Bacteremia in patients hospitalized
with cellulitis].
2012
[Article in Spanish]
Lasa JS, Fernández Recalde ML, Finn BC, Bruetman JE, Peroni J, Young P.
Source
Servicio de Clínica Médica, Hospital Británico de Buenos Aires.
Abstract
Cellulitis is an acute inflammation of dermis and subcutaneous tissue, usually complicating wounds, ulcers, or dermatosis. Even though in these cases it is recommended to perform culture from skin and soft tissue samples, the utility of blood cultures remains controversial due to the low frequency of positive results. Here we report the prevalence of bacteremia in patients with cellulitis admitted in our Hospital, and evaluate the presence of risk factors associated with the occurrence of this event.
Clinical records of patients with diagnosis of cellulitis admitted between June 2007 and March 2010 were retrospectively reviewed.
Patients without skin and soft tissue culture and/or blood cultures were excluded. Demographic data, presence of comorbidities, and culture results were analyzed. In this period, 140 patients were admitted with this diagnosis. Fifty six (40%) of them had positive skin and soft tissue cultures; where methicillin resistant Staphylococcus aureus (MRSA) was the most frequently isolated bacterium species (35.7%).
Bacteremia was detected in 8.6% of these cases, where the most frequently isolated bacteria were Group G Beta haemolytic Streptococcus (33%). Bacteremia was significantly associated with longer hospital stay (10.5 ± 8.98 vs. 4.9 ± 6, p = 0.004).
The following variables were significantly associated with the occurrence of positive blood cultures: diabetes (41.7% vs. 14.1%; p = 0.02; OR 4.4), positive skin and soft tissue culture (75% vs. 35.2%; p = 0.01; OR 5.5), alcoholism (16.7% vs. 3.9%; p = 0.01; OR 4.9), and chronic obstructive pulmonary disease (16.7% vs. 0.78%; p = 0.01; OR 25.4).
http://www.medicinabuenosaires.com/PMID/22892081.pdf
or
http://www.ncbi.nlm.nih.gov/pubmed/22892081
Codes for
Cellulitis
Arm
682.3
Finger 681.00
Foot 682.7
Hand 682.4
Leg
682.6
Neck 682.1
Toe 682.10
Torso 682.2
THESE
LETTERS MAY REFER TO:
C COMBINED, COMPLETE, OR COMPLEX
D
DECONGESTIVE
P PHYSIOTHERAPY OR PHYSICAL THERAPY
L
LYMPHEDEMA OR LYMPHATIC
ABBREVIATIONS
CDP COMPLETE OR
COMPLEX DECONGESTIVE PHYSIOTHERAPY (USED BY
MEDICARE
FLORIDA)
CPDT COMPLEX PHYSICAL DEONGESTIVE THERAPY (FOLDI,
GERMANY)
CPT COMPLEX PHYSICAL THERAPY (CASLEY-SMITH, AUSTRALIA
1980)
CLT COMPLEX LYMPHATIC THERAPY (CASLEY-SMITH,
AUSTRALIA)
CDT COMBINED DECONGESTIVE THERAPY (VODDER)
LT
LYMPHEDEMA THERAPY
LMT LYMPHEDEMA MULTIMODAL THERAPY
* NOTE IT ALSO STANDS FOR LICENSED MASSAGE THERAPY/THERAPIST
AS WELL
MLD MANUAL LYMPH DRAINAGE (ORIGINALLY
VODDER)
MLT MANUAL LYMPH/LYMPHATIC THERAPY/TREATMENT/TECHNIQUE
(USED IN
SCIENTIFIC MAGAZINES)
LDT LYMPH
DRAINAGE THERAPY (CHIKLY)
MLDT MANUAL LYMPH DRAINAGE THERAPY, A
COMBINATION OF THE ABOVE
THE FOLLOWING TERMS SHOULD NOT BE USED IF
POSSIBLE
LM LYMPHATIC MASSAGE
LDM LYMPHATIC DRAINAGE
MASSAGE
MLM MANUAL LYMPHATIC MASSAGE
MLDM MANUAL LYMPH DRAINAGE
MASSAGE
THE WORD "MASSAGE" IS MISLEADING TO PATIENTS AND INSURANCE IN
DESCRIBING
THE LIGHT AND SPECIFIC TOUCH OF LYMPHATIC
DRAINAGE.
---------------------------------------------------------
Killing bacteria isn't enough to
restore immune function after infection, researchers find
http://www.utsouthwestern.edu/utsw/cda/dept353744/files/486618.html
DALLAS — Sept. 10,
2008 — A bacterial molecule that initially signals to animals that they have
been
invaded must be wiped out by a special enzyme before an
infected animal can regain full health, researchers
at UT
Southwestern Medical Center have found.
Using a genetically engineered
mouse model, the team found that simply eradicating the infection-causing bug
isn’t enough to restore an animal’s immune function.
Lipopolysaccharide, or LPS, the dominant bacterial
“signal”
molecule that heralds the invasion, must also be inactivated. The findings are
to appear online Sept.
11 in Cell Host & Microbe.
“We
think this is the first evidence that killing the causative agent of a
bacterial infection isn’t enough for an
animal to recover fully,”
said Dr. Robert Munford, professor of internal medicine and microbiology, and
senior author of the study. “You’ve got to get rid of this molecule
that the host is responding to or else its
immune system remains
suppressed.”
Drs. Mingfang Lu (left) and Robert
Munford.
--------------------------------------------------------------------------------
By
sensing and responding to LPS, animals mobilize their defenses to attack and
kill the bacteria. This
immune response also causes inflammation in
the host. For a few days after the infection begins, however, an
animal’s ability to sense the bacteria is turned down, presumably to
prevent further inflammation. In the
current study, the researchers
found that mice didn’t recover from this “tolerant” period unless the LPS was
inactivated by acyloxyacyl hydrolase, an enzyme discovered in 1983
by Dr. Munford and Dr. Catherine
Hall, now an assistant professor
of internal medicine at UT Southwestern.
Dr. Mingfang Lu, instructor of
internal medicine and lead author of the current study, said the team also
found that prolonged tolerance was immunosuppressive, reducing the
animal’s ability to stave off another
bacterial
infection.
Dr. Lu said that how long an animal remains in this tolerant
state varies from animal to animal. “But mice that
can’t make the
enzyme acyloxyacyl hydrolase seem to stay tolerant forever, leaving them unable
to fight
additional infections,” she said.
For the study,
researchers injected LPS or a common bacterium that makes LPS into the abdomens
of two
types of mice: ones that could produce the acyloxyacyl
hydrolase enzyme and ones that could not. Two
weeks later they
injected the mice with a deadly strain of Escherichia coli — which can cause
loss of water
and salts, damage to blood vessels, and bleeding in
humans — to gauge how prolonged tolerance influences
the animal’s
internal defense mechanisms.
Though almost all of the mice with the
enzyme survived, 90 percent of those without the enzyme died.
“Being
tolerant, or unable to respond normally, made them more susceptible to the E
coli we injected them
with,” Dr. Lu said.
Dr. Munford said
they don’t have any evidence that this finding is applicable to humans, who
also make the
enzyme, but it is possible.
“One theory is
that there is variability among humans in the production of acyloxyacyl
hydrolase,” he said.
“We don’t know this yet, but if it’s true, then
the presence or absence of the enzyme might contribute to the
length of immunosuppression after serious bacterial infections. It
might even be reversible if we could
provide the enzyme or figure
out a way for people to make more of it.”
The team’s next step is to
investigate further how LPS continues to stimulate the host’s immune cells for
such
long periods of time if it does not get degraded. They also
hope to use this animal model to understand
better on a molecular
scale exactly what happens during post-infection
immunosuppression.
Other UT Southwestern researchers involved in the
study were Dr. Alan Varley, assistant professor of
internal
medicine, and John Hardwick, former research associate in internal medicine.
Shoichiro Ohta, a
researcher from Saga Medical School in Japan,
also contributed to the study.
The work was supported by the National
Institute of Allergy and Infectious Diseases.
Visit
http://www.utsouthwestern.org/infectiousdiseases to learn more about
UT
Southwestern’s clinical services in infectious
diseases.
###
Media Contact: Kristen Holland
Shear
214-648-3404
[email protected]
---------------------------------------------------------------
What
is cellulitis?
Cellulitis, what is it?
Cellulitis is an infection
of the skin and underlying tissues that can affect any area of the body. Not to
be
confused with cellulite - the cottage-cheese-like, lumpy fat
often found on the hips, thighs, and buttocks,
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.
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.
Signs and
Symptoms
Cellulitis begins as a small, inflamed area of pain, swelling,
warmth, and redness on skin. As this red area
begins to spread, you
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.
Contagiousness
Cellulitis is
not contagious.
If you 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. If you notice any symptoms, see a doctor
immediately. Cellulitis
can spread and invade the blood system and
become deadly fast.
++++++++++++++++++++++++++++++++
Common
Cellulitis Symptoms by Diane Sievert
Cellulitis symptoms are often
ignored because many people characterize this infection as nothing more than a
rash. As cellulitis symptoms do indeed mirror those of a common
rash, it's perfectly comprehensible how this
mistake could be made.
The main difference between a rash and cellulitis is that cellulitis, since
it's a deep
tissue infection, generally appears near a wound of some
sort.
As cellulitis is an infection, the symptoms associated with it are
those most often associated with various skin
infections. These
symptoms include the following: redness, warmth, swelling and pain. If you have
a wound
or skin trauma of some sort that is exhibiting these common
inflammation symptoms, you may have a case of
cellulitis.
Sometimes noninfected swelling and inflammation
problems are taken to be cellulitis symptoms when they
are in fact
something else entirely. For instance, people who suffer from poor leg
circulation can develop a
condition called "stasis dermatitis" that
is often mistaken for cellulitis because of the scaly red skin it causes.
This, however, is only one of many conditions that is often
misdiagnosed as cellulitis.
Where Do Cellulitis Symptoms Develop?
As
earlier stated, most cases of cellulitis develop near areas of skin trauma. If
you're not sure what
constitutes "skin trauma," it includes
anything from slight scratches to surgical wounds and ulcers. But do be
aware, however, that sometimes cases of cellulitis develop when there
is no skin trauma at all.
TO TRY TO PREVENT CELLULITIS:
Wear
gloves when doing housework, gardening, dealing with pets or sharp objects. In
the winter time,
protect your hands from chapping by using adequate
creams/lotions and wear gloves or mittens.
Wear long sleeves, pants,
shoes, adequate protection from sunburns, scratches, bumps, bruises, etc.
Examine your skin daily to make sure there are no irritations, cuts,
chapping, or breaks. If you do have a
break or irritation, cover
it with an antibiotic cream and gauze bandage if possible. Coving the skin
will
prevent bacteria from entering.
LYMPH NODE
CULTURES
Lymph node culture is a laboratory test performed on a lymph
node to identify organisms (bacteria, viruses,
and fungus) that
cause infection.
A needle aspiration or biopsy of an enlarged lymph
node(swollen gland) is obtained. The fluid is placed in
culture
media and observed for growth in the laboratory. Sometimes special stains are
also done.
The site may be numbed with a local anesthetic before the
node is aspirated. There may be some pain when
the needle is
inserted into the lymph node.
The test may be performed if the cause of
swollen glands is not known, and infection is suspected.
ARE GENERIC
ANTIBIOTICS OK TO TAKE FOR CELLULITIS AND INFECTIONS?
‘You can trust any
generic drug as much as you trust its brand name equivalent'
26 Jun
2005
The white pill on the left will restore a person's health. The
white pill on the right is advertised as being the
same drug, but
it costs half as much.
But are they really the same - and should people
be willing to bet their health on the answer?
James Adams, Ph.D.,
associate professor of molecular pharmacology and toxicology for the USC School
of
Pharmacy, says absolutely - at least in the United States and
Canada.
“You can trust any generic drug as much as you trust its brand
name equivalent,” Adams says. “The U.S.
Food and Drug Administration
is very strict about quality guidelines in the production of medicines and
rarely makes mistakes on that issue. If they find a difference in how
the drug is made or works, they pull it
immediately.”
Generics' lower cost stems from economics, not from
second-rate production of the plain-wrap version.
Generics may not
be made or sold until the manufacturer's patent on the brand-name version
expires, giving
the company time to recoup its investment in the
development and testing of the drug. Once the patent
expires,
different companies can produce generic versions, and the competition drives
down the price.
Because of trademark laws, generic drugs are not
allowed to resemble brand-name drugs too closely, but
Adams
emphasizes that there is no difference in quality or effectiveness.
He
also says that generic drugs purchased in Canada are as good as those from the
U.S. - and they are
often produced locally by American companies or
actually made in the U.S.
Generic drugs from Mexico are more risky. But
if you have a known sample of a pill and the bottle it came
in, and
the pharmacy in Mexico can offer you a pill and bottle that match, Adams says,
“you can usually trust
it.”
http://www.usc.edu/
-----------------------------------------------------------------
Infections
Related to Lymphedema
Introduction
Serious infections that can develop
within the affected tissues are a serious complication associated with
lymphedema. The risk of infection increases when lymphedema is not
controlled by proper treatment and
appropriate precautions.
The
risks of lymphedema related infections are due to:
The swelling of
lymphedema compromises the health of the skin. Healthy intact skin is the
body’s primary
line of defense against invading pathogens. Normal
skin is protected by a film known as the acid mantle. The
acidic
nature of this film discourages such pathogens. When skin is swollen, the acid
mantle is disrupted and
is not as effective in stopping invading
pathogens.
Protein-rich stagnant lymph within these swollen tissues creates
an environment that pathogens love! This
lymph has nutrients that
allow the pathogens to thrive. This stagnant lymph can also contain pathogens
and
damaging toxins that should have been removed by the normal
flow of lymph.
The deep skin folds resulting from the lymphedema are an
ideal breeding ground for fungal infections. The
area within the
folds in warm, moist, and dark. This creates an ideal environment for fungi
such as tinea pedis
(athlete's foot) and tinea cruris (jock
itch).
Cellulitis
Cellulitis (sell-you-LYE-tis), also known as
lymphangitis, is an infection that spreads freely, quickly, and
uncontrollably within the deeper tissues of the skin. Cellulitis
becomes a life-threatening emergency when it
spreads through the
lymphatic or circulatory systems and can reach vital organs and other body
parts. This
type of infection requires prompt treatment with
antibiotics.
Cellulitis is usually caused by the bacteria staphylococcus
aureus that normally live on the skin. Any break in
the skin, no
matter how small, provides an opening for them to march in, multiply, and
thrive. Even a simple
act such as shaving a swollen leg could be an
invitation to infection.
Symptoms of Cellulitis
Malaise (a general sense
of not feeling well)
Flu-like symptoms
Chills and fever
Discoloration
(redness, or streaky red lines)
Rash
Tissues that feel hot and
tender
Sudden swelling
Itching
Pain
Erysipelas
Erysipelas is
visible just below the ankle bone.
Erysipelas (er-ih-SIP-eh-las) is a
painful skin infection that affects the skin plus the subcutaneous tissues and
lymphatic structures that are located just under the skin. This is in contrast to cellulitis which thrives within the
deeper tissues;
however, erysipelas also requires prompt treatment with
antibiotics.
Erysipelas is caused by the bacteria Streptococci. These
pathogens, which normally live harmlessly on the
skin, can enter
through any break in the skin such as a scratch, pinprick, or the cracks caused
by athlete’s
foot.
Erysipelas invades rapidly and spreads
through the lymphatic vessels. This damages the lymph vessels and
increases the formation of fibrosis in the affected tissues. This
damage further disrupts the flow of lymph.
Erysipelas, which is one of the
most common complications of lymphedema, tends to recur and there
appears to be a correlation between the frequency of erysipelas
infection and the stage of lymphedema.
Symptoms of Erysipelas
An
expanding area of redness of the skin that most often occurs in the region of
the ankle
Itching
Pain High fever, and chills
Swelling and tenderness
of the regional lymph nodes.
Lymphangitis
Lymphangitis (lim-fan-JIGH-tis)
is an infection involving the lymphatic vessels that is most commonly caused
by the spreading of an acute streptococcal or staphylococcal
infection of the skin. The presence of
lymphangitis suggests that
an infection is progressing and should raise concerns of spread of bacteria to
the
bloodstream.
Known as sepsis, a bacterial infection in the
bloodstream can spread to all of the body systems within a
matter
of hours. Therefore, at the first signs of lymphangitis, you should seek
medical treatmentimmediately .
Symptoms of Lymphangitis
Malaise, loss of
appetite, headache, and muscle aches
Red streaks from infected area to the
armpit or groin (These may be faint or obvious)
Swollen lymph
nodes
Chills and fever
Fungal Infections
Fungal infections occur most
often when the genitalia, legs and feet are affected by stage 2 or stage 3
lymphedema.
Athlete’s Foot, which is caused by the fungus tinea
pedis, occurs on the feet and between the toes. Jock
itch, which is
caused by the fungus tinea cruris, thrives in the genital area. These
infections occur when the
right combination of conditions exists
including
A warm, dark humid environment, such as between the toes.
Any
change in the health of the skin.
Lowering of the body's natural
resistance.
Tinea Pedis Symptoms
Pain, burning, and itching
Drying,
cracking, and scaling of the skin
Blistering
Swelling
These infections
are difficult to treat and prevention is the best approach. This includes:
maintain cleanliness
by changing shoes and socks as often as
necessary; controlling moisture by using an antiperspirant powder
or spray; and routinely using an antifungal ointment, and/or powder as
recommended by your healthcare
provider.
Jock itch can be treated
with over-the-counter ointments; however, it is advisable to see your physician
for
professional advice. Once the condition is under control,
antifungal powders or sprays may be
recommended for daily use as a
preventive measure.
http://www.lymphnotes.com/article.php/id/323/
...............................................................................
Necrotizing
Fasciitis and Lymphedema
Introduction
Necrotizing fasciitis (NF) is a
bacterial infection caused by a Group A streptococcus. These bacteria usually
cause relatively mild illnesses such as a strep throat. On very rare
occasions, these bacteria cause the severe
and life-threatening
disease known as NF. [1]
NF, commonly known as flesh-eating bacteria, can
destroy the skin, the fat under the skin, and the adjacent
muscle
tissues. It also produces gangrene-like tissue changes resulting in tissue
death, body system failure,
and frequently death.
Those who
survive the initial infection, the severe skin and soft tissue damage produced
by NF can cause
secondary lymphedema to develop. The lymphedema is
caused by the disruption of the normal functioning
of the lymphatic
system in the affected tissues.
Lymphedema Does Not Cause NF
Lymphedema
is the result of damage to the lymphatic system caused by the NF related tissue
destruction.
Although those with lymphedema are at high risk of
developing an infection, cellulitis is the infection most
commonly
associated with lymphedema.
Cellulitis and NF are not the same. One
difference is that cellulitis travels through the blood and lymphatic
systems
and can damage tissues distant from the original wound. Another difference is
that NF is a rare
infection.
Despite the differences, cellulitis
is still a dangerous infection and is a medical emergency that requires
prompt medical treatment. To learn more read the article titled
Cellulitis.
Prevention
One common factor shared by NF and cellulitis is
that they enter the body through even the smallest break
in the
skin. The skin care precautions you take because of lymphedema also help to
protect you from other
bacterial infections that invade through a
break in the skin.
Michael’s Story
The onset and treatment of NF is best
described as a nightmare. To better understand this, read Michael’s
story, which was posted by a Lymph Notes member.
For more
information visit the National Necrotizing Fasciitis Foundation web
site.
...........................................................................................
Antibiotics:
When They Can and Can't Help
What are antibiotics?
Antibiotics are
strong medicines that can stop some infections and
save lives. But
antibiotics can cause more harm than good when they
aren't used the right
way. You can protect yourself and your family
by knowing when you should use
antibiotics and when you shouldn't.
Do antibiotics work against all
infections?
No. Antibiotics only work against infections caused by bacteria.
They
don't work against any infections caused by viruses. Viruses
cause
colds, the flu, and most coughs and sore throats.
What is
"bacterial resistance"?
Usually antibiotics kill bacteria or stop them from
growing. However,
some bacteria have become resistant to specific
antibiotics. This
means that the antibiotics don't work against them.
Bacteria become
resistant more quickly when antibiotics are used too often
or are not
used correctly.
Resistant bacteria sometimes can be
treated with different
antibiotics to which the bacteria have not yet become
resistant.
These medicines may have to be given intravenously (through a
vein)
in a hospital. A few kinds of resistant bacteria are
untreatable.
What can I do to help myself and my family?
Don't expect
antibiotics to cure every illness. Don't take
antibiotics for viral
illnesses like colds or the flu. Often, the
best thing you can do is let
colds and the flu run their course.
Sometimes this can take 2 weeks or more.
If your illness gets worse
after 2 weeks, talk to your doctor. He or she can
also give you
advice on what you can do to ease your symptoms while your
body
fights off the virus.
How do I know when I need antibiotics?
The
answer depends on what is causing your infection. The following
are some
basic guidelines:
Colds and flu. Viruses cause these illnesses. They
can't be cured
with antibiotics.
Cough or bronchitis. Viruses almost
always cause these. However, if
you have a problem with your lungs or an
illness that lasts a long
time, bacteria may actually be the cause. Your
doctor may decide to
try using an antibiotic.
Sore throat. Most sore
throats are caused by viruses and don't need
antibiotics. However, strep
throat is caused by bacteria. Usually
you'll have a throat swab and a lab
test before your doctor will
prescribe an antibiotic for strep
throat.
Ear infections. There are several types of ear
infections.
Antibiotics are used for some, but not all, ear
infections.
Sinus infections. Antibiotics are often used to treat
sinus
infections. However, a runny nose and yellow or green mucus do
not
necessarily mean you need an antibiotic.
Source: http://familydoctor.org/680.xml
American Academy of Family
Physicians
............................................................................
British
Lymphoedema Society Consensus
Consensus Document on the Management of
Cellulitis in Lymphoedema
Cellulitis is an acute spreading inflammation
of the skin and subcutaneous tissues characterised by pain,
warmth,
swelling and erythema. In lymphoedema, attacks are variable in presentation
and, because of
differences from classical cellulitis, are often
called acute inflammatory episodes. Cellulitis will be the term
used here (related terms: erysipelas, lymphangitis). Most episodes are
believed to be caused by Group A
Streptococci.
Some episodes
are accompanied by severe systemic upset, with high fever or rigors; others are
milder, with
minimal or no fever. Increased swelling of the affected
area may occur. Inflammatory markers (CRP, ESR)
may be raised. It
is difficult to predict response to treatment.
This document makes
recommendations about the use of antibiotics for cellulitis in patients with
lymphoedema, and advises when admission to hospital is indicated.
Prompt treatment is essential to avoid
further damage to the
affected part which in turn may predispose to repeated attacks.
1. ACUTE
ATTACK OF CELLULITIS
1.1 A decision whether hospital admission is
indicated should be based on the level of systemic upset:
* signs of
septicaemia (hypotension, tachycardia, severe pyrexia, confusion, tachypnoea or
vomiting) are an
absolute indication for admission;
* continuing
or deteriorating systemic signs, with or without deteriorating local signs,
after 48hrs of antibiotic
treatment;
* un-resolving or
deteriorating local signs, with or without systemic signs, despite trials of
first and second
line antibiotics.
1.2. Management at
home
1.2.1. It is essential that the patient is closely monitored,
ideally by the GP. To establish a baseline to
monitor progress,
record:
* extent and severity of rash - if possible, mark and date the
edge of the erythema (may be difficult in
lymphoedema as the rash is
often blotchy);
* level of systemic upset;
* CRP/ESR/white cell
count;
* Microbiology of any cuts or breaks in the skin before antibiotics
are started.
1.2.2. Oral amoxicillin 500mg 8-hourly is the treatment of
choice. If there is any evidence of Staph aureus
infection e.g.
folliculitis, pus formation or crusted dermatitis, then flucloxacillin 500mg
6-hourly should be
prescribed in addition.
1.2.3. Patients
who are allergic to penicillin should be prescribed clindamycin as in
1.2.4.
1.2.4. If there is no or a poor response (unresolving
inflammation or development of systemic symptoms) to
oral
amoxicillin after 48 hours, then clindamycin 300mg 6-hourly should be
substituted as second line oral
treatment.
1.2.5.
Antibiotics should be continued until all signs of acute inflammation have
resolved; this often means
taking antibiotics for 1-2 months and
the course of antibiotics should be for no less than 14 days from the
time
a definite clinical response is observed.
1.2.6. Bed rest and elevation
of the affected part is essential. Avoid compression garments during the acute
attack.
1.2.7. Appropriate analgesia, e.g. paracetamol, as
necessary.
1.2.8. When the inflammation is sufficiently reduced, wearing
of compression garments and normal levels of
exercise may resume. A
return to work depends on the patient's occupation, and there being no
deterioration when normal levels of exercise are
established.
1.3. Management in hospital
1.3.1. Choice of
antibiotics in hospital is largely dependent on local rules. Recommended first
line treatment
is amoxicillin 2g 8-hourly iv plus gentamicin 5mg/kg
iv daily; dose to be adjusted according to renal function
and
assay. Benzylpenicillin 1.2-2.4g 6-hourly may be preferred to the amoxicillin.
Convention is to use a
combination of benzylpenicillin and
flucloxacillin, however, doubts about the role of Staph aureus in cellulitis
make this combination less certain.
1.3.2. If there is no or
a poor response to this combination after 48 hours, clindamycin 600mg 6-hourly
iv
should be substituted for both.
1.3.3. Penicillin
allergic patients should receive clindamycin as in 1.3.2.
1.3.4. A
switch to oral treatment with amoxicillin 500mg 8-hourly, or clindamycin 300mg
6-hourly should
not be made before:
* Inflammation much
resolved;
* CRP falling.
then continue as in 1.2.5.
1.4.
Antibiotics “in case”
1.4.1. The risk of further attacks of cellulitis
in lymphoedema is high. It is recommended that patients who
have
had an attack of cellulitis should carry a two week supply of antibiotics with
them particularly when
away from home for any length of time, e.g.
on holiday. Amoxicillin 500mg tds is recommended or, for those
allergic to penicillin, clindamycin 300mg 6-hourly. Antibiotics should
be started immediately familiar
symptoms of cellulitis start but a
medical opinion should be sought as soon as possible.
2. RECURRENT
CELLULITIS
2.1. Antibiotic prophylaxis should be offered to patients who
have two or more attacks of cellulitis per year.
Penicillin V 500mg
daily (1g if weight >75kg) should be the first choice. The dose may be
reduced to
250mg daily after one year of successful prophylaxis.
Prophylaxis may need to be life-long if relapse occurs
when
antibiotics are discontinued after a two year period of successful prophylaxis.
For those allergic to
penicillin, erythromycin 250mg daily is
recommended; if this is not tolerated then clarithromycin 250mg daily
is
an alternative.
2.2. There is evidence that decongestive lymphatic
therapy reduces the frequency of attacks. Control of the
swelling is
therefore important. Patients undergoing intensive DLT and known to have
suffered cellulitis in the
past may benefit from antibiotic cover
in case cellulitis is provoked. Oral penicillin V 500mg daily is
recommended during the period of the intensive treatment. For those
allergic to penicillin, erythromycin is
advised (as in
2.1).
2.3. Apart from the swelling other risk factors for recurrent
cellulitis including cracked, macerated, inter-
digital skin,
dermatitis, open wounds including leg ulcers, and weeping lymphangiectasia
(leaking lymph
blisters on the skin surface) should be treated.
Treatment of inter-digital fungus should be with application of
terbinafine cream daily for two weeks.
2.4. Those patients in
whom first line antibiotic prophylaxis fails may need alternative strategies
including
trials of prophylactic clindamycin 150mg daily or
clarithromycin 250mg daily. Unusual circumstances, e.g.
animal bite
or lick, preceding an attack, or a failure of infection to respond to above
recommendations,
should prompt discussions with local
microbiologist.
Consensus Panel:
Professor Peter S. Mortimer,
Consultant Dermatologist at the Royal Marsden and St George's Hospitals,
London
Dr Christopher Cefai, Senior Lecturer in Microbiology,
North East Wales Trust
Dr Vaughan Keeley, Consultant in Palliative
Medicine, Derby Hospitals NHS Foundation Trust
Professor John Welsh,
Consultant in Palliative Medicine, Beatson Oncology Centre,
Greater
Glasgow NHS
Dr Robert Twycross, Emeritus Clinical Reader in Palliative
Medicine, Oxford University
Dr Andrew Hughes, Consultant in Palliative
Medicine, St Oswald's Hospice, Newcastle
Dr Caroline Cooke, Consultant
in Palliative Medicine, The Leicestershire Hospice (LOROS) Dr Ellie Bond,
Staff Grade Doctor in Palliative Medicine, St Oswald's Hospice,
Newcastle
Dr Sue Rudd, Staff Grade Doctor in Palliative Medicine, Derby
Hospitals NHS Foundation Trust
LSN Trustees
Published in February
2007 by the British Lymphology Society and the Lymphoedema Support
Network.
We welcome any comments from users (to be directed to
[email protected]).
The document will be revised in October
2007.
Reproduction of this information by individual hospital trusts is
permitted; however, the following statement
must be included in all
publications.
'This information is based on a Consensus Document
produced by medical experts and facilitated by the
Lymphoedema
Support Network. The document, originally produced in October 2005, is jointly
owned by
the British Lymphology Society and the Lymphoedema Support
Network'
The LSN has produced a new fact sheet based on the Consensus
Document, 'Management of Cellulitis in
Lymphoedema'.
Order
forms are available on the LSN website or from the LSN office.
Website:
www.lymphoedema.org/lsn
Tel: 020 7351
0990
Just an interesting tidbit on infections not yet cellulitis:
Pomegranate rind mixed with metal
salts can be used to create an ointment that is effective in treating
common
hospital infections.
A study out of Kingston University in London showed
that when pomegranate rind was combined with
metal salts and/or
vitamin C, it was effective in treating common hospital infections such as
methicillin-
resistant Staphlyoccus aureus (MRSA) bacteria. MRSA, as
defined by theNational Institute of Allergy
and Infectious
Diseases, is “largely a hospital-acquired infection” and is resistant to some
antibiotics.
The details of the study were outlined in an article in
ScienceDaily. According to the article, tests were
performed over a
three year period using microbes such as MRSA from hospital patients. In
treating
MRSA, pomegranate rind combined with metal salts without
vitamin C was most effective, however, in
treating other common
hospital infections, pomegranate rind mixed with metal salts and vitamin C was
most effective.
Project team leader, Declan Naughton, said, “The
increase in drug-resistant infections found in hospitals
made our
research topical and pressing. The idea of using foodstuff is unusual and means
that the body
should be able to cope more easily with its
application; patients are less likely to experience any major
side
effects.”
June 17, 2011
Lyme Disease
Bacteria Take Cover In Lymph Nodes
The bacteria that cause Lyme disease,
one of the most important emerging diseases in the United States,
appear to hide out in the lymph nodes, triggering a significant immune
response, but one that is not strong
enough to rout the infection,
report researchers at the University of California, Davis.
Results from
this groundbreaking study involving mice may explain why some people experience
repeated
infections of Lyme disease. The study appears online in
the journal Public Library of Science Biology..
"Our findings suggest for the first time that Borrelia burgdorferi, the bacteria that cause Lyme disease in
people, dogs and wildlife, have developed a novel
strategy for subverting the immune response of the
animals they
infect," said Professor Nicole Baumgarth, an authority on immune responses at
the UC Davis
Center for Comparative Medicine.
"At first it
seems counter intuitive that an infectious organism would choose to migrate to
the lymph nodes
where it would automatically trigger an immune
response in the host animal," Baumgarth said. "But B.
burgdorferi
have apparently struck an intricate balance that allows the bacteria to both
provoke and elude
the animal's immune response."
About Lyme
disease
Lyme disease, the most important tick-borne disease in the
United States is caused by Borrelia
burgdorferi, corkscrew-shaped
bacteria also known as spirochetes. The disease is transmitted to humans
and animals through bites from infected deer ticks.
The disease
occurs mainly in the Northeastern and Great Lakes states, and is present to a
lesser extent in
Northern California. However, the western
black-legged tick, the main carrier of Lyme disease in the
western
United States, has been found in 56 of California's 58 counties, according to
the California
Department of Public Health.
Symptoms of Lyme
disease are quite variable and may include fever, headache, fatigue and a skin
rash. If
the infection is not treated, it can spread to the joints,
heart and nervous system.
Usually, Lyme disease can be successfully
treated with about four weeks of antibiotics; treatment is most
successful during the early stages of infection.
The UC Davis
study
Swollen lymph nodes, or lymphadenopathy, is one of the hallmarks
of Lyme disease, although it has been
unclear why this occurs or how
it affects the course of the disease. The UC Davis research team set out to
explore in mice the mechanisms that cause the enlarged lymph nodes and
to determine the nature of the
resulting immune
response.
They found that when mice were infected with B. burgdorferi,
these live spirochetes accumulated in the
animals' lymph nodes. The
lymph nodes responded with a strong, rapid accumulation of B cells, white
blood cells that produce antibodies to fight infections. Also, the
presence of B. burgdorferi caused the
destruction of the distinct
architecture of the lymph node that usually helps it to function
normally.
While B cells accumulated in large numbers and made some
specific antibodies against B. burgdorferi, they
did not form
"germinal centers," structures that are needed for the generation of highly
functional and long-
lived antibody responses.
"Overall,
these findings suggest that B. burgdorferi hinder the immune system from
generating a response
that is fully functional and that can persist
and protect after repeat infections," Baumgarth said. "Thus, the
study might explain why people living in endemic areas can be
repeatedly infected with these disease-
causing
spirochetes."
Notes:
In addition to Baumgarth, members of the UC
Davis research team include Stephen Barthold, director of
the Center
for Comparative Medicine; Emir Hodzic, director of the Real-Time PCR Research
and
Diagnostics Core Facility; staff scientist Sunlian Feng;
graduate student Christine Hastey; and Stefan
Tunev, formerly of
the Center for Comparative Medicine and now at Medtronic Inc.
Funding
for the study was provided by the National Institute of
Health.
Source:
Patricia Bailey
University of California –
Davis
Good resource
for reading more on cellulitis
http://www.nfsuk.org.uk/strepcg2.php
2012
[Article in Spanish]
Lasa JS, Fernández Recalde ML, Finn BC, Bruetman JE, Peroni J, Young P.
Source
Servicio de Clínica Médica, Hospital Británico de Buenos Aires.
Abstract
Cellulitis is an acute inflammation of dermis and subcutaneous tissue, usually complicating wounds, ulcers, or dermatosis. Even though in these cases it is recommended to perform culture from skin and soft tissue samples, the utility of blood cultures remains controversial due to the low frequency of positive results. Here we report the prevalence of bacteremia in patients with cellulitis admitted in our Hospital, and evaluate the presence of risk factors associated with the occurrence of this event.
Clinical records of patients with diagnosis of cellulitis admitted between June 2007 and March 2010 were retrospectively reviewed.
Patients without skin and soft tissue culture and/or blood cultures were excluded. Demographic data, presence of comorbidities, and culture results were analyzed. In this period, 140 patients were admitted with this diagnosis. Fifty six (40%) of them had positive skin and soft tissue cultures; where methicillin resistant Staphylococcus aureus (MRSA) was the most frequently isolated bacterium species (35.7%).
Bacteremia was detected in 8.6% of these cases, where the most frequently isolated bacteria were Group G Beta haemolytic Streptococcus (33%). Bacteremia was significantly associated with longer hospital stay (10.5 ± 8.98 vs. 4.9 ± 6, p = 0.004).
The following variables were significantly associated with the occurrence of positive blood cultures: diabetes (41.7% vs. 14.1%; p = 0.02; OR 4.4), positive skin and soft tissue culture (75% vs. 35.2%; p = 0.01; OR 5.5), alcoholism (16.7% vs. 3.9%; p = 0.01; OR 4.9), and chronic obstructive pulmonary disease (16.7% vs. 0.78%; p = 0.01; OR 25.4).
http://www.medicinabuenosaires.com/PMID/22892081.pdf
or
http://www.ncbi.nlm.nih.gov/pubmed/22892081
Codes for
Cellulitis
Arm
682.3
Finger 681.00
Foot 682.7
Hand 682.4
Leg
682.6
Neck 682.1
Toe 682.10
Torso 682.2
THESE
LETTERS MAY REFER TO:
C COMBINED, COMPLETE, OR COMPLEX
D
DECONGESTIVE
P PHYSIOTHERAPY OR PHYSICAL THERAPY
L
LYMPHEDEMA OR LYMPHATIC
ABBREVIATIONS
CDP COMPLETE OR
COMPLEX DECONGESTIVE PHYSIOTHERAPY (USED BY
MEDICARE
FLORIDA)
CPDT COMPLEX PHYSICAL DEONGESTIVE THERAPY (FOLDI,
GERMANY)
CPT COMPLEX PHYSICAL THERAPY (CASLEY-SMITH, AUSTRALIA
1980)
CLT COMPLEX LYMPHATIC THERAPY (CASLEY-SMITH,
AUSTRALIA)
CDT COMBINED DECONGESTIVE THERAPY (VODDER)
LT
LYMPHEDEMA THERAPY
LMT LYMPHEDEMA MULTIMODAL THERAPY
* NOTE IT ALSO STANDS FOR LICENSED MASSAGE THERAPY/THERAPIST
AS WELL
MLD MANUAL LYMPH DRAINAGE (ORIGINALLY
VODDER)
MLT MANUAL LYMPH/LYMPHATIC THERAPY/TREATMENT/TECHNIQUE
(USED IN
SCIENTIFIC MAGAZINES)
LDT LYMPH
DRAINAGE THERAPY (CHIKLY)
MLDT MANUAL LYMPH DRAINAGE THERAPY, A
COMBINATION OF THE ABOVE
THE FOLLOWING TERMS SHOULD NOT BE USED IF
POSSIBLE
LM LYMPHATIC MASSAGE
LDM LYMPHATIC DRAINAGE
MASSAGE
MLM MANUAL LYMPHATIC MASSAGE
MLDM MANUAL LYMPH DRAINAGE
MASSAGE
THE WORD "MASSAGE" IS MISLEADING TO PATIENTS AND INSURANCE IN
DESCRIBING
THE LIGHT AND SPECIFIC TOUCH OF LYMPHATIC
DRAINAGE.
---------------------------------------------------------
Killing bacteria isn't enough to
restore immune function after infection, researchers find
http://www.utsouthwestern.edu/utsw/cda/dept353744/files/486618.html
DALLAS — Sept. 10,
2008 — A bacterial molecule that initially signals to animals that they have
been
invaded must be wiped out by a special enzyme before an
infected animal can regain full health, researchers
at UT
Southwestern Medical Center have found.
Using a genetically engineered
mouse model, the team found that simply eradicating the infection-causing bug
isn’t enough to restore an animal’s immune function.
Lipopolysaccharide, or LPS, the dominant bacterial
“signal”
molecule that heralds the invasion, must also be inactivated. The findings are
to appear online Sept.
11 in Cell Host & Microbe.
“We
think this is the first evidence that killing the causative agent of a
bacterial infection isn’t enough for an
animal to recover fully,”
said Dr. Robert Munford, professor of internal medicine and microbiology, and
senior author of the study. “You’ve got to get rid of this molecule
that the host is responding to or else its
immune system remains
suppressed.”
Drs. Mingfang Lu (left) and Robert
Munford.
--------------------------------------------------------------------------------
By
sensing and responding to LPS, animals mobilize their defenses to attack and
kill the bacteria. This
immune response also causes inflammation in
the host. For a few days after the infection begins, however, an
animal’s ability to sense the bacteria is turned down, presumably to
prevent further inflammation. In the
current study, the researchers
found that mice didn’t recover from this “tolerant” period unless the LPS was
inactivated by acyloxyacyl hydrolase, an enzyme discovered in 1983
by Dr. Munford and Dr. Catherine
Hall, now an assistant professor
of internal medicine at UT Southwestern.
Dr. Mingfang Lu, instructor of
internal medicine and lead author of the current study, said the team also
found that prolonged tolerance was immunosuppressive, reducing the
animal’s ability to stave off another
bacterial
infection.
Dr. Lu said that how long an animal remains in this tolerant
state varies from animal to animal. “But mice that
can’t make the
enzyme acyloxyacyl hydrolase seem to stay tolerant forever, leaving them unable
to fight
additional infections,” she said.
For the study,
researchers injected LPS or a common bacterium that makes LPS into the abdomens
of two
types of mice: ones that could produce the acyloxyacyl
hydrolase enzyme and ones that could not. Two
weeks later they
injected the mice with a deadly strain of Escherichia coli — which can cause
loss of water
and salts, damage to blood vessels, and bleeding in
humans — to gauge how prolonged tolerance influences
the animal’s
internal defense mechanisms.
Though almost all of the mice with the
enzyme survived, 90 percent of those without the enzyme died.
“Being
tolerant, or unable to respond normally, made them more susceptible to the E
coli we injected them
with,” Dr. Lu said.
Dr. Munford said
they don’t have any evidence that this finding is applicable to humans, who
also make the
enzyme, but it is possible.
“One theory is
that there is variability among humans in the production of acyloxyacyl
hydrolase,” he said.
“We don’t know this yet, but if it’s true, then
the presence or absence of the enzyme might contribute to the
length of immunosuppression after serious bacterial infections. It
might even be reversible if we could
provide the enzyme or figure
out a way for people to make more of it.”
The team’s next step is to
investigate further how LPS continues to stimulate the host’s immune cells for
such
long periods of time if it does not get degraded. They also
hope to use this animal model to understand
better on a molecular
scale exactly what happens during post-infection
immunosuppression.
Other UT Southwestern researchers involved in the
study were Dr. Alan Varley, assistant professor of
internal
medicine, and John Hardwick, former research associate in internal medicine.
Shoichiro Ohta, a
researcher from Saga Medical School in Japan,
also contributed to the study.
The work was supported by the National
Institute of Allergy and Infectious Diseases.
Visit
http://www.utsouthwestern.org/infectiousdiseases to learn more about
UT
Southwestern’s clinical services in infectious
diseases.
###
Media Contact: Kristen Holland
Shear
214-648-3404
[email protected]
---------------------------------------------------------------
What
is cellulitis?
Cellulitis, what is it?
Cellulitis is an infection
of the skin and underlying tissues that can affect any area of the body. Not to
be
confused with cellulite - the cottage-cheese-like, lumpy fat
often found on the hips, thighs, and buttocks,
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.
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.
Signs and
Symptoms
Cellulitis begins as a small, inflamed area of pain, swelling,
warmth, and redness on skin. As this red area
begins to spread, you
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.
Contagiousness
Cellulitis is
not contagious.
If you 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. If you notice any symptoms, see a doctor
immediately. Cellulitis
can spread and invade the blood system and
become deadly fast.
++++++++++++++++++++++++++++++++
Common
Cellulitis Symptoms by Diane Sievert
Cellulitis symptoms are often
ignored because many people characterize this infection as nothing more than a
rash. As cellulitis symptoms do indeed mirror those of a common
rash, it's perfectly comprehensible how this
mistake could be made.
The main difference between a rash and cellulitis is that cellulitis, since
it's a deep
tissue infection, generally appears near a wound of some
sort.
As cellulitis is an infection, the symptoms associated with it are
those most often associated with various skin
infections. These
symptoms include the following: redness, warmth, swelling and pain. If you have
a wound
or skin trauma of some sort that is exhibiting these common
inflammation symptoms, you may have a case of
cellulitis.
Sometimes noninfected swelling and inflammation
problems are taken to be cellulitis symptoms when they
are in fact
something else entirely. For instance, people who suffer from poor leg
circulation can develop a
condition called "stasis dermatitis" that
is often mistaken for cellulitis because of the scaly red skin it causes.
This, however, is only one of many conditions that is often
misdiagnosed as cellulitis.
Where Do Cellulitis Symptoms Develop?
As
earlier stated, most cases of cellulitis develop near areas of skin trauma. If
you're not sure what
constitutes "skin trauma," it includes
anything from slight scratches to surgical wounds and ulcers. But do be
aware, however, that sometimes cases of cellulitis develop when there
is no skin trauma at all.
TO TRY TO PREVENT CELLULITIS:
Wear
gloves when doing housework, gardening, dealing with pets or sharp objects. In
the winter time,
protect your hands from chapping by using adequate
creams/lotions and wear gloves or mittens.
Wear long sleeves, pants,
shoes, adequate protection from sunburns, scratches, bumps, bruises, etc.
Examine your skin daily to make sure there are no irritations, cuts,
chapping, or breaks. If you do have a
break or irritation, cover
it with an antibiotic cream and gauze bandage if possible. Coving the skin
will
prevent bacteria from entering.
LYMPH NODE
CULTURES
Lymph node culture is a laboratory test performed on a lymph
node to identify organisms (bacteria, viruses,
and fungus) that
cause infection.
A needle aspiration or biopsy of an enlarged lymph
node(swollen gland) is obtained. The fluid is placed in
culture
media and observed for growth in the laboratory. Sometimes special stains are
also done.
The site may be numbed with a local anesthetic before the
node is aspirated. There may be some pain when
the needle is
inserted into the lymph node.
The test may be performed if the cause of
swollen glands is not known, and infection is suspected.
ARE GENERIC
ANTIBIOTICS OK TO TAKE FOR CELLULITIS AND INFECTIONS?
‘You can trust any
generic drug as much as you trust its brand name equivalent'
26 Jun
2005
The white pill on the left will restore a person's health. The
white pill on the right is advertised as being the
same drug, but
it costs half as much.
But are they really the same - and should people
be willing to bet their health on the answer?
James Adams, Ph.D.,
associate professor of molecular pharmacology and toxicology for the USC School
of
Pharmacy, says absolutely - at least in the United States and
Canada.
“You can trust any generic drug as much as you trust its brand
name equivalent,” Adams says. “The U.S.
Food and Drug Administration
is very strict about quality guidelines in the production of medicines and
rarely makes mistakes on that issue. If they find a difference in how
the drug is made or works, they pull it
immediately.”
Generics' lower cost stems from economics, not from
second-rate production of the plain-wrap version.
Generics may not
be made or sold until the manufacturer's patent on the brand-name version
expires, giving
the company time to recoup its investment in the
development and testing of the drug. Once the patent
expires,
different companies can produce generic versions, and the competition drives
down the price.
Because of trademark laws, generic drugs are not
allowed to resemble brand-name drugs too closely, but
Adams
emphasizes that there is no difference in quality or effectiveness.
He
also says that generic drugs purchased in Canada are as good as those from the
U.S. - and they are
often produced locally by American companies or
actually made in the U.S.
Generic drugs from Mexico are more risky. But
if you have a known sample of a pill and the bottle it came
in, and
the pharmacy in Mexico can offer you a pill and bottle that match, Adams says,
“you can usually trust
it.”
http://www.usc.edu/
-----------------------------------------------------------------
Infections
Related to Lymphedema
Introduction
Serious infections that can develop
within the affected tissues are a serious complication associated with
lymphedema. The risk of infection increases when lymphedema is not
controlled by proper treatment and
appropriate precautions.
The
risks of lymphedema related infections are due to:
The swelling of
lymphedema compromises the health of the skin. Healthy intact skin is the
body’s primary
line of defense against invading pathogens. Normal
skin is protected by a film known as the acid mantle. The
acidic
nature of this film discourages such pathogens. When skin is swollen, the acid
mantle is disrupted and
is not as effective in stopping invading
pathogens.
Protein-rich stagnant lymph within these swollen tissues creates
an environment that pathogens love! This
lymph has nutrients that
allow the pathogens to thrive. This stagnant lymph can also contain pathogens
and
damaging toxins that should have been removed by the normal
flow of lymph.
The deep skin folds resulting from the lymphedema are an
ideal breeding ground for fungal infections. The
area within the
folds in warm, moist, and dark. This creates an ideal environment for fungi
such as tinea pedis
(athlete's foot) and tinea cruris (jock
itch).
Cellulitis
Cellulitis (sell-you-LYE-tis), also known as
lymphangitis, is an infection that spreads freely, quickly, and
uncontrollably within the deeper tissues of the skin. Cellulitis
becomes a life-threatening emergency when it
spreads through the
lymphatic or circulatory systems and can reach vital organs and other body
parts. This
type of infection requires prompt treatment with
antibiotics.
Cellulitis is usually caused by the bacteria staphylococcus
aureus that normally live on the skin. Any break in
the skin, no
matter how small, provides an opening for them to march in, multiply, and
thrive. Even a simple
act such as shaving a swollen leg could be an
invitation to infection.
Symptoms of Cellulitis
Malaise (a general sense
of not feeling well)
Flu-like symptoms
Chills and fever
Discoloration
(redness, or streaky red lines)
Rash
Tissues that feel hot and
tender
Sudden swelling
Itching
Pain
Erysipelas
Erysipelas is
visible just below the ankle bone.
Erysipelas (er-ih-SIP-eh-las) is a
painful skin infection that affects the skin plus the subcutaneous tissues and
lymphatic structures that are located just under the skin. This is in contrast to cellulitis which thrives within the
deeper tissues;
however, erysipelas also requires prompt treatment with
antibiotics.
Erysipelas is caused by the bacteria Streptococci. These
pathogens, which normally live harmlessly on the
skin, can enter
through any break in the skin such as a scratch, pinprick, or the cracks caused
by athlete’s
foot.
Erysipelas invades rapidly and spreads
through the lymphatic vessels. This damages the lymph vessels and
increases the formation of fibrosis in the affected tissues. This
damage further disrupts the flow of lymph.
Erysipelas, which is one of the
most common complications of lymphedema, tends to recur and there
appears to be a correlation between the frequency of erysipelas
infection and the stage of lymphedema.
Symptoms of Erysipelas
An
expanding area of redness of the skin that most often occurs in the region of
the ankle
Itching
Pain High fever, and chills
Swelling and tenderness
of the regional lymph nodes.
Lymphangitis
Lymphangitis (lim-fan-JIGH-tis)
is an infection involving the lymphatic vessels that is most commonly caused
by the spreading of an acute streptococcal or staphylococcal
infection of the skin. The presence of
lymphangitis suggests that
an infection is progressing and should raise concerns of spread of bacteria to
the
bloodstream.
Known as sepsis, a bacterial infection in the
bloodstream can spread to all of the body systems within a
matter
of hours. Therefore, at the first signs of lymphangitis, you should seek
medical treatmentimmediately .
Symptoms of Lymphangitis
Malaise, loss of
appetite, headache, and muscle aches
Red streaks from infected area to the
armpit or groin (These may be faint or obvious)
Swollen lymph
nodes
Chills and fever
Fungal Infections
Fungal infections occur most
often when the genitalia, legs and feet are affected by stage 2 or stage 3
lymphedema.
Athlete’s Foot, which is caused by the fungus tinea
pedis, occurs on the feet and between the toes. Jock
itch, which is
caused by the fungus tinea cruris, thrives in the genital area. These
infections occur when the
right combination of conditions exists
including
A warm, dark humid environment, such as between the toes.
Any
change in the health of the skin.
Lowering of the body's natural
resistance.
Tinea Pedis Symptoms
Pain, burning, and itching
Drying,
cracking, and scaling of the skin
Blistering
Swelling
These infections
are difficult to treat and prevention is the best approach. This includes:
maintain cleanliness
by changing shoes and socks as often as
necessary; controlling moisture by using an antiperspirant powder
or spray; and routinely using an antifungal ointment, and/or powder as
recommended by your healthcare
provider.
Jock itch can be treated
with over-the-counter ointments; however, it is advisable to see your physician
for
professional advice. Once the condition is under control,
antifungal powders or sprays may be
recommended for daily use as a
preventive measure.
http://www.lymphnotes.com/article.php/id/323/
...............................................................................
Necrotizing
Fasciitis and Lymphedema
Introduction
Necrotizing fasciitis (NF) is a
bacterial infection caused by a Group A streptococcus. These bacteria usually
cause relatively mild illnesses such as a strep throat. On very rare
occasions, these bacteria cause the severe
and life-threatening
disease known as NF. [1]
NF, commonly known as flesh-eating bacteria, can
destroy the skin, the fat under the skin, and the adjacent
muscle
tissues. It also produces gangrene-like tissue changes resulting in tissue
death, body system failure,
and frequently death.
Those who
survive the initial infection, the severe skin and soft tissue damage produced
by NF can cause
secondary lymphedema to develop. The lymphedema is
caused by the disruption of the normal functioning
of the lymphatic
system in the affected tissues.
Lymphedema Does Not Cause NF
Lymphedema
is the result of damage to the lymphatic system caused by the NF related tissue
destruction.
Although those with lymphedema are at high risk of
developing an infection, cellulitis is the infection most
commonly
associated with lymphedema.
Cellulitis and NF are not the same. One
difference is that cellulitis travels through the blood and lymphatic
systems
and can damage tissues distant from the original wound. Another difference is
that NF is a rare
infection.
Despite the differences, cellulitis
is still a dangerous infection and is a medical emergency that requires
prompt medical treatment. To learn more read the article titled
Cellulitis.
Prevention
One common factor shared by NF and cellulitis is
that they enter the body through even the smallest break
in the
skin. The skin care precautions you take because of lymphedema also help to
protect you from other
bacterial infections that invade through a
break in the skin.
Michael’s Story
The onset and treatment of NF is best
described as a nightmare. To better understand this, read Michael’s
story, which was posted by a Lymph Notes member.
For more
information visit the National Necrotizing Fasciitis Foundation web
site.
...........................................................................................
Antibiotics:
When They Can and Can't Help
What are antibiotics?
Antibiotics are
strong medicines that can stop some infections and
save lives. But
antibiotics can cause more harm than good when they
aren't used the right
way. You can protect yourself and your family
by knowing when you should use
antibiotics and when you shouldn't.
Do antibiotics work against all
infections?
No. Antibiotics only work against infections caused by bacteria.
They
don't work against any infections caused by viruses. Viruses
cause
colds, the flu, and most coughs and sore throats.
What is
"bacterial resistance"?
Usually antibiotics kill bacteria or stop them from
growing. However,
some bacteria have become resistant to specific
antibiotics. This
means that the antibiotics don't work against them.
Bacteria become
resistant more quickly when antibiotics are used too often
or are not
used correctly.
Resistant bacteria sometimes can be
treated with different
antibiotics to which the bacteria have not yet become
resistant.
These medicines may have to be given intravenously (through a
vein)
in a hospital. A few kinds of resistant bacteria are
untreatable.
What can I do to help myself and my family?
Don't expect
antibiotics to cure every illness. Don't take
antibiotics for viral
illnesses like colds or the flu. Often, the
best thing you can do is let
colds and the flu run their course.
Sometimes this can take 2 weeks or more.
If your illness gets worse
after 2 weeks, talk to your doctor. He or she can
also give you
advice on what you can do to ease your symptoms while your
body
fights off the virus.
How do I know when I need antibiotics?
The
answer depends on what is causing your infection. The following
are some
basic guidelines:
Colds and flu. Viruses cause these illnesses. They
can't be cured
with antibiotics.
Cough or bronchitis. Viruses almost
always cause these. However, if
you have a problem with your lungs or an
illness that lasts a long
time, bacteria may actually be the cause. Your
doctor may decide to
try using an antibiotic.
Sore throat. Most sore
throats are caused by viruses and don't need
antibiotics. However, strep
throat is caused by bacteria. Usually
you'll have a throat swab and a lab
test before your doctor will
prescribe an antibiotic for strep
throat.
Ear infections. There are several types of ear
infections.
Antibiotics are used for some, but not all, ear
infections.
Sinus infections. Antibiotics are often used to treat
sinus
infections. However, a runny nose and yellow or green mucus do
not
necessarily mean you need an antibiotic.
Source: http://familydoctor.org/680.xml
American Academy of Family
Physicians
............................................................................
British
Lymphoedema Society Consensus
Consensus Document on the Management of
Cellulitis in Lymphoedema
Cellulitis is an acute spreading inflammation
of the skin and subcutaneous tissues characterised by pain,
warmth,
swelling and erythema. In lymphoedema, attacks are variable in presentation
and, because of
differences from classical cellulitis, are often
called acute inflammatory episodes. Cellulitis will be the term
used here (related terms: erysipelas, lymphangitis). Most episodes are
believed to be caused by Group A
Streptococci.
Some episodes
are accompanied by severe systemic upset, with high fever or rigors; others are
milder, with
minimal or no fever. Increased swelling of the affected
area may occur. Inflammatory markers (CRP, ESR)
may be raised. It
is difficult to predict response to treatment.
This document makes
recommendations about the use of antibiotics for cellulitis in patients with
lymphoedema, and advises when admission to hospital is indicated.
Prompt treatment is essential to avoid
further damage to the
affected part which in turn may predispose to repeated attacks.
1. ACUTE
ATTACK OF CELLULITIS
1.1 A decision whether hospital admission is
indicated should be based on the level of systemic upset:
* signs of
septicaemia (hypotension, tachycardia, severe pyrexia, confusion, tachypnoea or
vomiting) are an
absolute indication for admission;
* continuing
or deteriorating systemic signs, with or without deteriorating local signs,
after 48hrs of antibiotic
treatment;
* un-resolving or
deteriorating local signs, with or without systemic signs, despite trials of
first and second
line antibiotics.
1.2. Management at
home
1.2.1. It is essential that the patient is closely monitored,
ideally by the GP. To establish a baseline to
monitor progress,
record:
* extent and severity of rash - if possible, mark and date the
edge of the erythema (may be difficult in
lymphoedema as the rash is
often blotchy);
* level of systemic upset;
* CRP/ESR/white cell
count;
* Microbiology of any cuts or breaks in the skin before antibiotics
are started.
1.2.2. Oral amoxicillin 500mg 8-hourly is the treatment of
choice. If there is any evidence of Staph aureus
infection e.g.
folliculitis, pus formation or crusted dermatitis, then flucloxacillin 500mg
6-hourly should be
prescribed in addition.
1.2.3. Patients
who are allergic to penicillin should be prescribed clindamycin as in
1.2.4.
1.2.4. If there is no or a poor response (unresolving
inflammation or development of systemic symptoms) to
oral
amoxicillin after 48 hours, then clindamycin 300mg 6-hourly should be
substituted as second line oral
treatment.
1.2.5.
Antibiotics should be continued until all signs of acute inflammation have
resolved; this often means
taking antibiotics for 1-2 months and
the course of antibiotics should be for no less than 14 days from the
time
a definite clinical response is observed.
1.2.6. Bed rest and elevation
of the affected part is essential. Avoid compression garments during the acute
attack.
1.2.7. Appropriate analgesia, e.g. paracetamol, as
necessary.
1.2.8. When the inflammation is sufficiently reduced, wearing
of compression garments and normal levels of
exercise may resume. A
return to work depends on the patient's occupation, and there being no
deterioration when normal levels of exercise are
established.
1.3. Management in hospital
1.3.1. Choice of
antibiotics in hospital is largely dependent on local rules. Recommended first
line treatment
is amoxicillin 2g 8-hourly iv plus gentamicin 5mg/kg
iv daily; dose to be adjusted according to renal function
and
assay. Benzylpenicillin 1.2-2.4g 6-hourly may be preferred to the amoxicillin.
Convention is to use a
combination of benzylpenicillin and
flucloxacillin, however, doubts about the role of Staph aureus in cellulitis
make this combination less certain.
1.3.2. If there is no or
a poor response to this combination after 48 hours, clindamycin 600mg 6-hourly
iv
should be substituted for both.
1.3.3. Penicillin
allergic patients should receive clindamycin as in 1.3.2.
1.3.4. A
switch to oral treatment with amoxicillin 500mg 8-hourly, or clindamycin 300mg
6-hourly should
not be made before:
* Inflammation much
resolved;
* CRP falling.
then continue as in 1.2.5.
1.4.
Antibiotics “in case”
1.4.1. The risk of further attacks of cellulitis
in lymphoedema is high. It is recommended that patients who
have
had an attack of cellulitis should carry a two week supply of antibiotics with
them particularly when
away from home for any length of time, e.g.
on holiday. Amoxicillin 500mg tds is recommended or, for those
allergic to penicillin, clindamycin 300mg 6-hourly. Antibiotics should
be started immediately familiar
symptoms of cellulitis start but a
medical opinion should be sought as soon as possible.
2. RECURRENT
CELLULITIS
2.1. Antibiotic prophylaxis should be offered to patients who
have two or more attacks of cellulitis per year.
Penicillin V 500mg
daily (1g if weight >75kg) should be the first choice. The dose may be
reduced to
250mg daily after one year of successful prophylaxis.
Prophylaxis may need to be life-long if relapse occurs
when
antibiotics are discontinued after a two year period of successful prophylaxis.
For those allergic to
penicillin, erythromycin 250mg daily is
recommended; if this is not tolerated then clarithromycin 250mg daily
is
an alternative.
2.2. There is evidence that decongestive lymphatic
therapy reduces the frequency of attacks. Control of the
swelling is
therefore important. Patients undergoing intensive DLT and known to have
suffered cellulitis in the
past may benefit from antibiotic cover
in case cellulitis is provoked. Oral penicillin V 500mg daily is
recommended during the period of the intensive treatment. For those
allergic to penicillin, erythromycin is
advised (as in
2.1).
2.3. Apart from the swelling other risk factors for recurrent
cellulitis including cracked, macerated, inter-
digital skin,
dermatitis, open wounds including leg ulcers, and weeping lymphangiectasia
(leaking lymph
blisters on the skin surface) should be treated.
Treatment of inter-digital fungus should be with application of
terbinafine cream daily for two weeks.
2.4. Those patients in
whom first line antibiotic prophylaxis fails may need alternative strategies
including
trials of prophylactic clindamycin 150mg daily or
clarithromycin 250mg daily. Unusual circumstances, e.g.
animal bite
or lick, preceding an attack, or a failure of infection to respond to above
recommendations,
should prompt discussions with local
microbiologist.
Consensus Panel:
Professor Peter S. Mortimer,
Consultant Dermatologist at the Royal Marsden and St George's Hospitals,
London
Dr Christopher Cefai, Senior Lecturer in Microbiology,
North East Wales Trust
Dr Vaughan Keeley, Consultant in Palliative
Medicine, Derby Hospitals NHS Foundation Trust
Professor John Welsh,
Consultant in Palliative Medicine, Beatson Oncology Centre,
Greater
Glasgow NHS
Dr Robert Twycross, Emeritus Clinical Reader in Palliative
Medicine, Oxford University
Dr Andrew Hughes, Consultant in Palliative
Medicine, St Oswald's Hospice, Newcastle
Dr Caroline Cooke, Consultant
in Palliative Medicine, The Leicestershire Hospice (LOROS) Dr Ellie Bond,
Staff Grade Doctor in Palliative Medicine, St Oswald's Hospice,
Newcastle
Dr Sue Rudd, Staff Grade Doctor in Palliative Medicine, Derby
Hospitals NHS Foundation Trust
LSN Trustees
Published in February
2007 by the British Lymphology Society and the Lymphoedema Support
Network.
We welcome any comments from users (to be directed to
[email protected]).
The document will be revised in October
2007.
Reproduction of this information by individual hospital trusts is
permitted; however, the following statement
must be included in all
publications.
'This information is based on a Consensus Document
produced by medical experts and facilitated by the
Lymphoedema
Support Network. The document, originally produced in October 2005, is jointly
owned by
the British Lymphology Society and the Lymphoedema Support
Network'
The LSN has produced a new fact sheet based on the Consensus
Document, 'Management of Cellulitis in
Lymphoedema'.
Order
forms are available on the LSN website or from the LSN office.
Website:
www.lymphoedema.org/lsn
Tel: 020 7351
0990
Just an interesting tidbit on infections not yet cellulitis:
Pomegranate rind mixed with metal
salts can be used to create an ointment that is effective in treating
common
hospital infections.
A study out of Kingston University in London showed
that when pomegranate rind was combined with
metal salts and/or
vitamin C, it was effective in treating common hospital infections such as
methicillin-
resistant Staphlyoccus aureus (MRSA) bacteria. MRSA, as
defined by theNational Institute of Allergy
and Infectious
Diseases, is “largely a hospital-acquired infection” and is resistant to some
antibiotics.
The details of the study were outlined in an article in
ScienceDaily. According to the article, tests were
performed over a
three year period using microbes such as MRSA from hospital patients. In
treating
MRSA, pomegranate rind combined with metal salts without
vitamin C was most effective, however, in
treating other common
hospital infections, pomegranate rind mixed with metal salts and vitamin C was
most effective.
Project team leader, Declan Naughton, said, “The
increase in drug-resistant infections found in hospitals
made our
research topical and pressing. The idea of using foodstuff is unusual and means
that the body
should be able to cope more easily with its
application; patients are less likely to experience any major
side
effects.”
June 17, 2011
Lyme Disease
Bacteria Take Cover In Lymph Nodes
The bacteria that cause Lyme disease,
one of the most important emerging diseases in the United States,
appear to hide out in the lymph nodes, triggering a significant immune
response, but one that is not strong
enough to rout the infection,
report researchers at the University of California, Davis.
Results from
this groundbreaking study involving mice may explain why some people experience
repeated
infections of Lyme disease. The study appears online in
the journal Public Library of Science Biology..
"Our findings suggest for the first time that Borrelia burgdorferi, the bacteria that cause Lyme disease in
people, dogs and wildlife, have developed a novel
strategy for subverting the immune response of the
animals they
infect," said Professor Nicole Baumgarth, an authority on immune responses at
the UC Davis
Center for Comparative Medicine.
"At first it
seems counter intuitive that an infectious organism would choose to migrate to
the lymph nodes
where it would automatically trigger an immune
response in the host animal," Baumgarth said. "But B.
burgdorferi
have apparently struck an intricate balance that allows the bacteria to both
provoke and elude
the animal's immune response."
About Lyme
disease
Lyme disease, the most important tick-borne disease in the
United States is caused by Borrelia
burgdorferi, corkscrew-shaped
bacteria also known as spirochetes. The disease is transmitted to humans
and animals through bites from infected deer ticks.
The disease
occurs mainly in the Northeastern and Great Lakes states, and is present to a
lesser extent in
Northern California. However, the western
black-legged tick, the main carrier of Lyme disease in the
western
United States, has been found in 56 of California's 58 counties, according to
the California
Department of Public Health.
Symptoms of Lyme
disease are quite variable and may include fever, headache, fatigue and a skin
rash. If
the infection is not treated, it can spread to the joints,
heart and nervous system.
Usually, Lyme disease can be successfully
treated with about four weeks of antibiotics; treatment is most
successful during the early stages of infection.
The UC Davis
study
Swollen lymph nodes, or lymphadenopathy, is one of the hallmarks
of Lyme disease, although it has been
unclear why this occurs or how
it affects the course of the disease. The UC Davis research team set out to
explore in mice the mechanisms that cause the enlarged lymph nodes and
to determine the nature of the
resulting immune
response.
They found that when mice were infected with B. burgdorferi,
these live spirochetes accumulated in the
animals' lymph nodes. The
lymph nodes responded with a strong, rapid accumulation of B cells, white
blood cells that produce antibodies to fight infections. Also, the
presence of B. burgdorferi caused the
destruction of the distinct
architecture of the lymph node that usually helps it to function
normally.
While B cells accumulated in large numbers and made some
specific antibodies against B. burgdorferi, they
did not form
"germinal centers," structures that are needed for the generation of highly
functional and long-
lived antibody responses.
"Overall,
these findings suggest that B. burgdorferi hinder the immune system from
generating a response
that is fully functional and that can persist
and protect after repeat infections," Baumgarth said. "Thus, the
study might explain why people living in endemic areas can be
repeatedly infected with these disease-
causing
spirochetes."
Notes:
In addition to Baumgarth, members of the UC
Davis research team include Stephen Barthold, director of
the Center
for Comparative Medicine; Emir Hodzic, director of the Real-Time PCR Research
and
Diagnostics Core Facility; staff scientist Sunlian Feng;
graduate student Christine Hastey; and Stefan
Tunev, formerly of
the Center for Comparative Medicine and now at Medtronic Inc.
Funding
for the study was provided by the National Institute of
Health.
Source:
Patricia Bailey
University of California –
Davis
Good resource
for reading more on cellulitis
http://www.nfsuk.org.uk/strepcg2.php