Infectious cellulitis: symptoms, diagnosis and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Infectious cellulitis is a bacterial infection of the skin and subcutaneous tissues. Symptoms, causes, risk factors, diagnosis and antibiotic treatment in Quebec.\">\n<meta name=\"keywords\" content=\"cellulite infectieuse, cellulite infectieuse sympt\u00f4mes, cellulite infectieuse traitement, cellulite infectieuse antibiotique, \u00e9rysip\u00e8le cellulite, cellulite infectieuse jambe, infection peau bact\u00e9rienne, fasciite n\u00e9crosante, cellulite infectieuse Qu\u00e9bec, Streptococcus Staphylococcus peau\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; margin-top: 10px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; letter-spacing: 0.5px; }\n.co-intro { font-size: 16px; font-weight: 400; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; letter-spacing: 0.3px; }\n.co-wrap p { font-size: 15px; font-weight: 400; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; font-weight: 400; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; font-weight: 400; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Infectiology & Dermatology<\/span>\n <h1>Infectious cellulitis<\/h1>\n\n <div class=\"co-intro\">\n Infectious cellulitis - not to be confused with cosmetic cellulitis (gynoid lipodystrophy), which is a non-infectious condition - is an acute bacterial infection of the skin and subcutaneous tissues characterized by a rapidly progressing, painful, warm, edematous erythematous plaque. It is one of the most frequent skin infections in primary care and emergency medicine, accounting for around 2 % of all emergency room visits in Canada, and a significant cause of hospitalization, particularly in patients who are immunocompromised, diabetic or have venous or lymphatic insufficiency of the lower limbs. The pathogens responsible are, in the vast majority of cases, Gram-positive bacteria: <em>Streptococcus pyogenes<\/em> (group A streptococcus) and <em>Staphylococcus aureus<\/em> - The latter includes methicillin-resistant strains (MRSA) in community-acquired forms, the prevalence of which is increasing in Quebec. The clinical distinction between infectious cellulitis (involvement of the deep dermis and hypodermis) and erysipelas (involvement of the superficial dermis and dermal lymphatics, with sharp, raised edges, due almost exclusively to streptococcus) is of practical importance, although the two entities are often grouped together under the generic term \u00abnon-purulent cellulitis\u00bb in North American guidelines. The major diagnostic challenge in infectious cellulitis is to rule out necrotizing fasciitis - a necrotic infection of deep fascia with a rapid progression rate and a mortality rate of 20 to 40 % - which constitutes an absolute surgical emergency and whose early signs may mimic common cellulitis. Management is based on oral or parenteral antibiotic therapy, depending on severity, with close clinical monitoring to detect progression or complications.\n <\/div>\n\n <h2>Classification of bacterial skin infections<\/h2>\n <p>Infections of the skin and soft tissues (ICTM) are classified according to the depth of the structures affected and the presence or absence of purulence, which directly affects the choice of treatment:<\/p>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Type of infection<\/th>\n <th>Affected structures<\/th>\n <th>Key features<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Erysipelas<\/td>\n <td>Superficial dermis and dermal lymphatic vessels<\/td>\n <td>Well-defined erythematous plaque with sharp, raised edges (peripheral beading) - distinctive feature; shiny, warm, painful; almost exclusively due to <em>Streptococcus pyogenes<\/em> (group A); high fever often in the foreground; preferential location: leg (80 %) and face (20 %); recurrence in 20-30 % of cases; excellent response to penicillin<\/td>\n <\/tr>\n <tr>\n <td>Non-purulent infectious cellulitis<\/td>\n <td>Deep dermis and subcutaneous tissue (hypodermis)<\/td>\n <td>Poorly defined erythema, without peripheral swelling, with progressive extension; local warmth, edema and pain; no palpable purulent collection or visible suppurative portal of entry; principal agents: <em>Streptococcus<\/em> spp. and <em>Staphylococcus aureus<\/em> meticillin-sensitive (MSSA); antibiotic therapy targeting streptococcus and MSSA<\/td>\n <\/tr>\n <tr>\n <td>Purulent cellulitis (abscess, furuncle, anthrax)<\/td>\n <td>Dermis and hypodermis with purulent collection<\/td>\n <td>Presence of fluctuating abscess, furuncle (deep folliculitis) or anthrax (confluence of furuncles); predominant agent: <em>Staphylococcus aureus<\/em> (SASM or SARM-CO); basic treatment: surgical drainage of the collection - antibiotic therapy alone is insufficient without drainage; adjuvant antibiotic therapy (trimethoprim-sulfamethoxazole, clindamycin) if systemic signs or immunosuppression<\/td>\n <\/tr>\n <tr>\n <td>Necrotizing fasciitis (type I and II)<\/td>\n <td>Deep fascias \u00b1 muscles (myonecrosis)<\/td>\n <td>ABSOLUTE SURGICAL EMERGENCY - pain disproportionate to skin appearance, crepitus on palpation (gas in tissue), gray or purplish necrotic areas, hemorrhagic bullae, local skin anesthesia (necrosis of nerve nets); LRINEC score \u2265 6 suggestive; CT scan urgent if suspected; surgical management (wide debridement) + broad-spectrum IV antibiotic therapy + resuscitation; type I: polymicrobial (diabetes, immunodepression); type II: monomicrobial (<em>Streptococcus pyogenes<\/em> - streptococcal toxic shock)<\/td>\n <\/tr>\n <tr>\n <td>Orbital and periorbital cellulitis<\/td>\n <td>Periorbital tissue (pre-septal) or orbit (post-septal)<\/td>\n <td>Preseptal cellulitis (pre-septal): infection limited in front of the orbital septum - palpebral edema, erythema, without limitation of eye movements or exophthalmos; orbital cellulitis (post-septal): infection behind the septum - exophthalmos, limitation of eye movements, diplopia, pain on eye movement, visual acuity sometimes diminished; ophthalmological emergency; orbital CT scan mandatory; hospitalization and IV antibiotic therapy; surgical drainage if subperiosteal abscess.<\/td>\n <\/tr>\n <tr>\n <td>Impetigo and ecthyma<\/td>\n <td>Superficial epidermis (impetigo) or epidermis + dermis (ecthyma)<\/td>\n <td>Impetigo: vesicles with meliceric crusts (honey-colored); highly contagious; common in children; agents: <em>S. aureus<\/em> and <em>S. pyogenes<\/em> ; topical (mupirocin) or oral treatment, depending on extent; ecthyma: deep ulcerated form of impetigo with thick grey-green crust<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Risk factors<\/h2>\n <ul class=\"co-list\">\n <li>Rupture of the skin barrier: bacterial entry point identified in 70-80 % of cellulitis cases - wound, scratch, insect bite, animal or human bite, toe intertrigo (mycosis of the feet - tinea pedis), leg ulcer, pre-existing dermatosis (eczema, psoriasis), intravenous injection ; tinea pedis is the most underestimated route of entry - its systematic treatment significantly reduces the risk of recurrence of leg cellulitis<\/li>\n <li>Chronic venous insufficiency and edema of the lower limbs: venous stasis and lymphedema create an environment conducive to bacterial proliferation and reduce local defence by diluting immune factors; major risk factor for recurrence.<\/li>\n <li>Lymphedema: history of lymph node dissection (breast cancer, melanoma), lymphatic filariasis, primary lymphedema - permanent reduction in lymphatic clearance of pathogens; risk of multiple recurrences justifying prolonged prophylactic antibiotic therapy (penicillin V or erythromycin) in patients with \u2265 2 episodes per year<\/li>\n <li>Diabetes mellitus: impaired immune response (neutrophil function, chemotaxis), peripheral neuropathy reducing wound perception, angiopathy reducing tissue vascularization - higher risk of infection with atypical germs (Gram-negative, anaerobic), particularly for diabetic foot infections<\/li>\n <li>Immunosuppression: HIV, chemotherapy, prolonged systemic corticosteroid therapy, immunosuppressants (transplantation) - more severe forms, broader pathogens (fungi, atypical mycobacteria, Gram-negative bacteria)<\/li>\n <li>Obesity: increased venous and lymphatic pressure, skin fragility in folds, reduced tissue diffusion of antibiotics - independent risk factor for recurrent cellulitis and poor response to treatment.<\/li>\n <li>History of infectious cellulitis: risk of recurrence at the same site of 8 to 20 % per year; each episode aggravates local lymphedema, increasing the risk of subsequent episodes - vicious circle justifying secondary prophylaxis<\/li>\n <\/ul>\n\n <h2>Symptoms<\/h2>\n <p>Infectious cellulitis typically presents acutely or subacutely, with a predominantly local picture accompanied by systemic signs that vary according to severity:<\/p>\n\n <ul class=\"co-list\">\n <li>Progressively-extending erythematous plaque: warm, ill-defined redness (with no clear bulge, unlike erysipelas), painful to the touch and sometimes spontaneously; centrifugal extension visible in a few hours to a few days - it is useful to mark the edges with a felt-tip pen during the first examination to objectivize progression<\/li>\n <li>Local edema and skin tension: swelling of affected tissues with taut, shiny skin; edema may be pitting in diffuse forms or in patients with pre-existing venous insufficiency<\/li>\n <li>Local heat: increased skin temperature at the infected site, easily detectable by palpation compared to the contralateral limb.<\/li>\n <li>Local pain: from mild to very intense, depending on severity; pain disproportionate to the appearance of the skin - particularly deep, intense pain poorly relieved by the usual analgesics - is a warning sign that necrotizing fasciitis may be present.<\/li>\n <li>Systemic signs according to severity: fever (often > 38.5\u00b0C in erysipelas; variable in cellulitis), chills, general malaise, tachycardia; severe systemic signs (fever > 39\u00b0C, hypotension, confusion) should alert to a serious infection requiring hospitalization<\/li>\n <li>Regional adenopathy and lymphangitis: painful regional lymph nodes; linear red streak running up the lymphatic pathway towards the draining lymph node (lymphangitis) - sign of lymphatic extension of the infection<\/li>\n <li>Most frequent location: lower limb (leg) in 70-80 % of cases; face, upper limb, thorax or abdomen in the remaining forms.<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Infectious cellulitis is frequently over-diagnosed - studies have shown that up to 30 % of patients hospitalized for \u00abcellulitis\u00bb don't actually suffer from it. Major confounding diagnoses include deep vein thrombosis (DVT), stasis dermatitis (varicose eczema), acute gout, erythema migrans (Lyme disease) and acute lymphedema. Before prescribing antibiotics, a thorough clinical examination is essential, including a search for a portal of entry, delineation of the edges and assessment of bilaterality (bilateral cellulitis of both legs is rare and should raise doubts about the diagnosis).<\/span>\n <\/div>\n\n <h2>Diagnosis<\/h2>\n <ul class=\"co-list\">\n <li>Clinical diagnosis first and foremost: the physical examination remains the cornerstone of the diagnosis - characterization of the plaque (sharp or blurred edges, presence of a bulge, unilaterality), search for a portal of entry, assessment of extension, signs of severity (crepitation, necrosis, hemorrhagic bullae, cutaneous hypoesthesia) and systemic signs; delineation of edges with a pen to monitor progression<\/li>\n <li>Biological workup: complete blood count (hyperleukocytosis with neutrophil polynucleosis), CRP and\/or procalcitonin (markers of inflammation and bacterial severity), urea and creatinine (renal function before antibiotic therapy), blood glucose (diabetes screening); blood cultures if fever > 38.5\u00b0C, immunodepression or signs of sepsis - low yield (2-4 %) in uncomplicated cellulitis but essential in severe forms<\/li>\n <li>Computed tomography (CT) with injection: urgently indicated if necrotizing fasciitis is suspected (presence of gas in deep tissues - pathognomonic sign, although absent in 25 % of cases) or deep abscess not accessible to clinical examination; not systematically indicated for uncomplicated cellulitis.<\/li>\n <li>Soft-tissue ultrasonography: useful for detecting a purulent collection (abscess) to be drained, distinguishing an abscess from cellulitis without a collection, and ruling out associated deep-vein thrombosis; first-line examination if there is any doubt about the presence of an abscess<\/li>\n <li>Microbiological samples: swab of the entry site if the wound is open, pus sample if the collection has been drained, skin biopsy in atypical or recurrent forms; blood cultures and superficial skin samples taken by needle aspiration have a low yield in common cellulitis and are not routinely recommended.<\/li>\n <li>LRINEC score (Laboratory Risk Indicator for Necrotizing Fasciitis): score based on CRP, leukocytosis, hemoglobin, natremia, creatinine and glycemia - score \u2265 6 suggestive of necrotizing fasciitis (sensitivity 68 %, specificity 84 %); decision-support tool, never used alone<\/li>\n <\/ul>\n\n <h2>Treatment<\/h2>\n <ul class=\"co-list\">\n <li>Outpatient oral antibiotic therapy (mild to moderate non-purulent cellulitis, non-immunocompromised patient, no severe systemic signs): cefalexin 500 mg 4 times\/day \u00d7 5-7 days - first-line treatment in Quebec (streptococcal and MSSA coverage); amoxicillin-clavulanate in case of animal or human portal of entry; clindamycin or trimethoprim-sulfamethoxazole if allergic to beta-lactams or suspected community-acquired MRSA; clinical reassessment at 48-72 hours mandatory<\/li>\n <li>Intravenous antibiotic therapy and hospitalization: indicated if severe systemic signs (fever > 39\u00b0C, hypotension, tachycardia, confusion), rapid progression despite 48-72 hours of oral antibiotic therapy, significant immunosuppression, diabetes with foot involvement, facial or periorbital localization, ambulatory failure; cefazolin IV 1-2 g every 8 hours as first-line treatment (MRSA, streptococcus); vancomycin IV if MRSA suspected or confirmed, severe sepsis or immunosuppressed patient; standard total duration: 5 to 10 days depending on clinical response<\/li>\n <li>Surgical drainage: indispensable treatment for all fluctuating abscesses - antibiotic therapy alone without drainage is insufficient and a source of therapeutic failure; incision-drainage under local anaesthesia with cavity lavage; meching or open drainage depending on size<\/li>\n <li>Adjuvant measures: elevation of the affected limb (to reduce swelling, improve lymphatic circulation and enhance diffusion of antibiotics into tissues); rest; analgesia (NSAIDs to be avoided if necrotizing fasciitis is suspected - may mask pain and delay diagnosis); treatment of the entry site (topical antifungal if tinea pedis, local wound care).<\/li>\n <li>Management of necrotizing fasciitis: extensive emergency surgical debridement of all necrotic tissues - the only curative treatment; broad-spectrum IV antibiotic therapy (piperacillin-tazobactam + clindamycin + vancomycin); hyperbaric oxygen therapy as an adjunct in some centers; intensive care; IV immunoglobulins if streptococcal toxic shock (IVIG).<\/li>\n <li>Recurrence prophylaxis: penicillin V 250-500 mg twice\/day or benzathine penicillin IM monthly for 6-12 months in patients with \u2265 2 episodes of cellulitis at the same site per year - reduction in recurrences of 50-70 % demonstrated in randomized trials; erythromycin or azithromycin in case of allergy to penicillin; concomitant treatment of lymphedema and venous insufficiency<\/li>\n <\/ul>\n\n <h2>Differential diagnoses not to be missed<\/h2>\n <ul class=\"co-list\">\n <li>Deep vein thrombosis (DVT): unilateral calf edema with possible erythema, without fever or identifiable portal of entry; venous Doppler ultrasound essential if in doubt - the two pathologies may coexist<\/li>\n <li>Stasis dermatitis (varicose eczema): bilateral erythema of the legs, pruritus, visible varicose veins, without fever or leukocytosis; bilateral cellulitis is very rare and should cast doubt on the diagnosis of infectious cellulitis.<\/li>\n <li>Acute gout: metatarsophalangeal arthritis or hyperalgesic, red, hot ankle - may simulate cellulitis of the foot; joint puncture (urate crystals) and uricemia guide diagnosis<\/li>\n <li>Erythema migrans (Lyme disease): centrifugal erythematous plaque with central pale ring, without significant heat or pain, without leukocytosis; context of exposure to ticks in an endemic area.<\/li>\n <li>Hypersensitivity reaction or insect sting: localized, pruritic erythema, without fever or rapid progression; regression spontaneously or with antihistamines<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Signs requiring urgent medical attention or 911<\/div>\n <p>Dial <strong>911<\/strong> or go immediately to the emergency room if cellulitis is accompanied by: intense pain disproportionate to the appearance of the skin, crepitation on palpation (sensation of bubbles under the skin), gray, purplish or necrotic areas, hemorrhagic bubbles, local cutaneous anesthesia or hypoesthesia, very high fever with intense chills, hypotension or confusion - these signs suggest necrotizing fasciitis or septic shock, which are life-threatening emergencies requiring immediate surgical management.<\/p>\n <p>Immediate medical consultation (within 24 hours) is also required for: rapidly progressing hot red patches, fever associated with skin redness, redness of the lower limb in diabetic or immunocompromised patients, or red streaks running up the limb (lymphangitis). For a medical consultation, Clinique Omicron offers consultations in our Quebec branches as well as via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's physicians assess bacterial skin infections, prescribe the appropriate antibiotic therapy according to clinical severity, drain accessible superficial collections and refer to emergency or to infectious diseases or surgical specialists depending on signs of severity. Consultations are available in our Quebec branches, as well as via telemedicine throughout the province. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The contents of this page are provided for information purposes only and do not replace the advice of a qualified healthcare professional. Any skin infection with rapid progression, systemic signs or in an immunocompromised patient requires immediate in-person medical evaluation.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p> Infectiologie & Dermatologie Cellulite infectieuse La cellulite infectieuse \u2014 \u00e0 ne pas confondre avec la cellulite esth\u00e9tique (lipodystrophie gyno\u00efde) qui est une condition non infectieuse \u2014 est une infection bact\u00e9rienne aigu\u00eb de la peau et des tissus sous-cutan\u00e9s caract\u00e9ris\u00e9e par une plaque \u00e9ryth\u00e9mateuse douloureuse, chaude et \u0153d\u00e9mati\u00e9e \u00e0 progression rapide. 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\n\t\t\t\t\t\n\n\n\n\nInfectious cellulitis: symptoms, diagnosis and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Infectious cellulitis is a bacterial infection of the skin and subcutaneous tissues. Symptoms, causes, risk factors, diagnosis and antibiotic treatment in Quebec.\">\n<meta name=\"keywords\" content=\"cellulite infectieuse, cellulite infectieuse sympt\u00f4mes, cellulite infectieuse traitement, cellulite infectieuse antibiotique, \u00e9rysip\u00e8le cellulite, cellulite infectieuse jambe, infection peau bact\u00e9rienne, fasciite n\u00e9crosante, cellulite infectieuse Qu\u00e9bec, Streptococcus Staphylococcus peau\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; margin-top: 10px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; letter-spacing: 0.5px; }\n.co-intro { font-size: 16px; font-weight: 400; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; letter-spacing: 0.3px; }\n.co-wrap p { font-size: 15px; font-weight: 400; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; font-weight: 400; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; font-weight: 400; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Infectiology & Dermatology<\/span>\n <h1>Infectious cellulitis<\/h1>\n\n <div class=\"co-intro\">\n Infectious cellulitis - not to be confused with cosmetic cellulitis (gynoid lipodystrophy), which is a non-infectious condition - is an acute bacterial infection of the skin and subcutaneous tissues characterized by a rapidly progressing, painful, warm, edematous erythematous plaque. It is one of the most frequent skin infections in primary care and emergency medicine, accounting for around 2 % of all emergency room visits in Canada, and a significant cause of hospitalization, particularly in patients who are immunocompromised, diabetic or have venous or lymphatic insufficiency of the lower limbs. The pathogens responsible are, in the vast majority of cases, Gram-positive bacteria: <em>Streptococcus pyogenes<\/em> (group A streptococcus) and <em>Staphylococcus aureus<\/em> - The latter includes methicillin-resistant strains (MRSA) in community-acquired forms, the prevalence of which is increasing in Quebec. The clinical distinction between infectious cellulitis (involvement of the deep dermis and hypodermis) and erysipelas (involvement of the superficial dermis and dermal lymphatics, with sharp, raised edges, due almost exclusively to streptococcus) is of practical importance, although the two entities are often grouped together under the generic term \u00abnon-purulent cellulitis\u00bb in North American guidelines. The major diagnostic challenge in infectious cellulitis is to rule out necrotizing fasciitis - a necrotic infection of deep fascia with a rapid progression rate and a mortality rate of 20 to 40 % - which constitutes an absolute surgical emergency and whose early signs may mimic common cellulitis. Management is based on oral or parenteral antibiotic therapy, depending on severity, with close clinical monitoring to detect progression or complications.\n <\/div>\n\n <h2>Classification of bacterial skin infections<\/h2>\n <p>Infections of the skin and soft tissues (ICTM) are classified according to the depth of the structures affected and the presence or absence of purulence, which directly affects the choice of treatment:<\/p>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Type of infection<\/th>\n <th>Affected structures<\/th>\n <th>Key features<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Erysipelas<\/td>\n <td>Superficial dermis and dermal lymphatic vessels<\/td>\n <td>Well-defined erythematous plaque with sharp, raised edges (peripheral beading) - distinctive feature; shiny, warm, painful; almost exclusively due to <em>Streptococcus pyogenes<\/em> (group A); high fever often in the foreground; preferential location: leg (80 %) and face (20 %); recurrence in 20-30 % of cases; excellent response to penicillin<\/td>\n <\/tr>\n <tr>\n <td>Non-purulent infectious cellulitis<\/td>\n <td>Deep dermis and subcutaneous tissue (hypodermis)<\/td>\n <td>Poorly defined erythema, without peripheral swelling, with progressive extension; local warmth, edema and pain; no palpable purulent collection or visible suppurative portal of entry; principal agents: <em>Streptococcus<\/em> spp. and <em>Staphylococcus aureus<\/em> meticillin-sensitive (MSSA); antibiotic therapy targeting streptococcus and MSSA<\/td>\n <\/tr>\n <tr>\n <td>Purulent cellulitis (abscess, furuncle, anthrax)<\/td>\n <td>Dermis and hypodermis with purulent collection<\/td>\n <td>Presence of fluctuating abscess, furuncle (deep folliculitis) or anthrax (confluence of furuncles); predominant agent: <em>Staphylococcus aureus<\/em> (SASM or SARM-CO); basic treatment: surgical drainage of the collection - antibiotic therapy alone is insufficient without drainage; adjuvant antibiotic therapy (trimethoprim-sulfamethoxazole, clindamycin) if systemic signs or immunosuppression<\/td>\n <\/tr>\n <tr>\n <td>Necrotizing fasciitis (type I and II)<\/td>\n <td>Deep fascias \u00b1 muscles (myonecrosis)<\/td>\n <td>ABSOLUTE SURGICAL EMERGENCY - pain disproportionate to skin appearance, crepitus on palpation (gas in tissue), gray or purplish necrotic areas, hemorrhagic bullae, local skin anesthesia (necrosis of nerve nets); LRINEC score \u2265 6 suggestive; CT scan urgent if suspected; surgical management (wide debridement) + broad-spectrum IV antibiotic therapy + resuscitation; type I: polymicrobial (diabetes, immunodepression); type II: monomicrobial (<em>Streptococcus pyogenes<\/em> - streptococcal toxic shock)<\/td>\n <\/tr>\n <tr>\n <td>Orbital and periorbital cellulitis<\/td>\n <td>Periorbital tissue (pre-septal) or orbit (post-septal)<\/td>\n <td>Preseptal cellulitis (pre-septal): infection limited in front of the orbital septum - palpebral edema, erythema, without limitation of eye movements or exophthalmos; orbital cellulitis (post-septal): infection behind the septum - exophthalmos, limitation of eye movements, diplopia, pain on eye movement, visual acuity sometimes diminished; ophthalmological emergency; orbital CT scan mandatory; hospitalization and IV antibiotic therapy; surgical drainage if subperiosteal abscess.<\/td>\n <\/tr>\n <tr>\n <td>Impetigo and ecthyma<\/td>\n <td>Superficial epidermis (impetigo) or epidermis + dermis (ecthyma)<\/td>\n <td>Impetigo: vesicles with meliceric crusts (honey-colored); highly contagious; common in children; agents: <em>S. aureus<\/em> and <em>S. pyogenes<\/em> ; topical (mupirocin) or oral treatment, depending on extent; ecthyma: deep ulcerated form of impetigo with thick grey-green crust<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Risk factors<\/h2>\n <ul class=\"co-list\">\n <li>Rupture of the skin barrier: bacterial entry point identified in 70-80 % of cellulitis cases - wound, scratch, insect bite, animal or human bite, toe intertrigo (mycosis of the feet - tinea pedis), leg ulcer, pre-existing dermatosis (eczema, psoriasis), intravenous injection ; tinea pedis is the most underestimated route of entry - its systematic treatment significantly reduces the risk of recurrence of leg cellulitis<\/li>\n <li>Chronic venous insufficiency and edema of the lower limbs: venous stasis and lymphedema create an environment conducive to bacterial proliferation and reduce local defence by diluting immune factors; major risk factor for recurrence.<\/li>\n <li>Lymphedema: history of lymph node dissection (breast cancer, melanoma), lymphatic filariasis, primary lymphedema - permanent reduction in lymphatic clearance of pathogens; risk of multiple recurrences justifying prolonged prophylactic antibiotic therapy (penicillin V or erythromycin) in patients with \u2265 2 episodes per year<\/li>\n <li>Diabetes mellitus: impaired immune response (neutrophil function, chemotaxis), peripheral neuropathy reducing wound perception, angiopathy reducing tissue vascularization - higher risk of infection with atypical germs (Gram-negative, anaerobic), particularly for diabetic foot infections<\/li>\n <li>Immunosuppression: HIV, chemotherapy, prolonged systemic corticosteroid therapy, immunosuppressants (transplantation) - more severe forms, broader pathogens (fungi, atypical mycobacteria, Gram-negative bacteria)<\/li>\n <li>Obesity: increased venous and lymphatic pressure, skin fragility in folds, reduced tissue diffusion of antibiotics - independent risk factor for recurrent cellulitis and poor response to treatment.<\/li>\n <li>History of infectious cellulitis: risk of recurrence at the same site of 8 to 20 % per year; each episode aggravates local lymphedema, increasing the risk of subsequent episodes - vicious circle justifying secondary prophylaxis<\/li>\n <\/ul>\n\n <h2>Symptoms<\/h2>\n <p>Infectious cellulitis typically presents acutely or subacutely, with a predominantly local picture accompanied by systemic signs that vary according to severity:<\/p>\n\n <ul class=\"co-list\">\n <li>Progressively-extending erythematous plaque: warm, ill-defined redness (with no clear bulge, unlike erysipelas), painful to the touch and sometimes spontaneously; centrifugal extension visible in a few hours to a few days - it is useful to mark the edges with a felt-tip pen during the first examination to objectivize progression<\/li>\n <li>Local edema and skin tension: swelling of affected tissues with taut, shiny skin; edema may be pitting in diffuse forms or in patients with pre-existing venous insufficiency<\/li>\n <li>Local heat: increased skin temperature at the infected site, easily detectable by palpation compared to the contralateral limb.<\/li>\n <li>Local pain: from mild to very intense, depending on severity; pain disproportionate to the appearance of the skin - particularly deep, intense pain poorly relieved by the usual analgesics - is a warning sign that necrotizing fasciitis may be present.<\/li>\n <li>Systemic signs according to severity: fever (often > 38.5\u00b0C in erysipelas; variable in cellulitis), chills, general malaise, tachycardia; severe systemic signs (fever > 39\u00b0C, hypotension, confusion) should alert to a serious infection requiring hospitalization<\/li>\n <li>Regional adenopathy and lymphangitis: painful regional lymph nodes; linear red streak running up the lymphatic pathway towards the draining lymph node (lymphangitis) - sign of lymphatic extension of the infection<\/li>\n <li>Most frequent location: lower limb (leg) in 70-80 % of cases; face, upper limb, thorax or abdomen in the remaining forms.<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Infectious cellulitis is frequently over-diagnosed - studies have shown that up to 30 % of patients hospitalized for \u00abcellulitis\u00bb don't actually suffer from it. Major confounding diagnoses include deep vein thrombosis (DVT), stasis dermatitis (varicose eczema), acute gout, erythema migrans (Lyme disease) and acute lymphedema. Before prescribing antibiotics, a thorough clinical examination is essential, including a search for a portal of entry, delineation of the edges and assessment of bilaterality (bilateral cellulitis of both legs is rare and should raise doubts about the diagnosis).<\/span>\n <\/div>\n\n <h2>Diagnosis<\/h2>\n <ul class=\"co-list\">\n <li>Clinical diagnosis first and foremost: the physical examination remains the cornerstone of the diagnosis - characterization of the plaque (sharp or blurred edges, presence of a bulge, unilaterality), search for a portal of entry, assessment of extension, signs of severity (crepitation, necrosis, hemorrhagic bullae, cutaneous hypoesthesia) and systemic signs; delineation of edges with a pen to monitor progression<\/li>\n <li>Biological workup: complete blood count (hyperleukocytosis with neutrophil polynucleosis), CRP and\/or procalcitonin (markers of inflammation and bacterial severity), urea and creatinine (renal function before antibiotic therapy), blood glucose (diabetes screening); blood cultures if fever > 38.5\u00b0C, immunodepression or signs of sepsis - low yield (2-4 %) in uncomplicated cellulitis but essential in severe forms<\/li>\n <li>Computed tomography (CT) with injection: urgently indicated if necrotizing fasciitis is suspected (presence of gas in deep tissues - pathognomonic sign, although absent in 25 % of cases) or deep abscess not accessible to clinical examination; not systematically indicated for uncomplicated cellulitis.<\/li>\n <li>Soft-tissue ultrasonography: useful for detecting a purulent collection (abscess) to be drained, distinguishing an abscess from cellulitis without a collection, and ruling out associated deep-vein thrombosis; first-line examination if there is any doubt about the presence of an abscess<\/li>\n <li>Microbiological samples: swab of the entry site if the wound is open, pus sample if the collection has been drained, skin biopsy in atypical or recurrent forms; blood cultures and superficial skin samples taken by needle aspiration have a low yield in common cellulitis and are not routinely recommended.<\/li>\n <li>LRINEC score (Laboratory Risk Indicator for Necrotizing Fasciitis): score based on CRP, leukocytosis, hemoglobin, natremia, creatinine and glycemia - score \u2265 6 suggestive of necrotizing fasciitis (sensitivity 68 %, specificity 84 %); decision-support tool, never used alone<\/li>\n <\/ul>\n\n <h2>Treatment<\/h2>\n <ul class=\"co-list\">\n <li>Outpatient oral antibiotic therapy (mild to moderate non-purulent cellulitis, non-immunocompromised patient, no severe systemic signs): cefalexin 500 mg 4 times\/day \u00d7 5-7 days - first-line treatment in Quebec (streptococcal and MSSA coverage); amoxicillin-clavulanate in case of animal or human portal of entry; clindamycin or trimethoprim-sulfamethoxazole if allergic to beta-lactams or suspected community-acquired MRSA; clinical reassessment at 48-72 hours mandatory<\/li>\n <li>Intravenous antibiotic therapy and hospitalization: indicated if severe systemic signs (fever > 39\u00b0C, hypotension, tachycardia, confusion), rapid progression despite 48-72 hours of oral antibiotic therapy, significant immunosuppression, diabetes with foot involvement, facial or periorbital localization, ambulatory failure; cefazolin IV 1-2 g every 8 hours as first-line treatment (MRSA, streptococcus); vancomycin IV if MRSA suspected or confirmed, severe sepsis or immunosuppressed patient; standard total duration: 5 to 10 days depending on clinical response<\/li>\n <li>Surgical drainage: indispensable treatment for all fluctuating abscesses - antibiotic therapy alone without drainage is insufficient and a source of therapeutic failure; incision-drainage under local anaesthesia with cavity lavage; meching or open drainage depending on size<\/li>\n <li>Adjuvant measures: elevation of the affected limb (to reduce swelling, improve lymphatic circulation and enhance diffusion of antibiotics into tissues); rest; analgesia (NSAIDs to be avoided if necrotizing fasciitis is suspected - may mask pain and delay diagnosis); treatment of the entry site (topical antifungal if tinea pedis, local wound care).<\/li>\n <li>Management of necrotizing fasciitis: extensive emergency surgical debridement of all necrotic tissues - the only curative treatment; broad-spectrum IV antibiotic therapy (piperacillin-tazobactam + clindamycin + vancomycin); hyperbaric oxygen therapy as an adjunct in some centers; intensive care; IV immunoglobulins if streptococcal toxic shock (IVIG).<\/li>\n <li>Recurrence prophylaxis: penicillin V 250-500 mg twice\/day or benzathine penicillin IM monthly for 6-12 months in patients with \u2265 2 episodes of cellulitis at the same site per year - reduction in recurrences of 50-70 % demonstrated in randomized trials; erythromycin or azithromycin in case of allergy to penicillin; concomitant treatment of lymphedema and venous insufficiency<\/li>\n <\/ul>\n\n <h2>Differential diagnoses not to be missed<\/h2>\n <ul class=\"co-list\">\n <li>Deep vein thrombosis (DVT): unilateral calf edema with possible erythema, without fever or identifiable portal of entry; venous Doppler ultrasound essential if in doubt - the two pathologies may coexist<\/li>\n <li>Stasis dermatitis (varicose eczema): bilateral erythema of the legs, pruritus, visible varicose veins, without fever or leukocytosis; bilateral cellulitis is very rare and should cast doubt on the diagnosis of infectious cellulitis.<\/li>\n <li>Acute gout: metatarsophalangeal arthritis or hyperalgesic, red, hot ankle - may simulate cellulitis of the foot; joint puncture (urate crystals) and uricemia guide diagnosis<\/li>\n <li>Erythema migrans (Lyme disease): centrifugal erythematous plaque with central pale ring, without significant heat or pain, without leukocytosis; context of exposure to ticks in an endemic area.<\/li>\n <li>Hypersensitivity reaction or insect sting: localized, pruritic erythema, without fever or rapid progression; regression spontaneously or with antihistamines<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Signs requiring urgent medical attention or 911<\/div>\n <p>Dial <strong>911<\/strong> or go immediately to the emergency room if cellulitis is accompanied by: intense pain disproportionate to the appearance of the skin, crepitation on palpation (sensation of bubbles under the skin), gray, purplish or necrotic areas, hemorrhagic bubbles, local cutaneous anesthesia or hypoesthesia, very high fever with intense chills, hypotension or confusion - these signs suggest necrotizing fasciitis or septic shock, which are life-threatening emergencies requiring immediate surgical management.<\/p>\n <p>Immediate medical consultation (within 24 hours) is also required for: rapidly progressing hot red patches, fever associated with skin redness, redness of the lower limb in diabetic or immunocompromised patients, or red streaks running up the limb (lymphangitis). For a medical consultation, Clinique Omicron offers consultations in our Quebec branches as well as via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron's physicians assess bacterial skin infections, prescribe the appropriate antibiotic therapy according to clinical severity, drain accessible superficial collections and refer to emergency or to infectious diseases or surgical specialists depending on signs of severity. Consultations are available in our Quebec branches, as well as via telemedicine throughout the province. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The contents of this page are provided for information purposes only and do not replace the advice of a qualified healthcare professional. Any skin infection with rapid progression, systemic signs or in an immunocompromised patient requires immediate in-person medical evaluation.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p> Infectiologie & Dermatologie Cellulite infectieuse La cellulite infectieuse \u2014 \u00e0 ne pas confondre avec la cellulite esth\u00e9tique (lipodystrophie gyno\u00efde) qui est une condition non infectieuse \u2014 est une infection bact\u00e9rienne aigu\u00eb de la peau et des tissus sous-cutan\u00e9s caract\u00e9ris\u00e9e par une plaque \u00e9ryth\u00e9mateuse douloureuse, chaude et \u0153d\u00e9mati\u00e9e \u00e0 progression rapide. Elle constitue l’une des… <a href=\"https:\/\/cliniqueomicron.ca\/en\/cellulite-infectieuse\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Infectious cellulitis: symptoms, diagnosis and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Cellulite infectieuse : Sympt\u00f4mes et traitement | Brossard | Clinique Omicron","_metasync_otto_description":"Cellulite infectieuse : sympt\u00f4mes et traitements \u00e0 Brossard. 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