BIOLOGY

INVESTIGATORY
PROJECT
SUBMITTED BY : HARSHITA RAJESH MASRAM
CLASS: XII C ROLL NUMBER: 14
 CELLULITIS

 Abstract
 Cellulitis is a bacterial infection involving the skin. It specifically affects the dermis and
subcutaneous fat. Signs and symptoms include an area of redness which increases in size over
a couple of days. The borders of the area of redness are generally not sharp and the skin may
be swollen. While the redness often turns white when pressure is applied this is not always
the case. The area of infection is usually painful. Lymphatic vessels may occasionally be
involved and the person may have a fever and feel tired. The legs and face are the most
common site involved, though cellulitis can occur on any part of the body. The leg is typically
affected following a break in the skin. Other risk factors include obesity, leg swelling, and old
age. For face infections a break in the skin beforehand is not usually the case. The bacteria
most commonly involved are streptococci and Staphylococcus aureus. In contrast to cellulitis,
erysipelas is a bacterial infection involving the more superficial layers of the skin, presents
with an area of redness with well-defined edges, and more often is associated with fever.
more serious infections such as an underlying bone
infection or necrotizing fasciitis should be ruled out.
Diagnosis is usually based on the presenting signs and
symptoms with cell culture rarely being possible. Treatment
with antibiotics taken by mouth such as cephalexin,
amoxicillin or cloxacillin is often used. In those who are
seriously allergic to penicillin, erythromycin or
clindamycin may be used. When methicillin-resistant
Staphylococcus aureus (MRSA) is a concern doxycycline or
Trimethoprim/sulfamethoxazole may, in addition, be
recommended.o add text
concern is related to the presence of pus or previous MRSA
infections. Steroids may speed recovery in those on antibiotics.
Raising the infected area may be useful as may pain killers.
Around 95% of people are better after seven to ten days of
treatment. Potential complications include abscess formation.
Skin infections affect about 2 out of every 1000 people per year.
Cellulitis in 2010 resulted in about 27,000 deaths worldwide
that year. In the United Kingdom cellulitis was the reason for
1.6% of admissions to the hospital.
 Symptoms
 Possible signs and symptoms ofClick
cellulitis include:
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 • Redness
 • Swelling
 • Tenderness
 • Pain
 • Warmth
 • Fever
 Seek emergency care if:
Click to add text
 • You have a red, swollen, tender rash or a rash that's changing rapidly
 • You have a fever
 See your doctor, preferably that day, if:
 fected left shin in comparison to shin with no sign of symptoms
 • You have a rash that's red, swollen, tender and warm — and it's
expanding — but without fever.
CAUSES

 Cellulitis occurs when one or more types of bacteria enter through a

crack or break in your skin. The two most common types of bacteria that
are causes of cellulitis are streptococcus and staphylococcus. The
incidence of a more serious staphylococcus infection called methicillin-
resistant Staphylococcus aureus (MRSA) is increasing
 Although cellulitis can occur anywhere on your body, the most common
location is the lower leg. Bacteria is most likely to enter disrupted areas
of skin, such as where you've had recent surgery, cuts, puncture wounds,
an ulcer, athlete's foot or dermatitis.
 Certain types of insect or spider bites also can transmit the bacteria that
start the infection. Areas of dry, flaky skin also can be an entry point for
bacteria, as can swollen skin.
 Predisposing conditions for cellulitis include insect or spider
bite, blistering, animal bite, tattoos, pruritic (itchy) skin
rash, recent surgery, athlete's foot, dry skin, eczema,
injecting drugs (especially subcutaneous or intramuscular
injection or where an attempted intravenous injection
"misses" or blows the vein), pregnancy, diabetes and obesity,
which can affect circulation, as well as burns and boils,
though there is debate as to whether minor foot lesions
contribute.
 Tests And Diagnosis

 • The appearance of your skin will help your doctor make a diagnosis. Your doctor may
also suggest blood tests, a wound culture or other tests to help rule out a blood clot
deep in the vein of your legs. Cellulitis in the lower leg is characterized by signs and
symptoms that may be similar to those of a clot occurring deep in the veins, such as
warmth, pain and swelling.
 Lyme disease can be misdiagnosed as staphylococcal-or streptococcal-induced cellulitis. Because
the characteristic bullseye rash does not always appear in patients infected with Lyme disease,
the similar set of symptoms may be misdiagnosed as cellulitis. Standard treatments for cellulitis
are not sufficient for curing Lyme disease. The only way to rule out Lyme disease is with a blood
test, which is recommended during warm months in areas where the disease is endemic.
Treatments And Drugs

 Cellulitis treatment usually is a prescription oral antibiotic.

Within three days of starting an antibiotic, let your doctor
know whether the infection is responding to treatment.
You'll need to take the antibiotic for up to 14 days. In most
cases, signs and symptoms of cellulitis disappear after a few
days. If they don't clear up, if they're extensive or if you have
a high fever, you may need to be hospitalized and receive
antibiotics through your veins (intravenously).
 • Usually, doctors prescribe a drug that's effective against both
streptococci and staphylococci. Your doctor will choose an antibiotic
based on your circumstances. No matter what type of antibiotic your
doctor prescribes, it's important that you take the medication as directed
and that you finish the entire course of medication, even if you start
feeling better.
 • Your doctor also might recommend elevating the affected area, which
may speed recovery.
Recurrent cellulitis/abscess

 Various strategies can be tried to reduce bacterial skin

colonisation but requires motivation from the family.
Prevention of infected eczema is best done by proactive
management of the eczema rather than repeated antibiotics
alone. The infectious disease team is happy to see these
patients as out-patients. The typical waiting time is a few
weeks. If no cultures are available please swab any lesions
plus the nose & groin for bacterial culture.
 For children/families who have multiple episodes of skin infection:
 Reinforce personal hygiene measures
 Encourage early presentation to the GP .
 Household members are frequently also infected with Staph – it is appropriate to ask about skin
infections and examine family members (even adults) to ensure they also receive treatment.
 Some families may find adding Janola to bathwater useful for reducing the bacterial load on the
skin. 5ml Janola per 5L of water twice a week. This is approximately 100ml for a 15cm deep full sized
bath. Baby’s baths use a capful. Alternatives include antiseptic bath oils (oilatum plus, QV flare up).
If there is no bath then Chlorhexidine washes or even Protex soap (these two not recommended in
eczema).
 Family to consider discussion with GP regarding other possible decontamination strategies (may
include short/medium term antibiotics or intranasal mupirocin).
CONCLUSIONS

 Cellulitis is a clinical diagnosis based on the spreading involvement of

skin and subcutaneous tissues with erythema, swelling, and local
tenderness, accompanied by fever and malaise. The approach to therapy
involves the identification of the likely source as either local (secondary
to abrasion or ulcer or due to another exposure, such as an animal bite or
seawater, which implicates particular bacterial species — P. multocida
and V. vulnificus, respectively) or an uncommon bacteremic spread of
infection. Distinctive features of the patient (such as the presence of
diabetes or immunocompromise) or anatomical sites should also be
considered in treatment decisions. Streptococci (groups A, G, and B) and
S. aureus are the most frequently isolated bacterial species.
 Initial empirical antimicrobial treatment for moderate or severe cellulitis
in a patient such as the one described in the vignette would thus consist
of an intravenous cephalosporin (cefazolin or ceftriaxone) or nafcillin
(vancomycin in patients with an allergy to penicillin), followed by
dicloxacillin or an oral cephalosporin, generally for a course of 7 to 14
days. In patients with recurrent cellulitis of the leg, any fissures in the
interdigital spaces caused by epidermophytosis should be treated with
topical antifungal agents in order to prevent recurrences. Daily
prophylaxis with oral penicillin G (or amoxicillin) should be considered
for patients who have had more than two episodes of cellulitis at the
same site.