This is a clinical and histologic term describing a diffuse inflammation of the skin and deep soft tissue. It presents with an expanding area of pain and erythema. Histopathologically, there is a diffuse infiltrate of neutrophils. There may be necrosis and a necrotizing vasculitis. In cases associated with bacteria, a tissue gram stain may revela micro-organisms, usually in necrotic areas. There are various types of cellulitis, differing by both the clinical presentation and organism.
Erysipelas Gp. A Streptococcus
Elevated border with rapid spread
Lower extremities, face
Erysipeloid Erysipelothrix rhusiopathiae
Associated with meat and fish handlers
Spreading infection usually in the hands
Blistering distal dactylitis Gp. A Streptococcus
Localized to the volar fat pad of the fingers
DISEASE ASSOCIATIONS CHARACTERIZATION AIDS
Epidemiology and microbiology of cellulitis and bacterial soft tissue infection during HIV disease: a 10-year survey.
Manfredi R, Calza L, Chiodo F.
Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna, S. Orsola Hospital, Bologna, Italy.
J Cutan Pathol 2002 Mar;29(3):168-72 Abstract quote
BACKGROUND:: Cellulitis and soft tissue infection are underestimated complications of HIV disease.
PATIENTS AND METHODS: Sixty-seven bacteriologically proven consecutive episodes were identified among 2221 HIV-infected patients hospitalized in a 10-year period, and assessed according to several epidemiological, microbiological and clinical variables.
RESULTS: Staphylococcus aureus was the most frequently cultured pathogen (50% of 92 isolates), followed by Pseudomonas spp., Escherichia coli and Streptococcus pyogenes; a polymicrobial infection was present in 38.1% of episodes. Drug addiction (p < 0.003) and male gender (p < 0.04) were significantly associated with the occurrence of these complications, which were community-acquired in 83.6% of cases. While a remarkable variation in the severity of underlying immunodeficiency was shown, hematogenous dissemination occurred in 25.4% of episodes, and proved significantly related to a low CD4+ lymphocyte count, and neutropenia. A 21.7% methicillin-resistance rate was shown among S. aureus isolates. All episodes were favorably treated in 5-16 days, in over 60% of cases with associated beta-lactam-aminglycoside antibiotics; a recurrence of staphylococcal cellulitis occurred in four patients only.
CONCLUSION: Skin and soft tissue infections are continuing causes of morbidity in HIV-infected patients, even in the highly active antiretroviral therapy era.
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Brown and Brenn-Tissue gram stain performed upon formalin fixed tissue
Gram stain -Routine microbiological stain dividing bacteria into gram negative and positive types.
Last Updated 5/29/2002
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