Cellulitis Symptoms, Treatment And Causes

Write a short note on cellulitis.

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Define, and describe clinical features and principles of treatment of cellulitis.

Answer. Cellulitis is defined as spreading inflammation of subcutaneous tissues and fascial planes.
When a periapical infection fails to localize as an abscess it leads to cellulitis where infection rapidly spreads through facial tissue planes diffsely.

Cellulitis Bacteriology

• Commonly due to Streptococcus pyogenes and other Grampositive organisms.
• The release of streptokinase and hyaluronidase can cause the spread of infection.
• Often gram-negative organisms such as Klebsiella, Pseudomonas, and E. coli are also involved.

Read And Learn More: General Surgery Questions and Answers

Cellulitis  Source of infection

• Injuries
• Graze or scratch
• Snakebite.

Cellulitis Clinical Features

• Acute inflammatory lesions such as cellulitis especially when situated in the dangerous area of the face are prone to spread in the cavernous sinus.
• The patient is morbidly ill and may be delirious or semi-conscious.
• High-grade fever, headache, nausea, and vomiting are common.
• Local signs such as edema of conjunctiva and eyelids dilated and sluggishly reacting pupils may be present.
• Also, there will be movements of the eyeball due to the involvement of the 3rd, 4th, and 6th cranial nerves.
• Proptosis and involvement of opposite site eye in advanced cases
• It spreads through loose connective and interstitial tissues of the face.
• Tender regional lymph nodes may be palpable which signifies the severity of infection.
• There is no edge, no pus, no fluctuation, and no limit.

Cellulitis Complications

• Cellulitis can drain into an abscess which needs to be drained.
• Necrotizing fasciitis: Certain highly invasive strains of Streptococcus pyogenes can cause extensive necrosis of skin, and subcutaneous tissue and may result in necrotizing fasciitis.
• Toxemia and septicemia: Streptococcal toxic shock syndrome can result if exotoxins are produced by microorganisms.
• Cellulitis can precipitate ketoacidosis, if patient is diabetic.

Cellulitis Treatment

• The principles of treatment are:
• Bed rest and elevation of limb
• Dressing of glycerine magnesium sulfate
• Control of diabetes mellitus
• Parenteral antibiotic therapy
• Treatment of septicemia, if present
• Surgical decompression of tissues

• Bed rest and elevation of limb or part to reduce edema, to increase the circulation and bandaging.
• Glycerine magnesium sulfate dressing should be given which decreases edema of the affected part.
• Diabetes mellitus, if present is treated with insulin therapy.
• Appropriate antibiotics such as injection crystalline penicillin 10 lakh units IM or IV 6 hourly for 5 to 7 days or ciprofloxacin 500 mg BD is given.
• Often a patient may be in septicemia, A patient in this condition is treated with higher antibiotics, critical care with fluid management, along with maintaining adequate urine output.

Cellulitis Surgical Management

• Since the tissues are tense and stretched, an incision and exploration of that area decompress or relieve pressure within the tissues.
• Decompressing the tissues helps improve the vascularity, allowing better penetration of I.V. antibiotics to the area.

 

Cellulitis in Oral Cavity

Cellulitis is defined as spreading inflammation of subcutaneous tissues and fascial planes.

Cellulitis Etiology

Alpha-hemolytic streptococci is the etiologic agent.

Cellulitis in Oral Cavity Clinical Features

• Presence of widespread swelling, redness, and tenderness without proper localization.
• Tissues become edematous and there is a presence of induration. On palpation, tissues are firm to hard in consistency.
• Tissues get discolored and the temperature rises.
• Depending on the location and proximity of anatomical structures pus can evacuate on the nose, maxillary sinus, vestibule, floor of mouth, infratemporal fossa, and fascial spaces.
• Infection occurring in the maxilla perforates the outer cortical layer of bone above the buccinators and leads to swelling of the upper half of the face, and if infection perforates the outer cortical plate in the mandible below the buccinators, there is swelling in the lower half of the face.
• If a maxillary tooth is associated with infection, then redness can be seen in the eye.

Cellulitis in Oral Cavity Management

• Surgical incision and drainage: This is done if pus is diagnosed.
  In large cellulitis, an erythematous area is present which consists of pus near the superficial surface.
  These areas are incised and drained under local anesthesia. The knife is inserted in the most inferior portion of the fluctuant area.
  A small sinus forceps is inserted in the wound and is opened in various directions so that pus is drained.
  A rubber drain is placed in the deepest area of the wound and suturing is done. Dressing is given.
• Broad-spectrum antibiotics should be given to the patient.
  Antibiotics of the cephalosporin family are preferred.
• The associated tooth should be extracted.