Introduction
Cellulitis is a skin infection caused by the bacteria Staphylococcus aureus particularly when the physical skin barrier, the immune system, and the circulatory system are impaired. It manifests itself in the human skin as reddish, swollen, and tender parts. The disease is devastating and easily spread across the human body hence making it painful. The largely affected part of the human body is the lower limbs though other areas are not exceptions. It both affects the overlying and minimally the subcutaneous tissues of the skin. The bloodstream and the lymph nodes are not exempted though this is witnessed only at the advanced level of the disease. If not well managed the disease can become lethal.
Incidence and Prevalence
Studies reveal that the incidence rate of cellulitis is 24.1/per 1000 persons a year. Males of approximately all ages are usually vulnerable and show a high risk of contracting the disease. The incidence rate increases with an increase in age. It is also evident from the research studies that 78% of cellulitis cases were reported to receive treatment in outpatient setups. This is a considerably higher incident rate in comparison with population-based studies. Less than 20% of the patients studied developed the disease again and also required care in a period of 28 days and above. Studies also reveal that the lower extremity is the common site of the disorder in both genders. The study used in assessing the incidence and prevalence included an equal number of both gender in an age range of 0-64 years. The population had both sick and healthy individuals. Though the insurance claims have some limitations, it was used to evaluate the prevalence rates. The limitations associated with insurance claims includes data entry errors as well as over or underreporting.
Pathophysiology
Cellulitis is associated with the infestation of the staphylococcus aureus bacteria. The most common forms of bacteria that are pathogenic include Group A Streptococcus and Staphylococcus. This bacteria is harmless and is usually found on the skin’s surface. It is only harmful when the skin surface is broken and the bacteria gains access to the subcutaneous layer and the dermis. Conditions such as insect and animal bites, recent surgery, athlete foot, burns, and dry skin usually predispose the skin to cellulitis. The bacteria then becomes an antigen to the body since it is foreign. The body reacts to the foreign body by causing swelling, pain, redness, and itching. These are the results of the body’s inflammatory response to kill the foreign body. In case the cellulitis spread to the fascial lining it causes necrotizing fasciitis. This may result in an immediate medical emergency.
Physical Assessment and Examination
The physical assessment and examination of cellulitis are majorly based on the morphology of the lesion as well as the clinical setting. The diagnosis is more accurate and improved with the help of dermatologists. The symptoms of the disease are swelling and redness of the disease, and swollen glands in the affected area. The physician is expected to mark the edges of the redness with a pen. This is to evaluate if the redness surpasses the boundary marked over the days. The patient may be questioned about other dermatological disorders in particular those caused by fungus. He or she should let the physician know of other comorbid conditions. These may be risk factors for cellulitis and the most renowned ones are human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), diabetes, chronic liver disease, and diabetes. Edema and impaired lymphatic drainage are also some of the predisposing factors to leg cellulitis. The leg is usually the most vulnerable site of cellulitis infection.
Treatment Plan and Patient Education
The treatment plan includes antibiotic regimens. This has been found effective in more than 90% of the patients. Drainage may be employed in the cases of abscesses. Drainage is seen to suffice in absence of the antibiotics. This only applies in case the abscess is relatively isolated. Methicillin-resistant Staphylococcus aureus and macrolide or erythromycin-resistant Streptococcus pyogenes usually complicate the treatment of the disease. Less severe cases of cellulitis are treated with semisynthetic penicillin such as first and second-order cephalosporin, clindamycin, and macrolides. Beta-lactam antibiotic therapy is used in the treatment of cellulitis that does not need the draining of the abscess. Parenteral therapy is used in cases of severe cellulitis. Though the disease is not contagious the patients are expected to keep high levels of hygiene. They are expected to wash their hands regularly with soap and water and also not to share towels. They are also expected to keep the wound clean and dry.
Follow-up and Evaluation of the Treatment Plan
Early treatment positive response is a clear indicator of drug efficacy. However, the disease is indolent since the edema and inflammation have a prolonged time to clear. The ultimate determination of absolute cure or failure to cure relies on the global assessment of the course of the illness. Adjunctive measures such as compression and elevation that may result in improvement within two days may not predict the ultimate cure. Therefore, early follow-up may result in false positive results.
References
Quirke, M. etl (2017). Risk factors for non-purulent leg cellulitis: a systematic review and meta‐analysis. British Journal of Dermatology, 177(2), 382-394.
Quirke, M. etl (2015). Prevalence and predictors of initial oral antibiotic treatment failure in adult emergency department patients with cellulitis: a pilot study. BMJ open, 5(6), e008150.
Raff, A. B., & Kroshinsky, D. (2016). Cellulitis: a review. Jama, 316(3), 325-337.
