MRSA risk factors), Ability to adhere to an abx regimen (e.g. FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Pasteurella (most common, 70-80% of cat bite infections) Pasteurella multocida and Pasteurella septica ; causes intense pain, swelling in 48h other organisms similar to dog bites; rabies Aka: Cellulitis, Staphylococcal Cellulitis, Streptococcal Cellulitis, These images are a random sampling from a Bing search on the term "Cellulitis." Don’t forget to send wound cultures for patients receiving antibiotics to help tailor therapy. The potential for infection from a dog bite is extremely high. Categorize skin and soft tissue infections to determine appropriate therapy, Determine the appropriate antibiotic choice for common skin and soft tissue infections: Abscess, cellulitis and bites wounds. Also, ask yourself, “Is this really cellulitis or pseudocellulitis?”. Clean and debride the wound thoroughly and assess the need for tetanus immunisation. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: to offer FREE continuing education credits for physicians and other healthcare professionals. For infected dog or cat bites the antibiotic choices are the same noted above for human bites as are the principles for, Watto MF, Titanji BK, Williams PN, Garbitelli B. Compressive therapy can help prevent recurrent lower extremity cellulitis. Inflamación localizada que puede extenderse a lo largo de los planos de tejido conjuntivo. Key Points. IV antibiotic selection may be ill fitted for convience (e.g. Treatment for Erysipelothrix, Aeromonas = Fluoroquinolones. Preemptive antibiotic therapy for uninfected human bite wounds: Dr Titanji recommends a short course of prophylactic antibiotics and repeat evaluation of the wound. A recent trial found high cure rates at 7-10 days follow up for abscesses less than 5cm treated with I&D plus adjunctive clindamycin or TMP-SMX for 10 days (, Not a requirement. Content is updated monthly with systematic literature reviews and conferences. of the affected limb can improve recovery time. Kashlak Pearl: Remember to cover for anaerobes (w/either clinda or metronidazole) in areas where anaerobes are likely to be lurking e.g. Inflammation that may involve the skin and or subcutaneous tissues, and or muscle. The infections are usually polymicrobial. Master common skin and soft tissues infections: cellulitis, abscesses, human and animal bites with returning guest, infectious diseases expert, Dr Boghuma Titanji MD, PhD @boghuma (Emory; TED). She notes that decolonization often works initially, but future recurrence is common. infection was left behind). cefadroxil only requires twice daily dosing), Despite the classic teaching that TMP-SMX does not reliably cover Strep, a recent RCT found no difference in efficacy for clindamycin vs TMP-SMX for uncomplicated cellulitis (regardless of the presence of purulence) —. Start: 50 mg orally three times daily for 2-3 days; Then: 25 mg orally three times daily for 4-10 days Signs and symptoms include pain, tenderness and reddening in the affected area, fever, chills, and lymphadenopathy. Copyright © 2021 The Curbsiders, All Rights Reserved. Prophylactic antibiotic treatment is recommended for human, dog or cat bites, severe or deep bites, bites on the hand, foot, face, tendon or ligament, in immunocompromised people and people presenting with an untreated bite, more than eight hours later. E.g. Spino-bulbar muscular atrophy. She may add coverage for anaerobes if infection involves the genitals, axilla, perioral tissues or perineum. (a) Photograph of the right hand demonstrates swelling and erythema of the dorsum of the hand and wrist with obscuration of dorsal extensor tendon impressions in that region. Also, ask yourself, “Is this really cellulitis or pseudocellulitis?”. When to get Imaging and Blood Cultures. if infection involves the genitals, axilla, perioral tissues or perineum (expert opinion). Cellulitis is overdiagnosed, with the risk of antibiotic adverse effects (e.g. | Top Picks | Mailing List | thecurbsiders@gmail.com | CME! Dr. Matthew Watto is an Internist, Clinician Educator and Podcaster. Common mimics include: stasis dermatitis, contact dermatitis, viral rash, trauma, and chronic wounds. Cellulitis from a dog or cat bite or scratch may be caused by the Pasteurella multocida bacteria, which has a very short incubation period of only four to 24 hours. Staphylococccal scalded skin syndrome. Bilateral cellulitis is rare so consider an alternate explanation! Antibiotic selection is the same as for abscess with Cellulitis (typically MRSA) Choose a single agent (esp. Among the classic signs of preseptal cellulitis are eyelid edema/erythema/warmth and fever. *Be on high alert for severe infection if the patient has underlying liver disease or hemochromatosis. A cat that's been given a shot may have a lump for a few days, too. Cellulitis associated with mammalian bite wounds is often polymicrobial and should be treated empirically with antimicrobials that target anaerobic bacteria in addition to the common cellulitis pathogens, as described below: ... Cat bite. An abscess is a pus-filled, swollen spot on the skin that sometimes forms where your cat has been bitten or scratched. Dr Titanji points out that trial adherence was 66%. A rash with painful, red, tender skin. The opinions expressed on this show are those of The Curbsiders and do not necessarily represent the views and opinions of their places of employment. Splenic atrophy/absence. For infected dog or cat bites the antibiotic choices are the same noted above for human bites as are the principles for early imaging, surgical consultation and potential need for tetanus booster. Spinal muscular atrophy. This page was written by Scott Moses, MD, last revised on 10/24/2019 and last published on 2/4/2021. if present. perianal and perioral tissues, axilla, and groin (expert opinion). I get so much from these different episodes! Kashlak Pearl: Dr Titanji cautions against moxifloxacin monotherapy as there is limited experience and she’d worry about treatment failure (expert opinion). It specifically affects the dermis and subcutaneous fat. Dr Titanji has a low threshold for hospital admission. Dr Titanji mentions packing may be considered if the clinician is worried that further drainage is needed (i.e. Chlorhexidine), Dilute bleach: 1 teaspoon bleach per gallon water OR, One quarter cup bleach per 20 gallons water (or 1/4 tub of water), Soak in the dilute bleach for 15 minutes twice weekly for 3 months, Make certain to rinse and dry feet before walking across carpet (and bleaching the carpet), Prophylactic antibiotics are not recommended, Not typically effective, especially if there is an underlying predisposing condition, Strategies that have been used historically for 4-52 weeks (not recommended), Chan (2014) Crit Dec Emerg Med 28(9): 2-7, Moran in Majoewsky (2013) EM:Rap 13(2): 11, Orman and Hayes in Herbert (2015) EM:Rap 15(4):4-6. Transition to oral when clinical exam improves and vitals signs have normalized (expert opinion). Lymph nodes that drain the infected area enlarge about 3 weeks after inoculation. Your health care provider may take a sample or culture from your skin or do a blood test to identify the bacteria causing infection. Therefore, Dr Titanji recommends a discussion with the surgical team about risks/benefits of approximating the wound edges vs primary closure of a wound that may still have deeper infection. This recommendation is based on expert opinion in review articles [Chhabra et al, 2015; Rothe et al, 2015; Edens et al, 2016].Cat bites involve deep puncture wounds which can cause severe infections within a short time (median 12 hours), and an unprovoked animal bite increases suspicion of rabies [Edens et al, 2016]. If a cat bites you, the bacteria transferred to the skin can spread rapidly in the surrounding tissue, causing cellulitis. Septra DS 1-2 tabs twice daily for 7-10 days or. This was a great episode. Cellulitis, Impetigo and other Bacterial Infections Eczema Photos Exanthems and Drug Eruptions Hair Loss Photos, Alopecia and other Hair Diseases ... Cat Bite Cat Scratch Disease Caterpillar Dermatitis Cellulitis Cement Dermatitis Burns Chancroid Chapped Fissured Feet Chemotherapy Cherry Angioma Dog bites inoculate bacteria deep into tissue, and while not as aggressive as cat bites, the majority of dog bites get infected. While the redness often turns white when pressure is applied, this is not always the case. Avoid in elderly, renal or liver disease, Heart Failure, or Peptic Ulcer Disease In these cases, use Corticosteroids instead; Indomethacin (historically has been preferred NSAID in gout). = Redness, pain, swelling and warmth in the skin caused by an introduction of infection. Sterile pyuria. Kashlak Pearl: Bilateral cellulitis is rare so consider an alternate explanation! Purulent Cellulitis. Laboratory Risk Indicator for Necrotizing Fasciitis, Differential Diagnosis: Non-infectious Conditions (Pseudocellulitis), Management: Factors affecting antibiotic selection and course, Management: Emergency Department Approach, Management: Extremity Infections (non-diabetic patients), Management: Special circumstances (including complicated Cellulitis), Prevention: Recurrent skin and subcutaneous tissue infection (SSTI), Dermatologic Manifestations in Returning Traveler, Methicillin Resistant Staphylococcus Aureus, Vergidis (2005) Ann Intern Med 142:47-55 [PubMed], Dall (2005) Cutis 75(3): 177-80 +PMID:15839362 [PubMed], Hepburn (2004) Arch Intern Med 164:1669-74 [PubMed], Peterson (2014) Acad Emerg Med 21(5):526-31 +PMID:24842503 [PubMed], Kilburn (2010) Cochrane Database Syst Rev 16(6): CD004299 +PMID:20556757 [PubMed], Aboltins (2015) J Antimicrob Chemother 70(2): 581-6 [PubMed], Moran (2017) JAMA 317(20): 2088-96 +PMID:28535235 [PubMed], Grayson (2002) Clin Infect Dis 34:1440-8 [PubMed], Cadena (2011) Antimicrob Agents Chemother 55(12):5430-2 +PMID: 21930870 [PubMed], Ramakrishnan (2015) Am Fam Physician 92(6): 474-83 [PubMed], Stulberg (2002) Am Fam Physician 66(1):119-24 [PubMed], Pathology and Laboratory Medicine Chapter, Back Links (pages that link to this page), Cutaneous Conditions in Febrile Returning Traveler, Fever Without Focus Management 3 to 36 months, Ultrasound-Guided Internal Jugular Vein Catheterization, Accounts for 2% of all Emergency Department visits, Post-operative infection at incision site, Lymphatic Cutaneous metastases from neoplasms, Staphylococcal Cellulitis (typically with abscess). In preseptal cellulitis secondary to a human bite it is frequent to isolate anaerobic bacteria such as Clostridium. Compressive therapy, in addition to patient education, recently proved effective for the prevention of recurrent cellulitis of the leg (Webb, NEJM 2020). Terms | Privacy (EHS) | About | Site Map | Blog, Inflamación que puede afectar la piel, los tejidos subcutáneos y/o el músculo. For *large abscesses over 2 cm, Dr Titanji recommends antibiotics (typically doxy, TMP-SMX or clindamycin) plus incision & drainage. Written (including CME) and Produced by: Matthew Watto MD, FACP, Cover Art and Infographic by: Beth Garbitelli, Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Editor: Matthew Watto (written materials); Clair Morgan of, Guest: Boghuma Titanji MD, M.Sc., DTM&H, PhD. When evaluating cellulitis or bites and choosing antibiotics (abx) consider these factors: Cellulitis = Redness, pain, swelling and warmth in the skin caused by an introduction of infection. Merck and the Merck Manuals. MRSA risk factors include: HIV, on dialysis, long term resident in a facility, recent hospitalization or surgery (UpToDate accessed 12/5/20), military recruits, and those in gyms. Watto MF, Titanji BK, Williams PN, Garbitelli B. Sperm donation. Note: A free VCU Health CloudCME account is required in order to seek cre. It can be uncomfortable for the patient. “246 Take a Bite out of Cellulitis with Dr Boghuma Titanji.” The Curbsiders Internal Medicine Podcast. From there, an aggressive cellulitis (skin infection) can take root and spread quickly. An acute, spreading infection of the deep tissues of the skin and muscle that causes the skin to become warm and tender and may also cause fever, chills, swollen lymph nodes, and blisters. Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. She engages in shared decision making for patients who’ve had recurrent infections. Linezolid (typically reserved for unique cases). Pasteurella multocida, Streptococcus anginosus (formerly known as Streptococcus milleri), and Capnocytophaga canimorsus - following cat or dog bites. Started in 1995, this collection now contains 6897 interlinked topic pages divided into a tree of 31 specialty books and 737 chapters. Although access to this website is not restricted, the information found here is intended for use by medical providers. Listeners will develop a framework to approach skin and soft tissue infections including: abscess, cellulitis and bites. Streptococci cause diffuse, rapidly spreading infection because enzymes produced by the organism (streptokinase, DNase, hyaluronidase) break down cellular components that would otherwise contain and localize the inflammation. Dr Titanji’s rule of thumb: *Small abscesses under 2 cm typically don’t need antibiotics after incision & drainage (expert opinion). A bacterial infection that affects and spreads in the skin and soft tissues. Aeromonas hydrophilia, Vibrio vulnificus, and other bacteria are causes of cellulitis that develops after exposure to freshwater or seawater. Note the normal left hand for comparison. See info sheet for further directions. It’s not clear that packing works (List, S D Med 2016 ). Kashlak Pearl: Dr Titanji may be more aggressive with IV antibiotics based on location of the cellulitis (e.g. Haemophilus influenzae cellulitis is a cutaneous condition characterized by a distinctive bluish or purplish-red cellulitis of the face. Compressive therapy, in addition to patient education, recently proved effective for the prevention of recurrent cellulitis of the leg (, Bacteria found in fish and water that may contribute to skin infection include. causes cellulitis, sepsis, endocarditis, meningitis, DIC, ARDS and death; highest mortality in immunocompromised (30-60%) cat bites. Dr Titanji recommends a short course of prophylactic antibiotics and repeat evaluation of the wound. Patients complain of eyelid swelling and redness. In classic cat scratch disease, a papule or pustule develops from 3–30 days following a scratch or a bite. face) and immunocompromised status. Filed Under: ID&Derm, Podcast Tagged With: abscess, animal bite, assistant, care, cat bite, cellulitis, Doctor, dog bite, education, family, foam, FOAMed, FOAMim, Health, hospital, Hospitalist, human bite, infection, internal, Internist, meded, medical, Medicine, MRSA, nurse, physician, practitioner, primary, Primary Care, professional, resident, skin, soft tissue, student. Thank you and happy holidays to you also! It can be uncomfortable for the patient. Documenting how and when the bite occurred. Rare causes of cellulitis include: Pseudomonas aeruginosa, usually in a puncture wound of foot or hand; Haemophilus influenzae, in children with facial cellulitis; Anaerobes, Eikenella, Streptococcus viridans, due to human bite; Pasteurella multocida, due to cat or dog bite; Vibrio vulnificus, due to saltwater exposure, eg coral injury
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