etiologic diagnosis often unrewarding and opinions differ on empiric therapy. The purpose of this study was to determine the major microbiologic causes of bacterial cellulitis in a walk-in Emergency Room setting. 94 cases in 89 patients with clinical signs of cellulitis were studied. The infection was closed in 74 cases and associated with an open skin lesion in 22. The infection site was aspirated with a suction air-buffer technique employing a Cameco handle for easier handling and stabilization of the aspiration needle. After exclusion of contaminated samples, positive cultures were obtained from 30 cases (31.9%). Cultures were positive in 30.6% of open lesions and in 36.4% of closed ones. Staphylococcus aureus was the most common organism, present in 11 cases, S. epidermidis in 8 and group A beta-hemolytic streptococci in 5. All S. aureus strains were methicillin-sensitive and only 1 was sensitive to penicillin. The most common site of infection was the lower extremity (59%). According to these data the optimal initial therapy for bacterial cellulitis in adults should be with drugs active against both staphylococci and streptococci.

Adult↗
PubMed2001

Eosinophilic cellulitis (Wells' syndrome) successfully treated with low-dose cyclosporine.

Eosinophilic cellulitis (Wells'syndrome) is an uncommon skin disorder. We report two adult male patients who had recurrent erythematous plaques and a nodular lesion on the abdomen. The histopathologic feature of their skin biopsies similarly indicated a marked infiltrate of eosinophils in the dermis with the fashion of "flame figures". One of the patients demonstrated blood eosinophilia. Given the clinicohistological findings, the patients fulfilled the criteria for the diagnosis of eosinophilic cellulitis. The skin lesions remained refractory to medications such as corticosteroids, sulfones, antihistamines, and minocycline. Considering the beneficial effect of cyclosporine in the treatment of eosinophilia-associated dermatoses, we speculated that eosinophilic cellulitis might respond to cyclosporine therapy. Thus, each of the two patients was given cyclosporine (microemulsion formulation) at a daily dose of 1.25 or 2.5 mg/kg, i.e., 100 or 200 mg, respectively. Complete remission of the skin eruptions was obtained in both patients during a 3- or 4-week period of treatment. No side effects were observed. Neither of the patients experienced relapse of the disease at least over 10 months after the discontinuation of the cyclosporine therapy. We suggest that administration of low-dose cyclosporine be a safe and useful therapeutic option in patients with eosinophilic cellulitis.

Adult↗
PubMedDate not supplied

Periorbital and orbital cellulitis in the Haemophilus influenzae vaccine era.

BACKGROUND: Prior to development of the Haemophilus-influenzae vaccine, a significant number of periorbital and orbital infections were associated with H influenzae type b bacteremia. The incidence of invasive H influenzae type b disease has decreased dramatically since the introduction of these vaccines. The effect of the H influenzae type b vaccine on the microbiology of periorbital and orbital infections has not been examined. METHODS: Charts of 134 hospitalized patients with the discharge diagnosis of periorbital or orbital cellulitis from 1985 to 1995 were reviewed. RESULTS: In contrast with studies performed in the pre-vaccine era, H influenzae type b was not a significant pathogen. The pathogen was isolated from only 2 of 133 blood cultures performed, and was not isolated from any of the 101 patients discharged after July 1987. Sinusitis, however, remains an important cause of these eye infections. Of patients who underwent radiographic evaluation, sinusitis was present in 96% of children with orbital cellulitis and 81% of patients with periorbital cellulitis. CONCLUSIONS: H influenzae type b is no longer a significant pathogen in periorbital or orbital cellulitis and management should be modified accordingly.

Adolescent↗
PubMed2006

Late onset lamellar keratitis and epithelial ingrowth following orbital cellulitis.

PURPOSE: To report a case of late onset lamellar keratitis and epithelial ingrowth associated with orbital cellulitis 1 month after LASIK surgery. METHODS: A 19-year-old patient presented with pain and subsequent blurry vision in the right eye. One month prior to presentation, he had undergone LASIK in both eyes. Orbital cellulitis was suspected. RESULTS: Under aggressive treatment, the patient recovered from orbital cellulitis and lamellar keratitis and he also regained his vision with topical steroid treatment. CONCLUSIONS: Lamellar keratitis does not always occur early following LASIK and may be associated with orbital cellulitis.

Adult↗
PubMed2005

[Preseptal and orbital cellulitis in childhood: response to intravenous antibiotics].

PURPOSE: To evaluate retrospectively the response of preseptal and orbital cellulitis in children to empiric antibiotic treatment. METHOD: We included nine patients (five male and four female) admitted to our hospital between October 2002 and October 2003 because of preseptal or orbital cellulitis. RESULTS: Four patients (44.4%) responded to empiric antibiotic treatment (R); five (55.5%) did not respond (NR) and required a second antibiotic to resolve the infection. The presence of an upper respiratory infection was the most common associated disease in both groups, R and NR. However we also found two cases of acute dacryocystitis in the NR. Four patients (44.4%) were treated with cefotaxime intravenously with the infection resolving in three of these. Five patients (55.6%) were treated with cefuroxime intravenously as first empiric option, however only one patient responded. CONCLUSIONS: We found a high prevalence of acute dacryocystitis as a potential cause of the cellulitis. Children with preseptal and orbital cellulitis responded better to cefotaxime than to cefuroxime. The presence of acute dacryocystitis was associated with a lack of response to cefuroxime.

Acute Disease↗
PubMed2005

Narrative review: diseases that masquerade as infectious cellulitis.

For cellulitis that does not respond to conventional antimicrobial treatment, clinicians should consider, among other explanations, several noninfectious disorders that might masquerade as infectious cellulitis. Diseases that commonly masquerade as this condition include thrombophlebitis, contact dermatitis, insect stings, drug reactions, eosinophilic cellulitis (the Wells syndrome), gouty arthritis, carcinoma erysipelatoides, familial Mediterranean fever, and foreign-body reactions. Diseases that uncommonly masquerade as infectious cellulitis include urticaria, lymphedema, lupus erythematosus, sarcoidosis, lymphoma, leukemia, Paget disease, and panniculitis. Clinicians should do an initial diagnostic work-up directed by the findings from a detailed history and complete physical examination. In many cases, skin biopsy is the only tool that helps identify the correct diagnosis. Special tests may also be needed.

Biopsy↗