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Pathophysiology of cellulitis in adults.

Cellulitis, a bacterial infection of the skin and underlying tissue, is a common presentation to Emergency Departments (ED). The clinical spectrum of presentation can vary from local inflammation to diffuse inflammation involving a whole limb, to more severe, even life threatening presentations of necrotizing fascitis and associated sepsis. The rationale for choosing this condition is to enable me to efficiently differentiate between those cases that require immediate medical or surgical intervention and treatment and those that can be managed effectively as an outpatient, and to gain a keen understanding of the pathogenesis of the condition. The terms cellulitis and erysipelas are often used interchangeably and current usage tends to regard erysipelas as a form of cellulitis rather than a separate entity, making clear distinction difficult (Hay 2004, Kilburn et al 2010). Erysipelas affects the upper dermis and superficial lymphatics, with distinctly raised lesions and clear lines of demarcation between involved and uninvolved tissue. Cellulitis extends more deeply, involving the deeper dermis and subcutaneous fat and lacks the distinctive anatomical features of erysipelas. For the purpose of this essay I will be using the term ‘cellulitis’ to refer to both conditions. This essay will endeavor to discuss the incidence, its clinical presentation, risk factors, differential diagnosis, pathophysiology and classification according to severity of cellulitis with reference to current and relevant literature. The management of cellulitis will not be discussed as it goes beyond the capacity of this essay to accommodate this highly researched area (See appendix IV for empirical antibiotics used to treat common SSTIs).

Skin and soft tissue infections (SSTI) are relatively common, however there seems to be a…...

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