Cellulitis complications

A third case of intramuscular ricin injection involved a 53 year-old male who injected part of 13 chewed castor beans into his thigh with suicidal intent (Passeron et al., 2004). He developed necrotic cellulitis complicated by Enterococcus faecalis infection requiring emergency surgical debridement, but recovered after three months hospitalization. 

The manifestations of and diagnostic criteria for erysipelas and cellulitis are presented in Table 70-2. Once diagnosed, cellulitis is grouped into uncomplicated or complicated presentations depending on patient characteristics and severity of... 

The goals of therapy for cellulitis and erysipelas are rapid and successful eradication of the infection and prevention of related complications. 

Mild 2 Presence of at least two manifestations of inflammation (purulence or erythema, pain, tenderness, warmth or induration), but any cellulitis/erythema extends no more than 2 cm around the ulcer, and infection is limited to the skin or superficial subcutaneous tissues no other local complications or systemic illness... 

Complications associated with i.m. administration include nerve injury, muscle contracture, and abscess formation. Less common problems include intramuscular hemorrhage, cellulitis, skin pigmentation, tissue necrosis, muscle atrophy, gangrene, and cyst or scar formation. In addition, injury may occur from broken needles and inadvertent injection into a joint or vein. ... 

Although impetigo may resolve spontaneously, antimicrobial treatment is indicated to relieve symptoms, prevent formation of new lesions, and prevent complications, such as cellulitis. PeniciUinase-resistant penicillins (dicloxacUlin 12.5 mg/kg orally daily in fom divided doses for children) are preferred for treatment because of the increased incidence of infections caused by S. aureus. First-generation cephalosporins are also effective, although they are generally more expensive. Cephalexin (25-50 mg/kg orally daily in two divided doses for children) and cefadroxU (30 mg/kg oraUy daily in two divided doses for children) are used commonly. Penicillin, administered as either a single intramuscular dose of benzathine penicillin G (300,000-... 

Acute cellulitis with mixed aerobic and anaerobic flora generally occurs in diabetics, where the skin is adjacent to some site of trauma, at sites of surgical incisions to the abdomen or perineum, or where host defenses have been otherwise compromised (vascular insufficiency). In older patients, cellulitis of the lower extremities also may be complicated by thrombophlebitis. Other comphcations of cellulitis include local abscess, osteomyehtis, and septic arthritis. ... 

The goal of therapy of acute bacterial cellulitis is rapid eradication of the infection and prevention of further complications. Antimicrobial therapy of bacterial cellulitis is directed against the type of bacteria either documented or suspected to be present based on the clinical presentation. Local care of cellulitis includes elevation and immobilization of the involved area to decrease swelling. Cool sterile saline dressings can decrease pain and can be followed later with moist heat to aid in localization of the cellulitis. Surgical intervention (incision and drainage) as a mode of therapy is rarely indicated in the treatment of cellulitis. 

Three major types of foot infections are seen in diabetic patients deep abscesses, cellulitis of the dorsum, and mal perforans ulcers. Most deep abscesses involve the central plantar space (arch) and are caused by minor penetrating trauma or by an extension of infection of a nail or web space of the toes. Skin infections of the dorsal area generally arise from infections in the toes that are related to routine care of the nails, nailbeds, and calluses of the toes. Mal perforans ulcer is a chronic ulcer of the sole of the foot. The ulcer develops on thickened, hardened calluses over the first or fifth metatarsal. Mal perforans ulcers are associated with neuropathy, which is responsible for the misalignment of the weight-bearing bones of the foot. Osteomyelitis is one of the most serious complications of foot problems in diabetic patients and may occur in 30% to 40% of infections. ... 

Complications from IP therapy may be related to catheter fnnc-tion, infection, or bowel problems. Mechanical obstrnction to flnid inflow has been reported in approximately 5% of patients. Most commonly, this results from fibrin sheath formation around the catheter tip. In some cases, peritoneal adhesions obstruct fluid entry into the abdominal cavity, causing uneven distribution of the chemotherapentic agent. Infections complications, such as superficial cellulitis around the catheter entry site, deep tissue infections, and peritonitis, are the most prevalent IP-related comphcations and are reported in approximately 10% of patients. Bowel-related comphcations (approximately 3% incidence) inclnde obstruction. Ecus, and perforation. IP administration may also resnlt in a false CA-125 elevation. ... 

Penile abscesses are uncommon. They usually result as a complication of an advanced or untreated superficial balanitis or cellulitis, from infection of the corpora cavernosa, or following a systemic infection with lymphatic or haematogenous dissemination (Sater and Vandendris 1989). Immuno-compromised patients are at high risk of developing a penile abscess. Diabetic patients may develop penile infections after surgical manoeuvres or prosthesis implantation. 

Infection of the corpora cavernosa can be a serious life-threatening complication of intracavemosal drug injection. Other causes include spreading of perineal inflammatory processes and complicated penile cellulitis or balanitis. Cavernous tissue ischaemia represents a predisposing factor, in particular, in diabetic patients. 

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