| disease | Acute Cellulitis |
| alias | Acute Cellulitis, Creeping Sound Cellulitis |
Acute cellulitis is an acute diffuse suppurative infection of the subcutaneous tissue, subfascial tissue, intermuscular spaces, or deep cellular tissue. It is characterized by lesions that are difficult to localize, spread rapidly, and have no clear boundaries with normal tissue. The inflammation can be caused by infection after skin or soft tissue injury, or it can occur through direct spread from a local suppurative infection or via lymphatic or blood circulation. Acute cellulitis caused by hemolytic streptococci spreads rapidly due to the action of streptokinase and hyaluronidase, and can sometimes lead to sepsis. Cellulitis caused by staphylococci is more likely to localize into an abscess.
bubble_chart Pathogen
The primary pathogenic bacteria are hemolytic streptococci, followed by Staphylococcus aureus, and anaerobic bacteria can also be involved.
bubble_chart Clinical Manifestations
The symptoms often vary depending on the type of pathogenic bacteria, their virulence, and the location and depth of the infection. In superficial acute cellulitis, there is obvious local redness, swelling, severe pain, and rapid expansion to the surrounding areas, with no clear boundary between the affected area and normal skin. The central part of the lesion often undergoes necrosis due to ischemia. If the affected tissue is loose, such as in the face or abdominal wall, the pain may be milder. In deep acute cellulitis, local redness and swelling are often not obvious, and there is usually only local edema and deep tenderness. However, the condition is severe, with intense systemic symptoms such as high fever, shivering, headache, general weakness, and increased white blood cell count. Acute cellulitis in the floor of the mouth, submandibular region, and neck can cause laryngeal edema and compression of the trachea, leading to difficulty breathing or even suffocation; the inflammation may sometimes spread to the mediastinum. Cellulitis caused by anaerobic streptococci, Bacteroides, and various enteric bacilli, also known as crepitant cellulitis, can occur in the perineum or abdominal wounds contaminated by intestinal or urinary tract contents. Local crepitus can be detected, with necrosis of the cellular tissue and fascial membrane, accompanied by progressive skin necrosis, foul-smelling pus, and severe systemic symptoms.
1. It commonly affects the lower limbs, feet, painful areas, external genitalia, and perianal region.
2. Skin lesions: The affected area generally presents with diffuse redness and swelling, with unclear boundaries. Blisters may form on the surface, with pronounced central inflammation, and local pain and tenderness. Fluctuation, ulceration, and expelling pus may occur, or it may not rupture, instead being absorbed and subsiding. When it occurs on the fingers or toes, it is referred to as snake-head whitlow (felon). Chronic cellulitis leading to local hardening and atrophy is called sclerosing cellulitis.
3. It is often accompanied by systemic symptoms such as fever and shivering.
4. There may be local lymphadenitis, lymphangitis, and even complications such as metastatic abscesses and sepsis.
bubble_chart Treatment Measures
Rest the affected area, apply local heat, Chinese medicinal external applications, or physical therapy. Strengthen nutrition appropriately. Administer painkillers and antipyretics as necessary. Use sulfonamides or antibiotics. If the above measures fail to control the spread, perform extensive multiple incisions for drainage. For acute cellulitis of the floor of the mouth and submandibular region, if short-term aggressive anti-inflammatory treatment is ineffective, early incision and decompression should be performed to prevent laryngeal edema and airway obstruction leading to suffocation; be vigilant for possible laryngeal spasms during surgery and prepare for emergency treatment. For crepitant cellulitis, perform extensive incision and drainage early, remove necrotic tissue, and rinse and wet the wound with a 3% hydrogen peroxide solution.
Differential diagnosis with erysipelas:
The lesions of erysipelas have clear boundaries, are superficial, with mild local edema, and do not suppurate.
