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Aksoy H, Gurel MS, Sarmış A, Aslan M. Effect of finger socks on clinical cure in interdigital tinea pedis. J Am Acad Dermatol 2025; 92:1032-1038. [PMID: 39832679 DOI: 10.1016/j.jaad.2024.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 11/25/2024] [Accepted: 12/20/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND Humidity between the toes and occlusion are risk factors and causes of recurrence for interdigital tinea pedis. OBJECTIVE To determine the role of wearing "finger-socks" in addition to topical antifungal treatment in managing interdigital tinea pedis. METHODS Among 54 patients with interdigital tinea pedis confirmed by direct microscopy, 31 in the study group were recommended to wear 5-finger socks in addition to topical antifungal treatment for 4 weeks, while 23 in the control group received only topical antifungal treatment without sock recommendations. RESULTS Pretreatment culture positivity rate was 20.4%, whereas post-treatment, all cases had negative culture results. The most commonly detected microorganisms were Trichophyton rubrum and Candida parapsilosis. In the finger-socks group, the rates of complete cure, partial cure, and treatment failure were 74.2%, 16.1%, and 9.7%, respectively, while 21.7%, 26.1%, and 52.2% in the control group (P < .001). STUDY LIMITATIONS The small sample size and the high rate of false-negative fungal culture results were our limitations. CONCLUSIONS The clinical complete cure rate was significantly higher in those who wore 5-finger socks compared to those who did not. Finger socks increase treatment success in interdigital tinea pedis, presumably by reducing the humidity between the toes, independently of daily habits.
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Affiliation(s)
- Hasan Aksoy
- Department of Dermatology, Göztepe Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey.
| | - Mehmet Salih Gurel
- Department of Dermatology, Istanbul Medeniyet University Göztepe Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
| | - Abdurrahman Sarmış
- Department of Microbiology, Göztepe Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
| | - Müge Aslan
- Department of Medical Microbiology, Ankara Etlik City Hospital, Ankara, Turkey
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Belinchón-Romero I, Merino E, Ramos-Rincón JM. Sex differences in clinical characteristics and outcomes in patients hospitalized with cellulitis in Spain (2016-2022). Int J Infect Dis 2025; 154:107846. [PMID: 39961451 DOI: 10.1016/j.ijid.2025.107846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/09/2025] [Accepted: 02/13/2025] [Indexed: 03/18/2025] Open
Abstract
PURPOSE To estimate hospitalization rates, analyze sex-specific clinical characteristics, assess in-hospital mortality and its risk factors, and measure the economic burden of cellulitis hospitalizations. MATERIALS AND METHODS This retrospective population-based study included adults aged ≥15 years hospitalized for cellulitis in Spain from 2016 to 2022. Multivariable logistic regression was used to identify factors associated with in-hospital mortality (IHM). RESULTS A total of 194,673 cellulitis hospitalizations were recorded (90,828 women and 103,845 men). The mean hospitalization rates per 1000 admissions and per 100,000 inhabitants were lower in women than men (6.0 vs. 7.6 and 63 vs. 76, respectively). In women, cellulitis was more common in those aged 65-75 and ≥80 years and in those with hypertension, dyslipidemia, heart failure, or hypothyroidism. Women had a higher crude IHM (7.4%) than men (5.9%), but sex was not significantly associated with mortality after adjustment (AOR: 1.02; 95% CI: 0.93-1.07). The strongest predictors of mortality were similar in both women and men. These included leukemia (AOR: 4.45 vs. 3.15), age ≥80 years (AOR: 3.96 vs. 4.39), sepsis (AOR: 3.59 vs. 2.95), neoplasia (AOR: 3.44 vs. 3.47), and cirrhosis (AOR: 2.49 vs. 2.41). The total hospitalization cost for women was €451.8 million, with a median cost of €3,653 per admission. CONCLUSIONS The clinical profile and outcomes of cellulitis differ by sex. In women, advanced age, comorbidities, and complications like sepsis significantly increased mortality risk.
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Affiliation(s)
- Isabel Belinchón-Romero
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain; Department of Dermatology, Dr. Balmis General University Hospital and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain; Division of Infectious Disease, Dr. Balmis General University Hospital and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José-Manuel Ramos-Rincón
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain; Department of Internal Medicine, Dr. Balmis General University Hospital and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
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Glennon CM, El Saleeby C, Kroshinsky D. Cellulitis in Pediatric Patients: Recognition and Management in the Era of Evolving Resistance. Am J Clin Dermatol 2025:10.1007/s40257-025-00936-w. [PMID: 40259138 DOI: 10.1007/s40257-025-00936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2025] [Indexed: 04/23/2025]
Abstract
Cellulitis, a bacterial skin infection most frequently caused by group A streptococci (Streptococcus pyogenes) and less so by Staphylococcus aureus, commonly occurs in pediatric patients. The non-specific clinical presentation of poorly demarcated, expanding erythema, and warmth is common to a multitude of similarly presenting conditions, contributing to challenges in accurate diagnosis. There is also no gold standard diagnostic test for cellulitis, as laboratory assessments, tissue and blood cultures, and imaging studies have not been helpful. These adjunctive studies may be useful, however, for ruling out mimickers or more serious or complicating conditions, such as osteomyelitis, necrotizing fasciitis, or abscess. Diagnosis remains largely clinical and evaluation by a dermatologist and/or infectious disease specialist continues to be the clinical gold standard. As a result, access to specialty care and further research into helpful adjunctive measures, such as thermal imaging, are imperative for accurate diagnosis and management to prevent inappropriate antibiosis. Multidrug resistance has continued to evolve since the initial emergence of community-associated methicillin-resistant Staphylococcus aureus, with more recent studies showing an overall decline of methicillin-resistant S. aureus in the community and highest rates remaining in the Southern region of the USA. Despite changing resistance patterns, inappropriate prescribing patterns have persisted and contribute to rising rates of resistance to antibiotics such as trimethoprim-sulfamethoxazole and clindamycin. Therefore, accurate diagnosis and subsequent management with the narrowest possible antimicrobial therapy is ideal both for individual patient outcomes and for public health.
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Affiliation(s)
- Colleen M Glennon
- Department of Dermatology, Duke University School of Medicine, 307 Research Drive, Durham, NC, 27710, USA
| | - Chadi El Saleeby
- Divisions of Pediatric Infectious Disease and Pediatric Hospital Medicine, Mass General for Children, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Duke University School of Medicine, 307 Research Drive, Durham, NC, 27710, USA.
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Burke CE, Maley OR, Mancini B, Sardesai S, Montgomery AB, King TS, Flemming DJ. Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis. Diagnosis (Berl) 2025:dx-2024-0156. [PMID: 40205844 DOI: 10.1515/dx-2024-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 03/21/2025] [Indexed: 04/11/2025]
Abstract
OBJECTIVES Cellulitis shares several clinical features with fulminant deep soft tissue infections, creating a diagnostic dilemma for which clinicians are increasingly using cross-sectional diagnostic imaging to resolve. However, the role of imaging in apparent cellulitis is poorly defined. In particular, the clinical utility of CT in extremity cellulitis is underexplored. The purpose of this study was to determine patient and clinical factors that increase likelihood for finding of deep infection on CT among patients with extremity cellulitis. METHODS A retrospective observational study was performed of patients with cellulitis of the extremities who were examined with computed tomography from January 1, 2012 to December 31, 2021. Demographics, medical history, and clinical and laboratory characteristics were collected. The presence of positive findings on CT report was recorded. Repeated measures logistic regression was used to evaluate significant predictors of positive CT. RESULTS There were 496 eligible patient encounters, and CT was positive for deep infection in 39 cases (7.9 %). Median patient age was 56 years of age, 58.1 % were male, and most patients had a history of diabetes mellitus, history of tobacco use, and/or obesity. Significant predictors for positive CT on multivariable analysis included gas on pre-CT radiographs, febrile leukopenic state, injection drug use, purulence on exam, and white blood cell count extremes. Elevated CRP was also a significant positive predictor on bivariate analysis. CONCLUSIONS Finding a deep infection on CT in a patient with extremity cellulitis is uncommon and is predominantly associated with a high-risk clinical picture, and/or with high index of suspicion based on pre-CT plain films. In the absence of these patient factors or compelling findings on radiographs, CT does not typically provide clinically actionable information for extremity cellulitis and should not be used as part of standard evaluation.
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Affiliation(s)
- Cynthia E Burke
- 12310 Pennsylvania State College of Medicine , Hershey, PA, USA
| | - Owen R Maley
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Sahil Sardesai
- 12310 Pennsylvania State College of Medicine , Hershey, PA, USA
| | | | - Tonya S King
- Department of Public Health Sciences, 12310 Penn State College of Medicine , Hershey, PA, USA
| | - Donald J Flemming
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Norimatsu Y, Fukasawa T, Ohno Y, Norimatsu Y, Matsuda KM, Hisamoto T, Kotani H, Kuzumi A, Yoshizaki‐Ogawa A, Miyagawa T, Oba K, Sato S, Yoshizaki A. Validation of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and establishment of novel score in Japanese patients with necrotizing fasciitis (J-LRINEC score). J Dermatol 2025; 52:439-444. [PMID: 39916636 PMCID: PMC11883723 DOI: 10.1111/1346-8138.17663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 01/21/2025] [Accepted: 01/25/2025] [Indexed: 03/08/2025]
Abstract
The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is widely used to distinguish between necrotizing fasciitis and cellulitis. However, LRINEC scores are not as sensitive or specific as initially reported, possibly due to differences in patient backgrounds in different countries. Here, we examined the validity of LRINEC scores in Japanese patients. We also investigated the possibility of developing a new scoring system. Patients with necrotizing fasciitis (n = 56) and cellulitis (n = 209) were retrospectively evaluated. The data were split into training (n = 199) and validation (n = 66) datasets. A logistic regression analysis was used to calculate the C-statistics of the LRINEC scores. A new equation was formulated using logistic regression analysis with an appropriate variable selection (Laboratory Risk Indicator for Necrotizing Fasciitis for Japanese Patients [J-LRINEC] score). The J-LRINEC score had a C-statistic of 0.9683, sensitivity of 91.4%, and specificity of 84.8%. The LRINEC score had a C-statistic of 0.914 and specificity of 96%; however, its usefulness was limited by its sensitivity of 68.9%. Our results suggest that the LRINEC score is valid for Japanese patients; however, the J-LRINEC score showed higher sensitivity and specificity, suggesting that it may be a useful tool for differentiating cellulitis from necrotizing fasciitis among Japanese patients.
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Affiliation(s)
- Yuta Norimatsu
- Department of DermatologyJR Tokyo General HospitalJapan
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
- Department of DermatologyInternational University of Health and Welfare Narita HospitalChibaJapan
| | - Takemichi Fukasawa
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
- Department of Clinical Cannabinoid ResearchThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Yuki Ohno
- Department of DermatologyJR Tokyo General HospitalJapan
| | - Yurie Norimatsu
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Kazuki M. Matsuda
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Teruyoshi Hisamoto
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Hirohito Kotani
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Ai Kuzumi
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Asako Yoshizaki‐Ogawa
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Takuya Miyagawa
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shinichi Sato
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
| | - Ayumi Yoshizaki
- Department of DermatologyThe University of Tokyo Graduate School of MedicineTokyoJapan
- Department of Clinical Cannabinoid ResearchThe University of Tokyo Graduate School of MedicineTokyoJapan
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Torres-Guzman RA, Avila FR, Maita K, Garcia JP, Eldaly AS, Sario GDD, Borna S, Gomez-Cabello CA, Pressman SM, Haider SA, Ho OA, Forte AJ. Identification of Potential Factors Associated with Cellulitis Following Lymphovenous Bypass Surgery in Breast Cancer Survivors. J Reconstr Microsurg 2025; 41:261-269. [PMID: 39038463 DOI: 10.1055/s-0044-1788345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Breast cancer is one of the most common types of cancer, with around 2.3 million cases diagnosed in 2020. One in five cancer patients develops chronic lymphedema caused by multifactorial triggers and treatment-related factors. This can lead to swelling, skin infections, and limb dysfunction, negatively affecting the patient's quality of life. This retrospective cohort study aimed to determine the associations between demographic and breast cancer characteristics and postoperative cellulitis in breast cancer survivors who underwent lymphovenous bypass surgery (LVB) at Mayo Clinic, Florida. METHODS We performed a retrospective chart review. Data were collected retrospectively from 2016 to 2022. Sixty adult breast cancer survivors who underwent LVB were included in the final analysis based on specific inclusion and exclusion criteria. Patients were excluded if they did not meet the inclusion criteria or had incomplete follow-up data. Demographic and surgical data were extracted, including body mass index (BMI), type of anastomosis, number of anastomoses, and preoperative cellulitis status. Lymphedema measurements were performed using tape measurements. Fisher's exact test was used to determine statistically significant associations between variables and postoperative cellulitis. RESULTS Postoperative cellulitis was more common in patients aged 60 to 69 years (43.2%), whites (75.0%), overweight or obese (90.9%), with one to four anastomoses (81.8%), and nonsmokers (79.5%). The mean International Society of Lymphology (ISL) criteria for both postoperative cellulitis and no postoperative cellulitis was 1.93. Statistically significant associations with postoperative cellulitis were found for the number of anastomoses (p = 0.021), smoking status (p = 0.049), preoperative cellulitis (p = 0.04), and the length of years with lymphedema diagnosis variable (p = 0.004). CONCLUSION Our results suggest that a greater number of anastomoses, smoking, preoperative cellulitis, and years with lymphedema are significantly associated with an increased risk of postoperative cellulitis. Awareness of these risk factors is crucial for monitoring and early treatment of infections following surgery.
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Affiliation(s)
| | | | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | | | | | - Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | | | | | - Syed Ali Haider
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Antonio Jorge Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota
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Wall J, Sutherland M, Levell NJ, Venables ZC, Mistry K. Higher proportion of cellulitis in severe lymphoedema. Br J Dermatol 2025; 192:353-355. [PMID: 39348492 DOI: 10.1093/bjd/ljae369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/06/2024] [Accepted: 11/03/2024] [Indexed: 10/02/2024]
Abstract
We read with interest the article by Burian et al. discussing the prevalence and risk factors of cellulitis in chronic leg oedema. We conducted a 12-year service evaluation at the Norfolk and Norwich University Hospital to investigate the applicability of these results in a real-world setting. Our study found that episodes of cellulitis were more common in patients with more severe lymphoedema, reinforcing the findings of Burian et al. and highlighting the importance of controlling lymphatic swelling to reduce the risk of cellulitis.
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Affiliation(s)
- James Wall
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Melanie Sutherland
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Nick J Levell
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Zoe C Venables
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Khaylen Mistry
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Wiederhold AK, Cartuliares MB, Jeppesen K, Skjøt-Arkil H. Characteristics and Antibiotic Treatment of Patients with Cellulitis in the Emergency Department. Antibiotics (Basel) 2024; 13:1021. [PMID: 39596716 PMCID: PMC11591235 DOI: 10.3390/antibiotics13111021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/22/2024] [Accepted: 10/28/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Cellulitis is a common infection in Emergency Departments (EDs), and unclear diagnostics may lead to unnecessary treatment with broad-spectrum antibiotics. The aim of this study was to characterize patients with cellulitis admitted to the ED, describe the type and route of antibiotic treatment and compare the prognosis for cellulitis to that for other infections. METHODS This multicenter, cross-sectional study prospectively included adult patients admitted to the ED suspected of having an infection. Data were collected from medical records, and an expert panel assigned a final diagnosis to each patient. Only patients diagnosed with an infection were included in this study. RESULTS A total of 777 patients were included, of which 77 were diagnosed with cellulitis. Diabetes, obesity and prior cellulitis were associated with cellulitis with an OR of 2.01 [95% CI: 1.17-3.46], OR 2.66 [95% CI: 1.54-4.59] and OR 14.88 [95% CI: 7.88-28.08], respectively. The majority of the patients were treated, according to the regional guidelines, with narrow-spectrum antibiotics. Broad-spectrum antibiotics were rarely used. The patients with cellulitis were hospitalized for a shorter time compared to those with other infections, but 26% were readmitted within 30 days. The 30-day mortality of the patients with cellulitis was 3.9% and did not differ significantly from other infections.
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Affiliation(s)
- Aaron K. Wiederhold
- Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Mariana B. Cartuliares
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | - Karin Jeppesen
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Southern Denmark, 6400 Sønderborg, Denmark
| | - Helene Skjøt-Arkil
- Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark
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Libson K, Barba J, Henning A, Fisher K, Kirven RM, Korman AM, Plaza JA, Kaffenberger BH, Chung C. Acute Interstitial Inflammation on Skin Biopsies and Positive Tissue Cultures in Cellulitis Patients Are Associated a Worse Prognosis. Am J Dermatopathol 2024; 46:663-667. [PMID: 38842316 DOI: 10.1097/dad.0000000000002753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Cellulitis is a significant public health burden and lacks a gold standard for diagnosis. Up to 1/3 of patients are incorrectly diagnosed. The skin biopsy has been proposed as the gold standard. OBJECTIVE In this study, we evaluate the histopathologic characteristics and tissue culture positivity of biopsies in patients diagnosed with cellulitis seen by our inpatient dermatology consultation service. METHODS This retrospective cohort study examined patients who were hospitalized with a skin and soft tissue infection at our institution between 2011 and 2020 and underwent a skin biopsy. RESULTS Those with a positive tissue culture were more likely to die within 30 days compared with those with negative tissue cultures (26% vs. 6%, P = 0.048). Patients who died within 30 days were more likely to have acute interstitial inflammation as a feature on histopathology (38%, P = 0.03). LIMITATIONS Single institutional design, unintentional exclusion of patients with organism-specific diagnosis, and selection for a medically complex patient population because of the nonroutine collection of biopsies. CONCLUSION Positive tissue cultures and histopathology showing acute interstitial space inflammation on skin and soft tissue infection (SSTI) biopsies are associated with increased mortality and thus may serve as indicators of poor prognosis.
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Affiliation(s)
- Karissa Libson
- The Ohio State University College of Medicine, Columbus, OH
| | - Johnny Barba
- The Ohio State University College of Medicine, Columbus, OH
| | - Ania Henning
- Department of Pathology, Summa Health, Akron, OH
| | - Kristopher Fisher
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Rachel M Kirven
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Jose A Plaza
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin H Kaffenberger
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Catherine Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH; and
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Muller I, Teasdale E, Cowdell F, Smart P, Santer M, Francis N. Practice and community nurses' views and experiences of helping people manage risk factors for recurrent lower limb cellulitis: A qualitative interview study. SKIN HEALTH AND DISEASE 2024; 4:e395. [PMID: 39355750 PMCID: PMC11442058 DOI: 10.1002/ski2.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 10/03/2024]
Abstract
Background Cellulitis is a painful infection of the skin and underlying tissues, commonly affecting the lower leg. Approximately one-third of people experience recurrence. Nurses who work in general practice (practice nurses) and see people at home (community or district nurses) could have an important role in managing risk factors for cellulitis, such as long-term leg swelling, wound care and skin care. Objective To explore practice and community nurses' views and experiences of helping people to manage risk factors for recurrent lower limb cellulitis. Methods Semi-structured, telephone interviews with 21 practice and community nurses in England from October 2020 to March 2021. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Results Nurses face multiple challenges when supporting people to manage risk factors for recurrent lower limb cellulitis. Key challenges include limited time and access to resources such as Doppler equipment, and the physical and psychosocial capabilities of patients to self-manage. Nurses identified potential strategies to overcome these challenges, such as placing greater emphasis on prevention and supporting self-management by providing resources for patients and support networks (paid and unpaid carers) to reinforce knowledge post-consultation and develop skills to self-care. Conclusions We identified a need to develop and evaluate resources, such as support materials, for nurses to use to help patients reduce their risk of recurrent cellulitis.
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Affiliation(s)
- Ingrid Muller
- Primary Care Research CentreFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Emma Teasdale
- Primary Care Research CentreFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Fiona Cowdell
- Faculty of Health, Education and Life SciencesBirmingham City UniversityBirminghamUK
| | - Peter Smart
- Patient RepresentativeCentre for Evidence Based DermatologyUniversity of NottinghamNottinghamUK
| | - Miriam Santer
- Primary Care Research CentreFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Nick Francis
- Primary Care Research CentreFaculty of MedicineUniversity of SouthamptonSouthamptonUK
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11
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Taira KG, Wang M, Guo W, Kam O, Kaufmann T. Association of Cellulitis With Obesity: Systematic Review and Meta-Analysis. JMIR DERMATOLOGY 2024; 7:e54302. [PMID: 39163102 PMCID: PMC11372331 DOI: 10.2196/54302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/21/2024] [Accepted: 07/08/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Cellulitis is a bacterial skin infection that tends to recur. Previous studies have identified several risk factors that may contribute to its pathogenesis. Obesity is an increasingly prevalent worldwide disease that has been associated with skin and soft tissue infections. OBJECTIVE The aim of our systematic review and meta-analysis was to investigate the association of cellulitis with obesity. METHODS The Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for the relevant studies from the inception of each respective database to March 13, 2021. Case-control, cross-sectional, or cohort studies that examined the odds or risk of increased BMI in patients with cellulitis were included. This study was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa scale (NOS) was used to evaluate the risk of bias in included studies. RESULTS In total, 9 case-control studies were included in our quantitative meta-analysis with a total of 68,148 study participants. A significant association was found between cellulitis and obesity (pooled odds ratio [OR] 2.67, 95% CI 1.91-3.71). No significant association was observed between cellulitis and being overweight (pooled OR 1.69, 95% CI 0.99-2.88). Patients with cellulitis were also found to have 1.63-fold increased odds of being male (pooled OR 1.63, 95% CI 1.12-2.38). CONCLUSIONS Our findings suggest that cellulitis is significantly associated with obesity. Maintaining a healthy BMI may be indicated for patients presenting with cellulitis.
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Affiliation(s)
- Kimi Gabriella Taira
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
- Mayo Clinic School of Graduate Medical Education, Rochester, MN, United States
| | - Madelyn Wang
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - William Guo
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, United States
| | - Olivia Kam
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Tara Kaufmann
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, United States
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Rathor AA, Lin M, MacArthur RD. Impact of Climate Change on Cellulitis: A Literature Review. Cureus 2024; 16:e64958. [PMID: 39161487 PMCID: PMC11331052 DOI: 10.7759/cureus.64958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
Climate change is a phenomenon that has had, and will continue to have, wide-ranging effects on the world in both the near and distant future. With regards to human health, research has demonstrated the impact of climate change on heat-related illness, mental health, and vector-borne infectious diseases. Through a review of the literature, this paper aims to elucidate both current and future consequences of climate change on cellulitis, a type of skin infection that is associated with significant morbidity, mortality, and cost. Factors such as elevated temperature, pollution, rising sea levels, and the increased frequency of natural disasters pose an alarming risk for the increased proliferation of infections such as cellulitis. Lastly, in light of these trends, this paper will address potential strategies individuals can implement to reduce the effects of climate change on cellulitis.
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Affiliation(s)
- Ahmad A Rathor
- Office of Academic Affairs, Augusta University Medical College of Georgia, Augusta, USA
| | - Michelle Lin
- Office of Academic Affairs, Augusta University Medical College of Georgia, Augusta, USA
| | - Rodger D MacArthur
- Office of Academic Affairs, Augusta University Medical College of Georgia, Augusta, USA
- Division of Infectious Diseases, Augusta University Medical College of Georgia, Augusta, USA
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13
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Wakai A. Mind the gap: the adjunctive role of anti-inflammatories for treating cellulitis. CAN J EMERG MED 2024; 26:445-446. [PMID: 38960971 DOI: 10.1007/s43678-024-00724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Affiliation(s)
- Abel Wakai
- Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
- Emergency Care Research Unit (ECRU), Royal College of Surgeons in Ireland (RCSI), Dublin, Dublin 2, Ireland.
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14
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Valesky EM, Hach-Wunderle V, Protz K, Zeiner KN, Erfurt-Berge C, Goedecke F, Jäger B, Kahle B, Kluess H, Knestele M, Kuntz A, Lüdemann C, Meissner M, Mühlberg K, Mühlberger D, Pannier F, Schmedt CG, Schmitz-Rixen T, Strölin A, Wilm S, Rabe E, Stücker M, Dissemond J. Diagnosis and treatment of venous leg ulcers: S2k Guideline of the German Society of Phlebology and Lymphology (DGPL) e.V. J Dtsch Dermatol Ges 2024; 22:1039-1051. [PMID: 38938151 DOI: 10.1111/ddg.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 06/29/2024]
Abstract
This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice.
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Affiliation(s)
- Eva Maria Valesky
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
| | - Viola Hach-Wunderle
- Vascular Center, Department of Angiology, Northwest Hospital, Frankfurt am Main, Germany
| | - Kerstin Protz
- Competence Center for Health Services Research in Dermatology, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim Nikola Zeiner
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
| | - Cornelia Erfurt-Berge
- Department of Dermatology, University Medical Center Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Björn Jäger
- Initiative Chronische Wunden, Quedlinburg, Germany
| | - Birgit Kahle
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Holger Kluess
- Professional Association of Phlebologists and Lymphologists, Freiburg, Germany
| | - Michaela Knestele
- Hospital Marktoberdorf, Department of Surgery, Kreiskliniken Ostallgäu, Marktoberdorf, Germany
| | - Anja Kuntz
- Welfare Center Leonberg, Gerlingen, Germany
| | | | - Markus Meissner
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
- Dermatology Office, Prof. Dr. Markus Meissner, Wiesbaden, Germany
| | - Katja Mühlberg
- Department of Angiology, University Hospital Leipzig, Leipzig, Germany
| | - Dominic Mühlberger
- St. Marien Hospital Herne, Department of Vascular Surgery, Ruhr University Bochum, Herne, Germany
| | | | | | - Thomas Schmitz-Rixen
- Goethe University Frankfurt, University Hospital, Department of Endovascular and Vascular Surgery, Frankfurt am Main, Germany
| | - Anke Strölin
- University Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Stefan Wilm
- Institute for General Practice, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eberhard Rabe
- Private Office Dermatology & Phlebology, Bonn, Germany
| | - Markus Stücker
- Department of Dermatology, Venereology and Allergology, Catholic Hospital Bochum, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
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15
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Taha M, Alzelaei MMM, Al-Qarni AMS, Al-Ammari MAM, Algamdi HST, Almaeidi AAI, Al-Faqih HAA. Assessment of Public Awareness of Cellulitis in Al-Qunfudhah Region, Saudi Arabia. Cureus 2024; 16:e63163. [PMID: 39070336 PMCID: PMC11272911 DOI: 10.7759/cureus.63163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The term "cellulitis" is frequently used to describe a non-necrotizing inflammation of the skin and subcutaneous tissues that is typically caused by an acute infection and does not affect the muscles or fascia. Warmth, erythema, tenderness, swelling, and localized pain are the hallmarks of cellulitis. Life-threatening and debilitating outcomes from cellulitis include necrotizing fasciitis, necrotizing hypodermitis, abscess formation, septic shock, and, in extreme cases, death. The current study aimed to assess public awareness of cellulitis in the Al-Qunfudhah region, Saudi Arabia. METHODS A descriptive cross-sectional study was conducted targeting all residents in Al-Qunfudhah, Saudi Arabia, during the period from January to March 2024. Data were collected using a pre-structured online questionnaire. The study questionnaire included participants' demographic data, cellulitis data, and knowledge and attitude towards cellulitis. The final questionnaire was uploaded online using social media platforms by the researchers and their friends until no more new participants were included. RESULTS A total of 470 records were analyzed. Among the respondents, the majority were male (n=347, 73.8%), and the highest proportion fell within the age range of 18 to 25 years (n=174, 37.0%). The highest proportion of respondents correctly identified cellulitis as a medical condition affecting the skin and soft tissues underneath it, typically caused by infection or injury (n=278, 59.1%). Additionally, the majority acknowledged that cellulitis can cause pain, swelling, and redness in the affected area (n=240, 51.1%). As for factors associated with awareness of cellulitis, significant associations were found with age group (p=0.031), educational levels (p=0.003), and employment status (p=0.002). CONCLUSIONS This study revealed a high level of awareness of cellulitis among participants, especially highly educated and employed participants. Participants believed that healthcare providers play a crucial role in raising population awareness of cellulitis health problems.
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Affiliation(s)
- Medhat Taha
- Department of Anatomy, Umm Al-Qura University, Al-Qunfudhah, SAU
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16
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Koike T, Fukushiro M, Ueno A, Nakashima S, Yamakawa S, Suda S, Hayashida K, Yamasaki O. Recurrent cellulitis and bacteremia in a patient with Noonan syndrome: A case report. J Infect Chemother 2024; 30:548-551. [PMID: 38042300 DOI: 10.1016/j.jiac.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/06/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Abstract
A 28-year old Japanese man with Noonan syndrome (NS) presented to our emergency department with painful erythema of the trunk and lower extremities since the previous day. He had been diagnosed with protein-losing enteropathy (PLE) with intestinal lymphangiectasia at age 25 years, and undergone lymphaticovenular anastomosis (LVA) twice. Three episodes of cellulitis of both lower extremities had occurred in the past 2 years. Extensive cellulitis with sepsis was diagnosed and piperacillin/tazobactam was started, which was de-escalated to ceftriaxone. He was discharged after 13 days of antibiotic therapy. After discharge, low-dose trimethoprim-sulfamethoxazole (SMZ-TMP) was started as the primary prophylaxis, but three episodes of cellulitis occurred in the next year and were treated with other antibiotics. NS, an autosomal dominant disease known as a RASopathy, is caused by germline mutations in RAS-MAPK pathway genes. Lymphedema resulting from lymphatic abnormalities is a concomitant manifestation in 20 % of patients with NS, and can be a risk factor for cellulitis. Hypoalbuminemia and hypoglobulinemia associated with PLE facilitate infections such as cellulitis. As a treatment for lymphedema in the extremities, LVA has shown objective and subjective improvements in most patients, and some studies have also reported its efficacy for lymphedema in patients with NS. Targeted molecular therapy with mitogen-activated protein kinase enzyme (MEK) inhibitor is used in treatment of cancers with activation of the RAS/MAPK pathway. MEK inhibitors have recently been tried in patients with RASopathies and severe lymphatic disorders, and can lead to rapid resolution of symptoms.
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Affiliation(s)
- Takayuki Koike
- Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Michihito Fukushiro
- Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Ayaka Ueno
- Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shigeki Nakashima
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan
| | - Sho Yamakawa
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shota Suda
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan.
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17
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L A Cross E, Quan TP, Hayward GN, Walker AS, Llewelyn MJ. Development and validation of the Baseline Recurrence Risk in Cellulitis (BRRISC) score. J Infect 2024; 88:103-111. [PMID: 38128701 PMCID: PMC11832457 DOI: 10.1016/j.jinf.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Cellulitis is often treated with antibiotics for longer than recommended by guidelines. Prolonged therapy may reduce recurrence in certain patients, but it is not known which patients are at greatest risk. Our objective was to develop and temporally validate a risk prediction score to identify patients attending hospital with cellulitis at highest risk of recurrence. METHODS We included UK adult patients with cellulitis attending hospital in an electronic health records (EHR) study to identify demographic, comorbid, physiological, and laboratory factors predicting recurrence (before death) within 90 days, using multivariable logistic regression with backwards elimination in complete cases. A points-based risk score integerised model coefficients for selected predictors. Performance was assessed using the C-index in development and temporal validation samples. RESULTS The final model included 4938 patients treated for median 8 days (IQR 6-11); 8.8% (n = 436) experienced hospitalisation-associated recurrence. A risk score using eight variables (age, heart rate, urea, platelets, albumin, previous cellulitis, venous insufficiency, and liver disease) ranged from 0-15, with C-index = 0.65 (95%CI: 0.63-0.68). Categorising as low (score 0-1), medium (2-5) and high (6-15) risk, recurrence increased fourfold; 3.2% (95%CI: 2.3-4.4%), 9.7% (8.7-10.8%), and 16.6% (13.3-20.4%). Performance was maintained in the validation sample (C-index = 0.63 (95%CI: 0.58-0.67)). Among patients at high risk, four distinct clinical phenotypes were identified using hierarchical clustering 1) young, acutely unwell with liver disease; 2) comorbid with previous cellulitis and venous insufficiency; 3) chronic renal disease with severe renal impairment; and 4) acute severe illness, with substantial inflammatory responses. CONCLUSIONS Risk of cellulitis recurrence varies markedly according to individual patient factors captured in the Baseline Recurrence Risk in Cellulitis (BRRISC) score. Further work is needed to optimise the score, considering baseline and treatment response variables not captured in EHR data, and establish the utility of risk-based approaches to guide optimal antibiotic duration.
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Affiliation(s)
- Elizabeth L A Cross
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer BN1 9PS, UK
| | - T Phuong Quan
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; NIHR Biomedical Research Centre, Oxford OX3 9DU, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; NIHR Biomedical Research Centre, Oxford OX3 9DU, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
| | - Martin J Llewelyn
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer BN1 9PS, UK.
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18
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Burian EA, Franks PJ, Borman P, Quéré I, Karlsmark T, Keeley V, Sugama J, Cestari M, Moffatt CJ. Factors associated with cellulitis in lymphoedema of the arm - an international cross-sectional study (LIMPRINT). BMC Infect Dis 2024; 24:102. [PMID: 38238718 PMCID: PMC10797905 DOI: 10.1186/s12879-023-08839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an international level. The aim of this study was to identify the frequency of cellulitis in patients with lymphoedema of the arm, including potential risk factors for cellulitis. METHODS An international, multi-centre, cross-sectional study including patients with clinically assessed arm lymphoedema. The primary outcome was the incidence of cellulitis located to the arm with lymphoedema within the last 12 months, and its potential associated risk factors. The secondary outcome was life-time prevalence of cellulitis. Adults with clinically-assessed arm lymphoedema/chronic oedema (all causes) and able to give informed consent were included. End-of-life-patients or those judged as not in the patient's best interest were excluded. Both univariable and multivariable analysis were performed. RESULTS A total of 2160 patients were included from Australia, Denmark, France, Ireland, Italy, Japan, Turkey and United Kingdom. Secondary lymphoedema was present in 98% of the patients; 95% of these were judged as related to cancer or its treatment. The lifetime prevalence of cellulitis was 22% and 1-year incidence 11%. Following multivariable analysis, factors associated with recent cellulitis were longer swelling duration and having poorly controlled lymphoedema. Compared to having lymphoedema less than 1 year, the risk increased with duration: 1-2 years (OR 2.15), 2-5 years (OR 2.86), 5-10 years (OR 3.15). Patients with well-controlled lymphoedema had a 46% lower risk of cellulitis (OR 0.54, 95% CI 0.39-0.73, p < 0.001). More advanced stages of lymphoedema were associated with cellulitis even after adjustment for swelling duration and control of swelling by logistic regression (stage II OR 5.44, stage III OR 9.13, p = 0.002), demonstrated in a subgroup analysis. CONCLUSION Patients with advanced arm lymphoedema are at particular risk of developing cellulitis. Prevention of lymphoedema progression is crucial. The results lend towards a positive effect of having well-treated lymphoedema on the frequency of cellulitis.
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Affiliation(s)
- Ewa Anna Burian
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark.
| | - Peter J Franks
- Centre for Research and Implementation of Clinical Practice, London, UK
| | - Pinar Borman
- Medical Faculty, Department of Physical Medicine and Rehabilitation, Ankara Medipol University, Ankara, Turkey
| | - Isabelle Quéré
- CHU Montpellier, University of Montpellier, IDESP, Montpellier, France
| | - Tonny Karlsmark
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark
| | - Vaughan Keeley
- Lymphoedema Department, University Hospitals of Derby and Burton NHS Trust, Derby and University of Nottingham Medical School, Nottingham, UK
| | - Junko Sugama
- Research Centre for Implementation Nursing Science Initiative, Research Promotion Headquarters, Fujita Health University, Aichi, Japan
| | | | - Christine J Moffatt
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Castater C, Bishop E, Santos A, Freedberg M, Kim P, Sciarretta C. Diabetic Soft Tissue Infections. Surg Clin North Am 2023; 103:1191-1216. [PMID: 37838463 DOI: 10.1016/j.suc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Diabetes is a systemic illness that can cause a broad range of physiologic effects. Infection rates and wound healing are both affected through multiple mechanisms. Other physiologic changes increase risk for wounds as well as complex soft tissue infections ranging from simple cellulitis to necrotizing soft tissue infections. Clinicians and surgeons need to have a low index of suspicion for severe infection in a patient presenting with diabetes, and even more so in patients with uncontrolled diabetes.
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Affiliation(s)
- Christine Castater
- Morehouse School of Medicine, Grady Memorial Hospital 1C-144, 80 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA.
| | - Elliot Bishop
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Adora Santos
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Mari Freedberg
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Phillip Kim
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Christopher Sciarretta
- University of Tennessee, University of Tennessee College of Medicine, 975 3rd Avenue, Chattanooga, TN 37403, USA
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20
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Knapik JJ, Farina EK, Steelman RA, Trone DW, Lieberman HR. The Medical Burden of Obesity and Overweight in the US Military: Association of BMI with Clinically Diagnosed Medical Conditions in United States Military Service Members. J Nutr 2023; 153:2951-2967. [PMID: 37619919 DOI: 10.1016/j.tjnut.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND A high BMI is associated with various medical conditions, notably type 2 diabetes, cardiovascular disease, and mental health disorders. In the US military, BMI increased linearly between 1975 and 2015. OBJECTIVE This cross-sectional study investigated the associations between BMI and a comprehensive range of clinically diagnosed medical conditions (CDMCs) in US military service members (SMs). METHODS A stratified random sample of SMs (n=26,177) completed an online questionnaire reporting their height, weight, and demographic/lifestyle characteristics. Medical conditions for 6 mo before questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 39 CDMCs covering both broad (largely systemic) and specific medical conditions. BMI was calculated as weight/height2 (kg/m2). The prevalence of CDMCs was compared among normal weight (<25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2) SMs. RESULTS After multivariable adjustment for demographic/lifestyle characteristics, higher BMI was associated with higher odds of a diagnosed medical condition in 30 of 39 CDMCs, with all 30 displaying dose-response relationships. The 5 major CDMCs with the largest odds ratios comparing obese to normal weight were endocrine/nutritional/metabolic diseases (OR=2.67, 95%CI=2.24-3.15), nervous system diseases (odds ratio [OR]=2.59, 95%CI=2.32-2.90), circulatory system diseases (OR=2.56, 95%CI=2.15-3.06), musculoskeletal system diseases (OR=1.92, 95%CI=1.76-2.09), and mental/behavioral disorders (OR=1.69, 95%CI=1.51-1.90). Compared with normal weight SMs, overweight or obese SMs had a higher number of CDMCs (1.8±1.9 vs. 2.0±2.0 and 2.5±2.3, mean ± standard deviation, respectively, P<0.01). CONCLUSIONS In a young, physically active population, higher BMI was associated with a host of medical conditions, even after adjustment for demographic/lifestyle characteristics. The US Department of Defense should improve nutrition education and modify other factors that contribute to overweight and obesity. This study demonstrates that the medical burden of obesity is substantial in overweight and obese SMs.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States.
| | - Emily K Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States
| | - Ryan A Steelman
- Clinical Public Health and Epidemiology, Defense Centers for Public Health-Aberdeen, MD, United States
| | - Daniel W Trone
- Deployment Health, Naval Health Research Center, CA, United States
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States
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21
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Mukhtar M, Khan B, Mukhtar N. Disposable Barrel Used for Easy and Fast Toe Space Examination. J Cutan Aesthet Surg 2023; 16:355-356. [PMID: 38314370 PMCID: PMC10833485 DOI: 10.4103/jcas.jcas_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Chronic candidiasis with bacterial infection is common infection in the toe web which is is not inspected and treated well in early stage, and it is now the cause of cellulitis in the leg in a number of cases. To examine the narrow space of the toe web and to treat and to reduce the complication, we described the use a disposable syringe barrel.
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Affiliation(s)
- Muhammed Mukhtar
- Mukhtar Skin Centre, Katihar Medical College Road, Katihar, India
| | | | - Nadia Mukhtar
- Mukhtar Skin Centre, Katihar Medical College Road, Katihar, India
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22
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Suchy JP, Glasoe WM, Koehler LA. A Tissue Dielectric Constant Evaluation of Knee Edema: A Retrospective Intra-rater Reliability and Association Study of Repeated Measures. Cureus 2023; 15:e42089. [PMID: 37602087 PMCID: PMC10435093 DOI: 10.7759/cureus.42089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND This research compared the reliability and association of tissue dielectric constant (TDC) measures of knee edema to circumferential measurements of knee girth recorded as part of a physical therapy examination. METHODS Twenty adults having observable unilateral knee edema were enrolled. A single examiner measured edematous knee swelling with a TDC device and a tape measure across two visits. The presence of edema was recorded as a positive number in reporting side-to-side differences and a positive percentage in documenting change over time. Intra-rater reliability of the measures was assessed with an intra-class correlation coefficient (ICC). Percent change in edema was evaluated independently for both methods using a paired t-test, and the association between measures was assessed by a Pearson's statistic. RESULTS Both measures were reliable (ICC ≥ 0.81), and both detected a significant percentage decrease (p < 0.05) in edema across visits. The TDC measure changed by 8.3%, an amount nearly four times larger compared to knee girth (2.4%). The subsequent follow-up comparison revealed an inverse relationship (p = 0.049; r = -0.44) between the two percent change measurements of edema. CONCLUSION The two methods capture different physical attributes of edema. The TDC records the water content of the tissue, while the use of a tape measure records circumferential limb girth. The TDC measurement was reliable and more responsive in detecting a percentage decrease in knee edema in comparison to a circumferential measure of knee girth. The TDC method may have wider use in directly measuring edema in other tissue structures and regions of the body.
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Affiliation(s)
- James P Suchy
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
| | - Ward M Glasoe
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
| | - Linda A Koehler
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA
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23
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Wang BY, Yang SF, Ting KH, Wang YH, Chou MC, Yeh CB. Evaluation of the Risk Factors for Cellulitis among Patients with Peripheral Artery Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050933. [PMID: 37241165 DOI: 10.3390/medicina59050933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: The objective of this study is to elucidate peripheral occlusion artery disease (PAOD) as a risk factor for cellulitis. Materials and Methods: This is a retrospective population-based cohort study. The database is the Longitudinal Health Insurance Database, which covers two million beneficiaries from the entire population of the 2010 registry for beneficiaries in Taiwan. The PAOD group is composed of patients who were newly diagnosed with PAOD from 2001 to 2014. The non-PAOD group is composed of patients who were never diagnosed with PAOD from 2001 to 2015. All patients were followed until the onset of cellulitis, death, or until the end of 2015. Results: Finally, 29,830 patients who were newly diagnosed with PAOD were included in the PAOD group, and 29,830 patients who were never diagnosed with PAOD were included in the non-PAOD group. The incidence densities (ID) of cellulitis were 26.05 (95% CI = 25.31-26.80) patients per 1000 person-years in the PAOD group and 49.10 (95% CI = 48.04-50.19) in the non-PAOD group. The PAOD group had an increased risk of cellulitis (adjusted HR = 1.94, 95% CI = 1.87-2.01) compared to the non-PAOD group. Conclusions: Patients with PAOD were associated with a higher risk of subsequent cellulitis compared to patients without PAOD.
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Affiliation(s)
- Bo-Yuan Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Ke-Hsin Ting
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Yunlin Branch, Changhua 648, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chao-Bin Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
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Samannodi M. Hospital Admissions Related to Infections and Disorders of the Skin and Subcutaneous Tissue in England and Wales. Healthcare (Basel) 2022; 10:healthcare10102028. [PMID: 36292475 PMCID: PMC9601618 DOI: 10.3390/healthcare10102028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate hospital admissions in England and Wales due to infections and diseases of the skin and subcutaneous tissue. METHODS Data from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) database in England for the years between April 1999 and April 2020 were used in this study. Using all the relevant diagnosis codes (L00-L99), hospital admissions related to various skin infections and diseases of the subcutaneous tissue were identified. RESULTS Hospital admissions for all causes increased overall by 78.8%, from 276,464 in 1999 to 494,433 in 2020, representing an increase in hospital admission rate of 56.1% (from 530.23 (95% CI 528.26-532.20) in 1999 to 827.92 (95% CI 825.62-830.22) per 100,000 people in 2020, p ≤ 0.05). The most prevalent diagnoses were disorders of the skin's appendages, infections of the skin and subcutaneous tissue, and other disorders of the skin and subcutaneous tissue. Nearly half of all hospital admissions were for males and for patients between the ages of 15 and 59. In 2020, the hospital admission rate for males increased by 60.2%, from 540.16 (95% CI 537.32-543.01) per 100,000 people in 1999 to 865.10 (95% CI 861.76-868.44) in 2020. From 520.75 (95% CI 518.02-523.48) in 1999 to 791.03 (95% CI 787.86-794.19) in 2020, the hospital admission rate for females grew by 51.9%. CONCLUSION Hospital admission due to infections and disorders of the skin and subcutaneous tissue increased during the past two decades in England and Wales. Further studies are needed to explore the risk factors associated with infections and disorders of the skin and subcutaneous tissue complications, and its associated admissions.
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Affiliation(s)
- Mohammed Samannodi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
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25
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Zhao DW, Ni J, Sun XL. Histiocytoid giant cellulitis-like Sweet syndrome at the site of sternal aspiration: A case report and review of literature. World J Clin Cases 2022; 10:9768-9775. [PMID: 36186189 PMCID: PMC9516896 DOI: 10.12998/wjcc.v10.i27.9768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/26/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Giant cellulitis-like Sweet syndrome (SS) is a rare subtype of SS, and reports of the combined histiocytoid type of pathology are scarce. Here, we report a case of SS with distinctive clinical presentations and which was difficult to distinguish from cellulitis. By sharing this case and a discussion of the related literature in detail, we aim to provide clinicians with new insights into the characteristics of histiocytoid giant cellulitis-like (HGC)-SS and the pathogenesis of SS.
CASE SUMMARY A 52-year-old male was admitted after experiencing progressive fatigue for 1 mo and tongue swelling with pain for 1 d. He was diagnosed with myelodysplastic syndrome (MDS) and angioneurotic edema of the tongue and floor of the mouth. However, 7 d after examination by sternal aspiration, a violaceous, tender, and swollen nodule developed at the site, with poorly demarcated erythema of the surrounding skin. Considering his profile of risk factors, the diagnosis of cellulitis was made and he was administered broad-spectrum antibiotics. When the lesion continued to worsen and he developed chills and fever, pathogenic and dermatopathological examination led to the diagnosis of HGC-SS. Treatment with prednisone led to the fever being relieved within 24 h and the skin lesion being resolved within 1 wk. The patient refused intensive treatment and was instead given thalidomide, erythropoietin, stanozolol, and supportive care. The prednisone was gradually tapered, with no signs of recurrence, but he died 2 mo later of severe pneumonia.
CONCLUSION HGC-SS demonstrates unique manifestation. SS and leukemia cutis share cytological origin. Myelofibrosis and SS are adverse prognostic factors for MDS.
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Affiliation(s)
- De-Wan Zhao
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian 116014, Liaoning Province, China
| | - Jing Ni
- Department of Dermatology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Xiu-Li Sun
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian 116014, Liaoning Province, China
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26
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Ong BS, Dotel R, Ngian VJJ. Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic Prophylaxis? Int J Gen Med 2022; 15:6561-6572. [PMID: 35983462 PMCID: PMC9379124 DOI: 10.2147/ijgm.s326459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Recurrent cellulitis following successful treatment is common and prevention should be a major component in the management of cellulitis. Conditions that increase the risk of recurrence include chronic edema, venous disease, dermatomycosis and obesity. These risk factors should be actively managed as further episodes of cellulitis increases the risk of recurrence. The role of non-antibiotic measures is important and should be first-line in prevention. Antibiotic prophylaxis is effective, but its role is limited to non-purulent cellulitis where risk factors are appropriately managed.
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Affiliation(s)
- Bin S Ong
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Ravindra Dotel
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Vincent Jiu Jong Ngian
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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27
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Biglione B, Cucka B, Kroshinsky D. Cellulitis and Its Mimickers: an Approach to Diagnosis and Management. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00363-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taniguchi T, Tsuha S, Shiiki S, Narita M, Teruya M, Hachiman T, Kogachi N. High yield of blood cultures in the etiologic diagnosis of cellulitis, erysipelas, and cutaneous abscess in elderly patients. Open Forum Infect Dis 2022; 9:ofac317. [PMID: 35899281 PMCID: PMC9310324 DOI: 10.1093/ofid/ofac317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/23/2022] [Indexed: 12/05/2022] Open
Abstract
Background Cellulitis is a common disease in the elderly, and detecting etiologic organisms with blood cultures is difficult because of the low positive rate and occasional skin contamination. Therefore, routine blood cultures are not recommended for uncomplicated cellulitis. However, it is unclear whether blood culture collection for the diagnosis of cellulitis in elderly patients is useful. Methods This single hospital–based observational study was performed between April 2012 and March 2015 in Okinawa, Japan. All enrolled patients were aged 15 years or older and admitted to the Division of Infectious Diseases with suspected cellulitis, erysipelas, and cutaneous abscess. Two routine sets of blood cultures were obtained. Results Two hundred and twenty-one patients were enrolled. The median age was 77 years. The proportion of bacteremia was 21.7% for all patients (48/221), 8.5% (4/47) for those <65 years, and 25.3% (44/174) for those ≥65 years old (P = .013). The skin contamination rate was 0.9% (2/221). The most common pathogen was Streptococcus dysgalactiae (62.5%). Gram-negative bacteremia not susceptible to cefazolin was detected in 8.3%. Cefazolin and ampicillin were the first- and second-most commonly used therapies. Anti–methicillin-resistant Staphylococcus aureus therapy was required in 3.6% of patients. In addition to age and severe infection, shaking chills and white blood count ≥13 000 cells/µL were independent risk factors of bacteremia. Conclusions Two routine sets of blood cultures are recommended for the precise diagnosis and appropriate treatment of cellulitis in elderly patients, especially in patients with shaking chills or leukocytosis.
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Affiliation(s)
- Tomohiro Taniguchi
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Chubu Hospital , 281 Miyazato, Uruma, Okinawa 904-2293 , Japan
- Division of General Internal Medicine and Infectious Diseases, Hiroshima Prefectural Hospital , 1-5-54 Ujinakanda, Minami-ku, Hiroshima 734-8530 , Japan
| | - Sanefumi Tsuha
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Chubu Hospital , 281 Miyazato, Uruma, Okinawa 904-2293 , Japan
- Division of General Internal Medicine and Infectious Diseases, Sakibana Hospital , 1-3-30 Nozomino, Izumi, Osaka 594-1105 , Japan
| | - Soichi Shiiki
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Chubu Hospital , 281 Miyazato, Uruma, Okinawa 904-2293 , Japan
| | - Masashi Narita
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Chubu Hospital , 281 Miyazato, Uruma, Okinawa 904-2293 , Japan
- Division of Infectious Diseases, Department of Medicine, Okinawa Nanbu Medical Center and Children's Medical Center, Arakawa 118-1, Haebaru-cho, Shimajiri-gun, Okinawa 901-1193 , Japan
| | - Mariko Teruya
- Microbiology Laboratory, Okinawa Chubu Hospital , 281 Miyazato, Uruma, Okinawa 904-2293 , Japan
| | - Teruyuki Hachiman
- Microbiology Laboratory, Okinawa Chubu Hospital , 281 Miyazato, Uruma, Okinawa 904-2293 , Japan
| | - Noriyasu Kogachi
- Microbiology Laboratory, Okinawa Chubu Hospital , 281 Miyazato, Uruma, Okinawa 904-2293 , Japan
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29
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Roberts E. Factors Associated with Rehospitalisation for Cellulitis and How to Mitigate Against Them. EMJ MICROBIOLOGY & INFECTIOUS DISEASES 2022. [DOI: 10.33590/emjmicrobiolinfectdis/22c6933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gavin Barlow, Hull York Medical School, UK, spoke with the EMJ about risk factors for the bacterial infection cellulitis, including prior history of the condition, older age, and a number of comorbidities ranging from diabetes to athlete’s foot. Following hospitalisation, readmission for cellulitis, which occurs in around 12% of patients in the first month, may be due to such risk factors, as well as socioeconomic conditions. Readmission can greatly impact healthcare utilisation in economic and infection control terms and the use of sparse facilities, such as side-room beds. It can also impact a patient’s quality of life (QoL). Mitigating against readmission for cellulitis necessitates an understanding of the reasons for such, including risk factors, and how best to control them by, for instance, giving proper healthcare provision for comorbidities and educating patients to raise awareness of the recurrence of cellulitis.
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30
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Xue Y, Zhou J, Xu BN, Li Y, Bao W, Cheng XL, He Y, Xu CP, Ren J, Zheng YR, Jia CY. Global Burden of Bacterial Skin Diseases: A Systematic Analysis Combined With Sociodemographic Index, 1990-2019. Front Med (Lausanne) 2022; 9:861115. [PMID: 35547219 PMCID: PMC9084187 DOI: 10.3389/fmed.2022.861115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The latest incidence and disability-adjusted life-years (DALYs) of major bacterial skin diseases (BSD) and their relationship with socioeconomic are not readily available. Objective Describe the global age-standardized incidence and DALYs rates of BSD and analyze their relationship with socioeconomic. Methods All data were obtained from Global Burden of Disease (GBD) 2019 database. The correlation between BSD and socioeconomic development status was analyzed. Results The age-standardized incidence and age-standardized DALYs rate of BSD are: 169.72 million [165.28-175.44] and 0.41 million [0.33-0.48]. Of the two main BSD, pyoderma cause significantly much heavier burden than cellulitis. The change of age-standardized incidence (7.38% [7.06-7.67]) and DALYs (-10.27% [-25.65 to 25.45]) rate of BSD presented an upward or downward trend from 1990 to 2019. The highest burden was in the low-middle sociodemographic index (SDI) area while the area with the lowest burden was recorded in the high-middle SDI area in 2019. Limitations GBD 2019 data of BSD are derived from estimation and mathematical modeling. Conclusion The burden of BSD is related to socioeconomic development status. The results based on GBD2019 data may benefit policymakers in guiding priority-setting decisions for the global burden of BSD.
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Affiliation(s)
- Yi Xue
- Department of Burns and Plastic & Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Jie Zhou
- School of Medicine, Xiamen University, Xiamen, China
| | - Bei-Ni Xu
- Department of Clinical Laboratory, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yue Li
- School of Medicine, Xiamen University, Xiamen, China
| | - Wu Bao
- Department of Burns and Plastic & Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Xia Lin Cheng
- Department of Burns and Plastic & Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Yan He
- Department of Burns and Plastic & Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Chun Peng Xu
- Division of Plastic Surgery, Siming Branch of the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jun Ren
- Department of Dermatology, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Ya Rong Zheng
- Division of Plastic Surgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Chi Yu Jia
- Department of Burns and Plastic & Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
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31
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Boettler MA, Kaffenberger BH, Chung CG. Cellulitis: A Review of Current Practice Guidelines and Differentiation from Pseudocellulitis. Am J Clin Dermatol 2022; 23:153-165. [PMID: 34902109 DOI: 10.1007/s40257-021-00659-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
Cellulitis, an infection involving the deep dermis and subcutaneous tissue, is the most common reason for skin-related hospitalization and is seen by clinicians across various disciplines in the inpatient, outpatient, and emergency room settings, but it can present as a diagnostic and therapeutic challenge. Cellulitis is a clinical diagnosis based on the history of present illness and physical examination and lacks a gold standard for diagnosis. Clinical presentation with acute onset of redness, warmth, swelling, and tenderness and pain is typical. However, cellulitis can be difficult to diagnose due to a number of infectious and non-infectious clinical mimickers such as venous stasis dermatitis, contact dermatitis, eczema, lymphedema, and erythema migrans. Microbiological diagnosis is often unobtainable due to poor sensitivity of culture specimens. The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus, and appropriate targeted coverage of this pathogen with oral antibiotics such as penicillin, amoxicillin, and cephalexin is sufficient. Even with rising rates of community-acquired methicillin-resistant Staphylococcus aureus, coverage for non-purulent cellulitis is generally not recommended.
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32
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Doub JB. Treatment of Recurrent Severe Cellulitis with a Pill in Pocket Approach. Infect Chemother 2022; 54:382-387. [PMID: 35132835 PMCID: PMC9259910 DOI: 10.3947/ic.2021.0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Cellulitis is a common condition that plagues healthcare systems and is associated with significant healthcare costs and resource allocations. With ample antimicrobial therapy this infectious syndrome can be easily treated but recurrence is common. Many conditions predispose patients to be at risk for recurrent cellulitis with chronic lymphoedema being a significant risk factor secondary to pooling of lymphatic fluid and impaired local immune responses. Moreover, patients with chronic lymphoedema can be at risk for acute onset of severe cellulitis requiring urgent medical evaluation and treatment. Consequently, to prevent recurrent cellulitis episodes, the use of long-term oral antibiotics has been advocated, but when recurrences occur despite long-term antibiotic use limited options are available. In this case report, a unique treatment approach for preventing severe cellulitis is discussed with a pill in the pocket approach with the use of oral tedizolid. This has thwarted the need for recurrent hospitalizations and reduced health care costs for this individual patient. Herein this treatment approach is discussed as is the rationale for using tedizolid instead of other antibiotics.
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Affiliation(s)
- James B. Doub
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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33
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Thakrar DB, Sultan MJ. Cellulitis: diagnosis and differentiation. J Wound Care 2021; 30:958-965. [PMID: 34881996 DOI: 10.12968/jowc.2021.30.12.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dixa B Thakrar
- General Surgery Trainee, Imperial College Healthcare NHS Trust, Department of General Surgery, London, UK
| | - Muhammad J Sultan
- Locum Consultant Vascular Surgeon, Hull Royal Infirmary; Senior Honorary Clinical Lecturer, University of Hull, UK
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34
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Long B, Gottlieb M. Diagnosis and Management of Cellulitis and Abscess in the Emergency Department Setting: An Evidence-Based Review. J Emerg Med 2021; 62:16-27. [PMID: 34657784 DOI: 10.1016/j.jemermed.2021.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/04/2021] [Accepted: 09/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cellulitis and abscess are a common reason for presentation to the emergency department, although there are several nuances to the care of these patients. OBJECTIVE The purpose of this narrative review article was to provide a summary of the background, pathophysiology, diagnosis, and management of cellulitis and abscesses with a focus on emergency clinicians. DISCUSSION The most common bacteria causing cellulitis are Staphylococcus aureus, Streptococcus pyogenes, and other β-hemolytic streptococci, and methicillin-resistant S. aureus is most common in abscesses. The history and physical examination are helpful in differentiating cellulitis and abscess in many cases, and point-of-care ultrasound can be a useful tool in unclear cases. Treatment for cellulitis typically involves a penicillin or cephalosporin, and treatment of abscesses is incision and drainage. Loop drainage is preferred over the traditional incision and drainage technique, and adjunctive antibiotics can be considered. Most patients can be managed as outpatient. CONCLUSIONS It is essential for emergency physicians to be aware of the current evidence regarding the diagnosis and management of patients with cellulitis and abscess.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Houston, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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35
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Gundogan B, Dowlut N, Rajmohan S, Borrelli MR, Millip M, Iosifidis C, Udeaja YZ, Mathew G, Fowler A, Agha R. Assessing the compliance of systematic review articles published in leading dermatology journals with the PRISMA statement guidelines: A systematic review. JAAD Int 2021; 1:157-174. [PMID: 34409336 PMCID: PMC8361930 DOI: 10.1016/j.jdin.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reporting quality of systematic reviews and meta-analyses is of critical importance in dermatology because of their key role in informing health care decisions. Objective To assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Methods This review was carried out in accordance with PRISMA guidelines. Included studies were reviews published across 6 years in the top 4 highest-impact-factor dermatology journals of 2017. Records and full texts were screened independently. Data analysis was conducted with univariate multivariable linear regression. The primary outcome was to assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the PRISMA statement. Results A total of 166 studies were included and mean PRISMA compliance across all articles was 73%. Compliance significantly improved over time (β = .016; P = <.001). The worst reported checklist item was item 5 (reporting on protocol existence), with a compliance of 15% of articles. Conclusion PRISMA compliance within leading dermatology journals could be improved; however, it is steadily improving.
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Affiliation(s)
- Buket Gundogan
- University College London Hospital, London, United Kingdom
| | - Naeem Dowlut
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Mirabel Millip
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christos Iosifidis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yagazie Z Udeaja
- Luton and Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom
| | - Ginimol Mathew
- University College London Medical School, Gower Street, London, United Kingdom
| | | | - Riaz Agha
- Bart's Health NHS Foundation Trust, London, United Kingdom
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36
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O'Brien G, White P. The Red Legs RATED tool to improve diagnosis of lower limb cellulitis in the emergency department. ACTA ACUST UNITED AC 2021; 30:S22-S29. [PMID: 34170719 DOI: 10.12968/bjon.2021.30.12.s22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lower limb cellulitis poses a significant burden for the Irish healthcare system. Accurate diagnosis is difficult, with a lack of validated evidence-based tools and treatment guidelines, and difficulties distinguishing cellulitis from its imitators. It has been suggested that around 30% of suspected lower limb cellulitis is misdiagnosed. An audit of 132 patients between May 2017 and May 2018 identified a pattern of misdiagnosis in approximately 34% of this cohort. OBJECTIVE The aim of this pilot project was to develop a streamlined service for those presenting to the emergency department with red legs/suspected cellulitis, through introduction of the 'Red Leg RATED' tool for clinicians. METHOD The tool was developed and introduced to emergency department clinicians. Individuals (n=24) presenting with suspected cellulitis over 4 weeks in 2018 were invited to participate in data gathering. Finally, clinician questionnaire feedback regarding the tool was evaluated. RESULTS Fourteen participants consented, 6 female and 8 male with mean age of 65 years. The tool identified 50% (n=7) as having cellulitis, of those 57% (n=4) required admission, 43% (n=3) were discharged. The remainder who did not have cellulitis (n=7) were discharged. Before introduction of the tool, all would typically have been admitted to hospital for further assessment and management of suspected lower limb cellulitis. Overall, 72% (n=10) of patients who initially presented with suspected cellulitis were discharged, suggesting positive impact of the tool. Clinician feedback suggested all were satisfied with the tool and contents. CONCLUSION The Red Leg RATED tool is user friendly and impacts positively on diagnosis treatment and discharge. Further evaluation is warranted.
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Affiliation(s)
- Gillian O'Brien
- Registered Advanced Nurse Practitioner Tissue Viability, Naas General Hospital, Naas, County Kildare
| | - Patricia White
- Research Fellow, Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin
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Abstract
Cellulitis is a common skin infection resulting in increasing hospitalizations and health care costs. There is no gold standard diagnostic test, making cellulitis a potentially challenging condition to distinguish from other mimickers. Physical examination typically demonstrates poorly demarcated unilateral erythema with warmth and tenderness. Thorough history and clinical examination can narrow the differential diagnosis of cellulitis and minimize unnecessary hospitalization. Antibiotic selection is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit.
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Affiliation(s)
- Renajd Rrapi
- Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, 2nd Floor, Boston, MA 02114, USA
| | - Sidharth Chand
- Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, 2nd Floor, Boston, MA 02114, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, 2nd Floor, Boston, MA 02114, USA.
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Burian E, Karlsmark T, Franks P, Keeley V, Quéré I, Moffatt C. Cellulitis in chronic oedema of the lower leg: an international cross‐sectional study. Br J Dermatol 2021; 185:110-118. [DOI: 10.1111/bjd.19803] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 01/03/2023]
Affiliation(s)
- E.A. Burian
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - T. Karlsmark
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - P.J. Franks
- Centre for Research and Implementation of Clinical Practice London UK
| | - V. Keeley
- Lymphoedema Department Royal Derby HospitalDerby and University of Nottingham Medical School Nottingham UK
| | - I. Quéré
- Department of Vascular Medicine Montpellier University Hospital CentreUniversity of Montpellier France
| | - C.J. Moffatt
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
- School of Social Sciences Nottingham Trent University Nottingham UK
- Nottingham University Hospitals NHS Trust Nottingham UK
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Vignes S, Poizeau F, Dupuy A. Cellulitis risk factors for patients with primary or secondary lymphedema. J Vasc Surg Venous Lymphat Disord 2021; 10:179-185.e1. [PMID: 33957278 DOI: 10.1016/j.jvsv.2021.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limb lymphedema is a chronic disease with primary and secondary forms, with the latter occurring essentially after cancer treatment. In the present study, we retrospectively analyzed the cellulitis frequency and its associated risk factors for patients with primary or secondary limb lymphedema. METHODS Information from all 1991 patients referred to a specialized lymphedema center from January to June 2018 was collected, including previous cellulitis episodes and the clinical and lymphedema characteristics. RESULTS Of the 1846 patients whose information could be analyzed, 695 (37.6%) had experienced one or more cellulitis episodes, and 23.3% had had recurrent cellulitis. Cellulitis occurred in 39.5%, 30.5%, and 38.6% (P = .02) of the patients with secondary upper limb, secondary lower limb, and primary lower limb lymphedema, respectively. The corresponding duration of lymphedema was 106.5, 97, and 243.1 months. For secondary upper limb lymphedema, a long interval from lymphedema onset to the first consultation at our specialized center, younger age at lymphedema onset, and the use of radiotherapy were independently associated with cellulitis. However, axillary lymph node excision, the use of chemotherapy, and segmentation of the upper limb lymphedema were not associated with cellulitis. A longer interval from lymphedema onset to the first consultation and lymph node excision were associated with cellulitis in those with lower limb secondary lymphedema but higher body mass index and younger age at lymphedema onset were not. For primary lower limb lymphedema, male sex, greater body mass index, and younger age at lymphedema onset were associated with cellulitis. CONCLUSIONS Different risk factors for cellulitis were identified for patients with lymphedema at risk. Awareness of those factors is important for physicians to recognize lymphedema promptly and refer patients to specialized centers to optimize treatment.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Referral Center for Rare Vascular Diseases, Cognacq-Jay Hospital, Paris, France.
| | - Florence Poizeau
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France; EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, Rennes, France
| | - Alain Dupuy
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France; EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), Rennes 1 University, Rennes, France
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40
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Abstract
Cellulitis is a common infection of the skin and subcutaneous tissue caused predominantly by gram-positive organisms. Risk factors include prior episodes of cellulitis, cutaneous lesions, tinea pedis, and chronic edema. Cellulitis is a clinical diagnosis and presents with localized skin erythema, edema, warmth, and tenderness. Uncomplicated cellulitis can be managed in the outpatient setting with oral antibiotics. Imaging often is not required but can be helpful. Recurrent cellulitis is common and predisposing conditions should be assessed for and treated at the time of initial diagnosis. For patients with frequent recurrences despite management of underlying conditions, antimicrobial prophylaxis can be effective.
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Affiliation(s)
- Rachel J Bystritsky
- Department of Medicine, Infectious Diseases, University of California-San Francisco, 350 Parnassus, Rm 808B, UCSF Box 0654, San Francisco, CA 94117, USA.
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Vignes S, Albuisson J, Champion L, Constans J, Tauveron V, Malloizel J, Quéré I, Simon L, Arrault M, Trévidic P, Azria P, Maruani A. Primary lymphedema French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins). Orphanet J Rare Dis 2021; 16:18. [PMID: 33407666 PMCID: PMC7789008 DOI: 10.1186/s13023-020-01652-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/19/2020] [Indexed: 11/10/2022] Open
Abstract
Primary lymphedema is a rare chronic pathology associated with constitutional abnormalities of the lymphatic system. The objective of this French National Diagnosis and Care Protocol (Protocole National de Diagnostic et de Soins; PNDS), based on a critical literature review and multidisciplinary expert consensus, is to provide health professionals with an explanation of the optimal management and care of patients with primary lymphedema. This PNDS, written by consultants at the French National Referral Center for Primary Lymphedema, was published in 2019 (https://has-sante.fr/upload/docs/application/pdf/2019-02/pnds_lymphoedeme_primaire_final_has.pdf).
Primary lymphedema can be isolated or syndromic (whose manifestations are more complex with a group of symptoms) and mainly affects the lower limbs, or, much more rarely, upper limbs or external genitalia. Women are more frequently affected than men, preferentially young. The diagnosis is clinical, associating mild or non-pitting edema and skin thickening, as confirmed by the Stemmer’s sign (impossibility to pinch the skin on the dorsal side or the base of the second toe), which is pathognomonic of lymphedema. Limb lymphoscintigraphy is useful to confirm the diagnosis. Other causes of swelling or edema of the lower limbs must be ruled out, such as lipedema. The main acute lymphedema complication is cellulitis (erysipelas). Functional and psychological repercussions can be major,
deteriorating the patient’s quality of life. Treatment aims to prevent those complications, reduce the volume with low-stretch bandages, then stabilize it over the long term by exercises and wearing a compression garment. Patient education (or parents of a child) is essential to improve observance.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France.
| | | | - Laurence Champion
- Department of Nuclear Medicine, René Huguenin-Curie Hospital, 35, rue Dailly, 92210, Saint-Cloud, France
| | - Joël Constans
- Department of Vascular Medicine, Saint-André Hospital, CHU de Bordeaux, 1, rue Jean-Burguet, 33000, Bordeaux, France
| | - Valérie Tauveron
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, 37044, Tours Cedex 9, France
| | - Julie Malloizel
- Department of Vascular Medicine, Rangueil Hospital, 1, avenue du Pr Jean-Poulhès, 31059, Toulouse, France
| | - Isabelle Quéré
- Department of Vascular Medicine and Reference Center for Rare Vascular Diseases, CHU Montpellier, 80, avenue Augustin-Fliche, 34090, Montpellier, France
| | - Laura Simon
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France
| | - Maria Arrault
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France
| | | | - Philippe Azria
- Department of Internal Medicine, Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75014, Paris, France
| | - Annabel Maruani
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, 37044, Tours Cedex 9, France.,INSERM 1246 - SPHERE, Universities of Tours and Nantes, 37000, Tours, France
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Gomes Siqueira GL, Alves de Olinda R, Barbosa de Siqueira CM, Barros de Vasconcelos Sá Torres A, de Carvalho Viana Corrêa L, de Assis Silva Lacerda F, Fernandes Guimarães PL. Non-necrotizing and necrotizing soft tissue infections in South America: A retrospective cohort study. Ann Med Surg (Lond) 2020; 59:24-30. [PMID: 32983444 PMCID: PMC7498730 DOI: 10.1016/j.amsu.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study analyzed and described factors related to necrotizing or non-necrotizing soft tissue infections (SSTIs) in a hospitalized patient population in Northeastern South America. MATERIALS AND METHODS This retrospective study included patients hospitalized with SSTIs between January 2011 and December 2016. The main factors related to necrotizing SSTIs (NSTIs) or non-necrotizing SSTIs were analyzed together or separately. RESULTS Of 344 SSTI patients (161 [46.8%] non-necrotizing, 183 [53.2%] necrotizing), NSTI patients had a higher incidence of heart disease (P = 0.0081) and peripheral arterial disease (PAD; p < 0.001), more antibiotic use, and longer hospital stay (P < 0.001). NSTI was associated with a 9.58, 33.28, 2.34, and 2.27 times higher risk of PAD (confidence interval [CI] 3.69-24.87), amputation (7.97-139), complications (1.45-3.79), and death (1.2-4.26), respectively, than non-necrotizing SSTI. The risk factors associated with amputation were PAD (P < 0.001) and poor glycemic control during hospitalization (P = 0.0011). Factors associated with higher mortality were heart disease (P < 0.001), smoking (P = 0.0135), PAD (P = 0.001), chronic renal failure (P = 0.0039), poor glycemic control (P = 0.0005), and evolution to limb irreversibility (P < 0.001). CONCLUSION Patients with NSTI have greater illness severity, with a greater association with PAD and amputation. Patients with poor glycemic control more frequently underwent amputation and died.
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43
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Ting SW, Fan PC, Lin YS, Lin MS, Lee CC, Kuo G, Chang CH. Uremic pruritus and long-term morbidities in the dialysis population. PLoS One 2020; 15:e0241088. [PMID: 33104746 PMCID: PMC7588085 DOI: 10.1371/journal.pone.0241088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Uremic pruritus (UP) is a multifactorial problem that contributes to low quality of life in dialysis patients. The long-term influences of UP on dialysis patients are still poorly understood. This study aims to elucidate the contribution of UP to long-term outcomes. Materials and method We used the Taiwan National Health Insurance Research Database to conduct this study. Patients on chronic dialysis were included and divided into UP and non-UP groups according to the long-term prescription of antihistamine in the absence of other indications. The outcomes include infection-related hospitalization, catheter-related infection, major adverse cardiac and cerebrovascular events (MACCE) and parathyroidectomy. Results After propensity score matching, 14,760 patients with UP and 29,520 patients without UP were eligible for analysis. After a mean follow-up of 5 years, we found that infection-related hospitalization, MACCE, catheter-related infection, heart failure and parathyroidectomy were all slightly higher in the UP than non-UP group (hazard ratio: 1.18 [1.16–1.21], 1.05 [1.01–1.09], 1.16 [1.12–1.21], 1.08 [1.01–1.16] and 1.10 [1.01–1.20], respectively). Subgroup analysis revealed that the increased risk of adverse events by UP was generally more apparent in younger patients and patients who underwent peritoneal dialysis. Conclusion UP may be significantly associated with an increased risk of long-term morbidities.
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Affiliation(s)
- Sze-Wen Ting
- Department of Dermatology, New Taipei City Tu-Cheng Municipal Hospital, New Taipei City (Built and Operated by Chang Gung Medical Foundation), Taoyuan, Taiwan
| | - Pei-Chun Fan
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Sheng Lin
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ming-Shyan Lin
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
| | - Cheng-Chia Lee
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- * E-mail: ,
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Patel M, Lee SI, Levell NJ, Smart P, Kai J, Thomas KS, Leighton P. An interview study to determine the experiences of cellulitis diagnosis amongst health care professionals in the UK. BMJ Open 2020; 10:e034692. [PMID: 33055110 PMCID: PMC7559118 DOI: 10.1136/bmjopen-2019-034692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To explore healthcare professionals (HCPs) experiences and challenges in diagnosing suspected lower limb cellulitis. SETTING UK nationwide. PARTICIPANTS 20 qualified HCPs, who had a minimum of 2 years clinical experience as an HCP in the national health service and had managed a clinical case of suspected cellulitis of the lower limb in the UK. HCPs were recruited from departments of dermatology (including a specialist cellulitis clinic), general practice, tissue viability, lymphoedema services, general surgery, emergency care and acute medicine. Purposive sampling was employed to ensure that participants included consultant doctors, trainee doctors and nurses across the specialties listed above. Participants were recruited through national networks, HCPs who contributed to the cellulitis priority setting partnership, UK Dermatology Clinical Trials Network, snowball sampling where participants helped recruit other participants and personal networks of the authors. PRIMARY AND SECONDARY OUTCOMES Primary outcome was to describe the key clinical features which inform the diagnosis of lower limb cellulitis. Secondary outcome was to explore the difficulties in making a diagnosis of lower limb cellulitis. RESULTS The presentation of lower limb cellulitis changes as the episode runs its course. Therefore, different specialties see clinical features at varying stages of cellulitis. Clinical experience is essential to being confident in making a diagnosis, but even among experienced HCPs, there were differences in the clinical rationale of diagnosis. A group of core clinical features were suggested, many of which overlapped with alternative diagnoses. This emphasises how the diagnosis is challenging, with objective aids and a greater understanding of the mimics of cellulitis required. CONCLUSION Cellulitis is a complex diagnosis and has a variable clinical presentation at different stages. Although cellulitis is a common diagnosis to make, HCPs need to be mindful of alternative diagnoses.
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Affiliation(s)
- Mitesh Patel
- Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, UK
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Siang Ing Lee
- Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nick J Levell
- Dermatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Peter Smart
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Joe Kai
- Division of Primary Care & National Institute for Health Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Quirke M, Mitchell N, Varley J, Kelly S, Boland F, Moughty A, McKeever J, Fahey T, Wakai A. Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study. BMJ Open 2020; 10:e034057. [PMID: 32868346 PMCID: PMC7462158 DOI: 10.1136/bmjopen-2019-034057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine the prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department (ED) patients with acute bacterial skin and skin structure infections (ABSSSIs). DESIGN Multicentre, pilot cohort study. SETTING Three urban EDs in Dublin, Ireland. PARTICIPANTS Consecutive ED patients aged >16 years old with ABSSSIs between March 2015 and September 2016. INTERVENTION Oral flucloxacillin 500 mg-1 g four times a day (alternative in penicillin allergy). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was to determine the prevalence and predictors of oral to intravenous antibiotic switch. Secondary outcomes were to determine the prevalence and predictors of receiving an extended course of oral antibiotic treatment and measurement of interobserver reliability for clinical predictors at enrolment. RESULTS Overall, 159 patients were enrolled of which eight were lost to follow-up and five were excluded. The majority of patients were male (65.1%) and <50 years of age (58.2%). Oral to intravenous antibiotic switch occurred in 13 patients (8.9%; 95% CI 4.8% to 14.7%). Increased lesion size (OR 1.74; 95% CI 1.09 to 2.79), white cell count (OR 1.32; 95% CI 1.05 to 1.67), athlete's foot (OR 8.00; 95% CI 2.31 to 27.71) and fungal nail infections (OR 7.25; 95% CI 1.99 to 26.35) were associated with oral to intravenous antibiotic switch. 24.8% (95% CI 18.1% to 33.0%) of patients received an extended course of oral antibiotic treatment. CONCLUSION The prevalence of oral to intravenous antibiotic switch in this pilot study is 8.9% (95% CI 4.8% to 14.7%). We identify the predictors of oral to intravenous switch worthy of future investigation. TRIAL REGISTRATION NUMBER NCT02230813.
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Affiliation(s)
- Michael Quirke
- Emergency Care Research Unit, Royal College of Surgeons Ireland, Dublin, Ireland
- Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland
| | - Niamh Mitchell
- Department of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
| | - Jarlath Varley
- Department of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
| | - Stephen Kelly
- Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland
| | - Fiona Boland
- HRB Centre For Primary Care Research, Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Adrian Moughty
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph McKeever
- Department of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
| | - Tom Fahey
- HRB Centre For Primary Care Research, Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Abel Wakai
- Emergency Care Research Unit, Royal College of Surgeons Ireland, Dublin, Ireland
- Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland
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Vignes S, Simon L, Benoughidane B, Simon M, Fourgeaud C. Clinical and Scintigraphic Predictors of Primary Lower Limb Lymphedema-Volume Reduction During Complete Decongestive Physical Therapy. Phys Ther 2020; 100:766-772. [PMID: 31944248 DOI: 10.1093/ptj/pzaa012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/27/2019] [Accepted: 11/18/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Primary lower limb lymphedema is a chronic debilitating disorder without curative treatment. The initial treatment phase is dedicated to reducing lymphedema volume, whereas the second aims to stabilize that volume. OBJECTIVE The objective of this study was to analyze clinical and lymphoscintigraphic characteristics during complete decongestive physical therapy as predictors of primary unilateral lower limb lymphedema-volume reduction. DESIGN This observational, retrospective study included 222 consecutive patients (January 2009-January 2017; median age: 45.8 years) with lymphedema affecting the entire lower limb, who received complete decongestive physical therapy for the first time in a specialized lymphedema management center. METHODS Complete decongestive physical therapy consisted of low-stretch bandaging, manual lymph drainage, exercises, and skin care for all patients. Lymphoscintigraphy preceded treatment. RESULTS Median lymphedema evolution was 73 months, and median excess volume was 34%. Median (interquartile range) lymphedema volumes were 2845 (1038-3487) mL before and 1276 (601-2195) mL after a median of 11 days of complete decongestive physical therapy, with 34% median reduction. Multivariate analyses retained age, body mass index >40 kg/m2, and previous cellulitis, as independently associated with lymphedema volume reduction. For each additional year of age, volume reduction increased 0.16%. Unexpectedly, log-transformed initial lymphedema volumes indicated a negative impact, that is, 4.95%, for each log-unit gain. Patients with previous cellulitis episode(s) obtained 6.9% and those with BMI >40 kg/m2 17.1% higher lymphedema volume reductions. Lower limb lymphoscintigraphy was available for 150 (67.6%) patients. Having dermal back flow was associated with greater lymphedema volume reduction than not (respectively, 39% vs 31%). LIMITATIONS This study was retrospective, and only 67.6% of patients underwent lymphoscintigraphy. CONCLUSION Our analysis identified clinical and scintigraphic predictors of primary lymphedema volume reduction for patients with unilateral disease. Lymphoscintigraphy helps confirm lymphedema and predict volume reduction. Further study is required to confirm these observations.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - Laura Simon
- Department of Lymphology, Hôpital Cognacq-Jay
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Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTIs) are among the most common infections in outpatients and the most frequent infectious cause of referrals to emergency departments in developed world, contributing to significant morbidity and healthcare expenditures. We sought to review recent literature covering epidemiology of SSTIs. RECENT FINDINGS Staphylococcus aureus and streptococci predominate and methicillin-resistant S. aureus (MRSA) poses additional challenges; community-acquired-MRSA in some areas is superseding methicillin-susceptible S. aureus and multidrug resistance is evolving. Incidence data of SSTIs from United States show a decreasing trend, whereas trends of hospitalization rates were increasing. Despite low mortality associated with SSTIs, high rates of treatment failure and relapses are of concern. Diagnosis and management decisions in the emergency department (ED) lack validated tools for prediction of clinical response particularly among elderly, immunocompromised, obese, and patients with comorbidities. A variety of modifiable and nonmodifiable risk factors of the host and data from local epidemiology should be considered to prevent recurrence and treatment failure. SUMMARY An evolving epidemiology of SSTIs make microbiologic documentation and surveillance of local data imperative. New assessment algorithms with potential use in the ED are a priority. The universal applicability of international guidelines is questioned in this setting.
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48
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Edwards G, Freeman K, Llewelyn MJ, Hayward G. What diagnostic strategies can help differentiate cellulitis from other causes of red legs in primary care? BMJ 2020; 368:m54. [PMID: 32051117 DOI: 10.1136/bmj.m54] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- George Edwards
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Karoline Freeman
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | | | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
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Brindle RJ, O’Neill LA, Williams OM. Risk, Prevention, Diagnosis, and Management of Cellulitis and Erysipelas. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00287-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Dai M, Nakagami G, Sugama J, Kobayashi N, Kimura E, Arai Y, Sato A, Mercier G, Moffatt C, Murray S, Sanada H. The Prevalence and Functional Impact of Chronic Edema and Lymphedema in Japan: LIMPRINT Study. Lymphat Res Biol 2020; 17:195-201. [PMID: 30995194 PMCID: PMC6639102 DOI: 10.1089/lrb.2018.0080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This was a part of LIMPRINT (Lymphoedema IMpact and PRevalence—INTernational), an international study aimed at capturing the size and impact of lymphedema and chronic edema in different countries and health services across the world. The purpose of this study was to clarify the prevalence and the impact of chronic edema in Japan. Methods and Results: This was a two-phase facility-based study to determine the prevalence and functional impact of chronic edema in the adult population in Japan between 2014 and 2015. The prevalence study involved a university hospital, an acute community hospital, and a long-term medical facility. The impact study involved six facilities, including two outpatient clinics in acute care hospitals (one led by a physician and the other led by a nurse), inpatient wards in two acute care hospitals, and two nursing home/long-term care facilities. Various questionnaires and clinical assessments were used to gather patient demographic data and assess the functional impact of chronic edema. The results showed that chronic edema was much more prevalent in the long-term care facility than in acute care hospitals; cellulitis episodes occurred in ∼50% of cases in the gynecologist-led outpatient clinic, even though >80.0% of patients received standard management for edema; edema was found in the trunk region, including the buttock, abdomen, and chest-breast areas, in addition to the upper and lower limbs; and subjective satisfaction with edema control was low, even though the quality-of-life scores were good. Conclusions: The prevalence of chronic edema varied according to the facility type, ranging from 5.0% to 66.1%. The edema was located in all body parts, including the trunk region. Subjective satisfaction with control of edema was poor, while general quality of life was good. This large health care issue needs more attention.
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Affiliation(s)
- Misako Dai
- 1 Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Gojiro Nakagami
- 2 Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,3 Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- 4 Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
| | - Noriko Kobayashi
- 5 Department of Gynecology, Hokkaido University Hospital, Sapporo, Japan
| | - Emiko Kimura
- 6 Department of Nursing, Aomori University of Health and Welfare, Aomori, Japan
| | | | - Aya Sato
- 8 Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, Eiheiji, Japan
| | - Gregoire Mercier
- 9 Département d'Information Médicale, Hôpital La Colombière, Montpellier, France
| | - Christine Moffatt
- 10 Nottingham Trent University, School of Social Sciences, Nottingham, United Kingdom
| | - Susie Murray
- 11 Centre for Research & Implementation of Clinical Practice, London, United Kingdom
| | - Hiromi Sanada
- 2 Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,3 Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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