Pathophysiology of Cellulitis

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1.) Pathophysiology – Cellulitis is a common, potentially serious bacterial skin infection. Cellulitis appears as a swollen, red area of skin that feels hot and tender (Patients J.D. chief Complaint), and it may spread rapidly. Skin on lower legs is most commonly affected, though cellulitis can occur anywhere on the body or face. Cellulitis may affect only the skin's surface, or cellulitis may also affect tissues underlying the skin and can spread to the lymph nodes and bloodstream. Left untreated, the spreading infection may rapidly turn life-threatening Cellulitis usually follows a breach in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound. In some cases, there is no obvious portal of entry and the breach may be due to microscopic changes in the skin or certain invasive bacteria. Organisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis. Cellulitis may progress to serious illness by uncontrolled contiguous spread via the lymphatic or circulatory systems. Complications include lymphangitis, abscess formation, and, gangrenous cellulitis or necrotizing fasciitis. Certain species, most notably group A beta-hemolytic Streptococcus (GABHS) and S aureus, produce toxins that may cause more severe systemic infection, leading to septic shock and death. 2.) Signs and Symptoms – Non-purulent cellulitis is associated with the 4 cardinal signs of infection, as follows: erythema, Pain, Swelling, Warmth. The following findings suggest severe infection: Malaise, chills, fever, and toxicity, Lymphangitic spread (red lines streaking away from the area of infection), Circumferential cellulitis, Pain disproportionate to examination findings Indications for emergent surgical evaluation are as follows: Violaceous bullae, Cutaneous hemorrhage, Skin sloughing, Skin anesthesia, Rapid progression, Gas in the tissue

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