Cellulitis and erysipelas

Cellulitis and erysipelas are bacterial infections of the skin and subcutaneous tissues. Fever may be present. Erysipelas is superficial with a sharply demarcated border; it is usually caused by group A streptococcus. Cellulitis is deeper; it is usually caused by group A or group G streptococcus.

CASES/YEAR
600,000 (US); 12,000,000 (Global)
CATEGORY
Localized Infections
AGENT TYPE
Bacteria
OTHER NAMES
Infection of the skin and subcutaneous tissues;
ACUITY
Acute-Moderate
INCUBATION
Estimated 1-5 days;
INITIAL SYMPTOMS
Pain, erythema, warmth, swelling, and discharge at site of infection; Fever may be present.
PRECAUTIONS
Standard
COMMENTS
Erysipelas is superficial with a sharply demarcated border; it is usually caused by group A streptococcus. Cellulitis is deeper; it is usually caused by group A or group G streptococcus. The skin is red, hot, tender, and swollen. Fever and adenopathy may be present. [ABX Guide] "Cellulitis is acute bacterial infection of the skin and subcutaneous tissue most often caused by streptococci or staphylococci." [Merck Manual, p. 994] In community-acquired cellulitis, only 2-6% of blood cultures are positive. [PPID, p. 1290] Streptococcus iniae (sensitive to penicillin) causes cellulitis in fish farmers, fish processors, and cooks who sustain wounds while handling tilapia or other aquaculture fish. [PPID, p. 1296] Aeromonas hydrophila cellulitis and Vibrio vulnificus cellulitis follow exposure to fresh water and salt water, respectively. Erysipelothrix rhusiopathiae causes erysipeloid in handlers of tissue from fish and domestic swine. [Harrisons, p. 435] Recurrent cellulitis caused by group A, C, or G streptococci is associated with chronic venous stasis or lymphedema. [Cohen, p. 90] See "Impetigo," "Erysipelothrix rhusiopathiae infection," "Bite wounds," " Mycobacterium marinum infections," "Buruli ulcer," "Necrotizing fasciitis," and "Orbital cellulitis."
DIAGNOSTIC
Clinical; Low yield of cultures; Blood and sometimes tissue cultures if patient immunocompromised; [Merck Manual, p. 995] DDx includes allergy, insect bite, Lyme disease, Sweet's syndrome, fixed drug reaction, and thrombophlebitis, [ABX Guide]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • G nausea, vomiting
  • H leukocytosis
  • H lymphadenopathy
  • N confusion, delirium
  • N headache
  • S cellulitis or rash, circinate
  • S entry wound with lymph nodes
  • S lymphangitis
  • S papules or plaques
  • S petechiae and ecchymoses
  • S pustule
  • S skin blister or vesicles
  • S skin or subcutaneous nodule
  • S ulcer of skin
  • *meningitis
  • *osteomyelitis
  • *sepsis
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Needle (Includes Drug Abuse), Scalpel or Transfusion, Skin or Mucous Membranes (Includes Conjunctiva), Animal Bite, Swimming
SOURCE
Animal Tissue, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Cattle, Goats and Sheep, Cats, Dogs, Fish and Shellfish, Horses, Monkeys, Rodents, Swine, Human, Wild Animals
RISK FACTORS
  • AIDS patients
  • Cancer patients
  • Injection drug users
  • Touch infected fish or shellfish
TREATMENT
"Most cellulitis resolves quickly with antibiotic therapy. Local abscesses occasionally form, requiring incision and drainage." [Merck Manual, p. 995]
DRUG LINK
Merck Manual: Cellulitis
REFERENCES FOR CASES/YEAR
1. (US) About 200 cases per 100,000/year; [5MCC-2020] Calculate: 200 x 3000 = 600,000 (US);
2. (Global) 20 X US cases/yr;