Presentasi

Etiology
Gram-positive cocci such as Streptococcus spp esp streptococcus pyogenes also
known as Group A beta-hemolytic streptococcus and Staphylococcus aureus are thought
to be the predominant cause of cellulitis.2

Positive blood cultures are found in less than 10% of cases. Wound or tissue cultures
are negative in up to 70% cases,3 with S aureus, group A streptococci and group G
streptococci being the most common isolates from wound cultures.4 Serological
studies suggest group A streptococcal infection is an important cause of culture
negative cellulitis.5 Skin infection with pus is strongly associated with S aureus.6

Animal bites can be associated with cellulitis due to Gram-negatives such as

Pasteurella and Capnocytophaga. Exposure of a skin break to salt or fresh water is
associated with Vibrio vulnificus and Aeromonas spp respectively.2

Group A streptococci can be associated with the development of necrotising fasciitis,

although this can also be due to mixed infection including Gram-negative and
anaerobic organisms, particularly in the elderly and immunosuppressed.2

Risk factors for cellulitis include any culprit that could cause a breakdown in the skin barrier
such as skin injuries, surgical incisions, intravenous site punctures, fissures between toes,
insect bites, animal bites, and other skin infections.[4] Patients with comorbidities such as
diabetes mellitus, venous insufficiency, peripheral arterial disease, and lymphedema are at
higher risk of developing cellulitis

Pathogenesis

Microbial pathogens gain access to the deep dermal

and subcutaneous tissues through breaks in the skin,
where they can spread into lymphatics, blood vessels,
and interstitial spaces. A portal of entry can be identified
in up to 62% of patients, with toe web infections
as the most common etiology.19 Disseminated infection
with secondary seeding of the skin is a rare cause
of cellulitis that may occur in immunocompromised
patients.
Given the difficulty in culturing or identifying
causative pathogens, cellulitis may be relatively
paucimicrobial, with a significant portion of the clinical
symptoms and signs due to host inflammatory
responses to killed bacteria and bacterial exotoxins

Bakteri patogen (streptokokus piogenes, streptokokus grup A,

stapilokokus aureus)

Menyerang kulit dan jaringan subkutan

Meluas ke jaringan yang lebih dalam

Menyebar secara sistemik

Terjadi peradangan akut

Eritema lokal pada kulit Edema kemerahan

Lesi Nyeri tekan

Gangguan rasa nyaman dan

Kerusakan integritas kulit nyeri

Gambar .Skema patogenesis

dan usia dekade keempat dan kelima.7Semakin bertambahnya usia,

insiden selulitis juga semakin meningkat.8 Hal ini kemungkinan
disebabkan oleh trauma pada kulit (abrasi) dan juga adanya penyakit
menahun. Abrasi kulit pada usia lanjut sering terjadi dikarenakan adanya
perubahan struktur kulit yang semakin menipis dan rapuh. Abrasi kulit ini
dapat menyebabkan timbulnya kolonisasi bakteri yang akan memicu
invasi bakteri sehingga memudahkan terjadinya infeksi. Pada usia lanjut
juga sering mengalami penyakit menahun (misalnya, diabetes). Penyakit
menahun ini akan menurunkan sistem imun dalam tubuh yang akan
menyebabkan mudahnya terkena infeksi.
Faktor risiko selulitis adalah segala bentuk penyebab yang dapat menyebabkan kerusakan
pada pelindung kulit seperti cedera kulit, sayatan bedah, tusukan di tempat intravena, celah di
antara jari kaki, gigitan serangga, gigitan hewan, dan infeksi kulit lainnya.7 Pasien dengan
penyakit penyerta seperti diabetes melitus, insufisiensi vena, penyakit arteri perifer, dan
limfedema berisiko lebih tinggi mengalami selulitis.8