CELLULITIS DEF: Cellulitis (sel-u-LI-tis) is a potentially serious bacterial infection of your skin.

Cellulitis appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly. It is unrelated to "cellulite," a cosmetic condition featuring dimpling of the skin. ETIOLOGY: Cellulitis begins in an area of broken skin, like a cut or scratch, allowing bacteria to invade and spread, causing inflammation, which includes pain, swelling, warmth, and redness. Disorders that create breaks in the skin and allow bacteria to enter, such as eczema and severe acne, will put a child at risk for Cellulitis. Chickenpox and scratched insect bites are also common causes. Cellulitis may also start in areas of intact skin, especially in people who have diabetes or who are taking medicines that suppress the immune system. Cellulitis can be caused by many different types of bacteria, but the most common are group A Streptococcus and Staphylococcus aureus. In special cases, other bacteria can cause cellulitis. Cellulitis after a cat or dog bite may be caused by Pasteurella multocida bacteria. Cellulitis due to Pseudomonas infection occurs after nail-puncture wounds through sneakers. Other types of bacteria from fish and farm animals can also cause cellulitis. One specific type of cellulitis that can occur in children and requires close monitoring is periorbital cellulitis, an infection of the eyelid and tissues surrounding the eye. It can be the result of minor trauma to the area around the eye (such as an insect bite or a scratch), or it may be the extension of another site of infection, such as sinusitis. Periorbital cellulitis is treated with antibiotics and close follow-up. If untreated, it can progress to orbital cellulitis (infection of the eye orbit, or socket), a much more severe infection that results in: A bulging eyeball, Eye pain, Restricted eye movements, Visual disturbances. This is an emergency that requires hospitalization and intravenous antibiotics. SIGNS AND SYMPTOMS The list of signs and symptoms mentioned in various sources for Cellulitis includes those listed below. Note that Cellulitis symptoms usually refers to various symptoms known to a patient, but the phrase Cellulitis signs may refer to those signs only noticeable by a doctor:

Cellulitis begins as a: Small, inflamed area, Pain, Swelling, warmth, Redness on skin, As this red area begins to spread, the child may begin to feel sick and develop a fever, Sometimes with chills and sweats, Swollen lymph nodes (commonly called swollen glands) are sometimes found near the area of infected skin, Painful skin, Tender skin, Fever, Chills, Blisters, Scabs, Skin rash, Erysipelas rash, Red lines toward lymph nodes. Usually associated with malaise, fever and a raised white cell count If not rapidly treated it can progress to lymphangitis and lymphadenitis Localized areas of skin necrosis may occur Predisposing factors include Lymphedema Venous stasis Diabetes mellitus Surgical wounds

Symptoms of Perianal cellulitis Anal itching Painful bowel movements

Contagiousness Cellulitis is not contagious. Prevention: You can prevent cellulitis by protecting your child's skin from cuts, bruises, and scrapes. Protective equipment worn to prevent other injuries during active play can also protect your child's skin: elbow and knee pads while skating, a bike helmet during bike riding, and shin guards during soccer, long pants and long-sleeved shirts while hiking in the woods, sandals (not bare feet) on the beach, and seatbelts while riding in a motor vehicle. If your child does get a scrape, wash the wound well with soap and water. Apply an antibiotic ointment and cover the wound with an adhesive bandage or gauze. Check with your child's doctor if your child has a large cut, deep puncture wound, or bite (animal or human).

Incubation The incubation period varies, depending on the type of bacteria causing the cellulitis. For example, cellulitis caused by Pasteurella multocida has a very short incubation period - less than 24 hours after an animal bite. But other types of bacteria may have incubation periods of several days.

Duration Cellulitis usually resolves after a few days of antibiotic therapy. However, it's very important that the child receives the medication on schedule for as many days, usually 7 to 10, as the doctor directs. Diagnosis Your child's doctor can usually make the diagnosis of cellulitis by asking a few questions and examining the area of affected skin. Sometimes, especially in younger children, the doctor may also order blood cultures - samples of your child's blood that are examined in the laboratory for growth of bacteria. Positive blood cultures mean that bacteria from your child's skin infection have spread into the bloodstream, a condition known as bacteremia. This can potentially lead to septicemia, a generalized infection affecting many systems of the body. Bacteremia can also be a cause of cellulitis in certain cases. Professional Treatment If your child has severe cellulitis, your child's doctor may decide to treat him or her in the hospital using intravenous (IV) antibiotics. The management includes: Rest and elevation of the affected limb, Antibiotics, May initially be given orally, Intravenous administration if no rapid improvement, Benzylpenicillin and flucloxacillin are usually antibiotics of choice. Home Treatment Children with milder cellulitis can be treated at home with the entire course of prescribed oral antibiotics, but with follow-up from the doctor to make sure symptoms are improving. The doctor may also suggest that the affected part of the body be immobilized and elevated to reduce swelling and pain. Using pain-relievers such as acetaminophen or ibuprofen may also help reduce discomfort. After 1 or 2 days of antibiotics at home, your child's doctor may schedule an office visit to check that the area of cellulitis has improved and that the antibiotics are working to heal the infection. Risk factors Several factors can place you at greater risk of developing cellulitis: Age. As you age, your circulatory system becomes less effective at delivering blood with its infection-fighting white blood cells to some areas of your body. As a result, skin abrasions may lead to infections such as cellulitis where your circulation is poor.

Weakened immune system. Illnesses that result in a weakening of your immune system leave you more susceptible to infections such as cellulitis. Examples of these illnesses include chronic lymphocytic leukemia and HIV infection. Taking immune-suppressing drugs, such as prednisone or cyclosporine, also can leave you more vulnerable to infections. Immune-suppressing drugs are used to treat a variety of illnesses and to help prevent rejection in people who receive organ transplants. Diabetes. Having diabetes not only increases your blood sugar level but also impairs your immune system and increases your risk of infection. Your skin is one of the many areas of your body that becomes more susceptible to infection. Diabetes may result in decreased circulation of blood to your lower extremities, potentially leading to chronic ulcers of your feet. These ulcers can serve as portals of entry for bacterial infections. Chickenpox and shingles. These common viral diseases typically cause broken blisters on the skin that can serve as potential entry points for bacterial invasion and infection. Chronic swelling of your arms or legs (lymphedema). Swollen tissue may crack, leaving your skin vulnerable to bacterial infection. Chronic fungal infection of your feet or toes. Recurrent fungal infection of your feet or toes can cause cracks in your skin, increasing your risk of bacterial infection.