▪︎یه تعریف کلی داشته باشیم:
Cellulitis and abscess are among the most common skin and soft tissue infections. Cellulitis (which includes erysipelas) manifests as an area of skin erythema, edema, and warmth; it develops as a result of bacterial entry via breaches in the skin barrier. A skin abscess is a collection of pus within the dermis or subcutaneous space. Misdiagnosis of these entities is common.
▪︎درباره سلولیت و اریزیپلاس بهتره بدانیم که:
Cellulitis and erysipelas are nearly always unilateral, and the lower extremities are the most common site of involvement; bilateral involvement should prompt consideration of alternative diagnoses.
▪︎و درباره آبسه هم:
Skin abscess is a collection of pus within the dermis or subcutaneous space. It manifests as a painful, fluctuant, erythematous nodule, with or without surrounding cellulitis. Spontaneous drainage of purulent material may occur. Regional adenopathy may be observed. Fever, chills, and systemic toxicity are unusual.
▫️حالا fluctuant یعنی چی؟
In a medical context, "fluctuante" refers to a condition where an abscess feels fluctuating or "wave-like" when palpated. This indicates the presence of fluid within the abscess, suggesting that it is filled with pus or other fluid.
▪︎طبق دوتا از کوییزها:
۱.هروقت نتونستیم سلولیت رو از Erysipelas افتراق بدیم بنا رو بر سلولیت گذاشته.
۲. و یا اگر بین orbital cellulitis و preseptal cellulitis شک داشتیم بازم بنا رو بر orbital cellulitis میذاریم.
▪︎توی سلولیت وقتی میخوایم درمان Empiric بذاریم چه جرم‌هایی رو باید همیشه کاور کنیم؟
Empiric antibiotics for cellulitis should always cover beta-hemolytic streptococci and methicillinsensitive S. aureus (MSSA) ,Studies suggest that most patients with cellulitis do not need MRSA coverage.
▫️پس MRSA چی؟
Conditions that warrant MRSA coverage include the following:
•Systemic signs of toxicity (eg, fever >100.5°F/38°C, hypotension, sustained tachycardia).
•Cellulitis with purulent wound drainage.
•Known MRSA colonization or infection.
•Injection drug use.
•High-risk neutropenia.
▪︎اینکه اصلا preseptal cellulitis چه فرقی با orbital cellulitis داره هم جلوتر یه عکس گذاشتم مطالعه بفرمایید.
▪︎توجه کنیم که:
Cellulitis can occur on any part of the body. Depending on the location of cellulitis, antibiotic selection and other interventions, including surgery, can vary.
▫️برای مثال:
If cellulitis involves the hand, hospitalization is typically recommended along with evaluation by a surgeon.
بقیه موارد هم مثل درگیری ژنیتالیا، صورت، شکم و... هم توی متن آورده شده.
▪︎انتظار پاسخ به درمان چطوریه؟
Patients with cellulitis or erysipelas typically have symptomatic improvement within 24 to 48 hours of beginning antimicrobial therapy, although visible improvement of skin manifestations can take 72 hours or longer.
▪︎درباره عود هم گفته not uncommon: و توی سلولیت اغلب در محل قبلی، و در آبسه هم معمولا در یک محل دیگر خودش رو نشون میده.
▪︎و درباره کلیندامایسین هم آپتودیت می‌فرماید که:
We generally avoid clindamycin, if possible, due to risk of Clostridium difficile infection and the possibility of streptococcal and staphylococcal resistance.
▪️درباره‌ی درمان سلولیت:
◽️این الگوریتم کامله فقط دو نکته رو حواسمون باشه که:
🔹️Red-flag" conditions – These warrant immediate hospitalization and often surgery:⤵️
- Toxic shock syndrome
- Necrotizing soft tissue infection (eg, necrotizing fasciitis, including Fournier's gangrene)
- Clostridial myonecrosis
- Pyomyositis
- Deep venous thrombosis (DVT)
- Compartment syndrome
🔹️Some exposures or anatomic sites may require distinct antibiotic coverage, surgical intervention, or specific radiographic imaging:
(یعنی یه جورایی همون بستری کردن منظورشه)⤵️
- Involvement of the hand, periorbital space, or neck
- Location over a joint (native or prosthetic), vascular graft, or other foreign body Infection of a diabetic foot ulcer, pressure ulcer, animal or human bite, puncture wound, or surgical wound
- Infection following exposure to water ,soil, or recent travel
▪️Treatment of skin abscess
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