Related Terms:
lymphedema, erythema, staph aureus, strep A,
gram-negative bacteria,
gangrene, tissue necrosis,
septicemia, regional lymphadenopathy, Keflex, Augmentin, penicillins,
pneumococcus, hemophilus influenzae, pasturella multocide,
erysipelothrix rhusiopathia, gram negative bacteria
Cellulitis
This is often our worst nightmare and sends us to
the hospital more than anything else regarding
lymphedema. In this section
there are many detailed articles on cellulitis, complications of and
treatment for cellulitis and/or
lymphangitis.
Acute Cellulitis
Acute Cellulitis is one of the complications of lymphedema.
The patient may
not be aware of the source of the
etiology.
Sometimes it may
be a cut, mosquito bite, open wound or other
infection in the body.
The first sign is increased or different quality
of PAIN involving the lymphedema limb. The patients often describe this
as a "flu like symptom or an ache" involving the Lymphedema arm or leg.
This is usually followed by sudden onset of ERYTHEMA (redness,
red streaks or blotches) on the involved limb. The
HYPERTHERMIA (lymphedema limb becomes warm, hot) will follow and the
patient may experience the CHILLS and even HIGH FEVER.
The early intervention and treatment with
antibiotics will resolve this condition (it usually takes a very minimum
ten day course of antibiotics). Only a Medical Doctor will be able to
prescribe the
antibiotics,
thus a
consultation with a
Doctor
is necessary.
Severe cellulitis may require
Intravenous Antibiotic
treatment and
hospitalization. Again, elevation of the affected limb is important.
During that phase the patient should NOT massage
the lymphedema limb, bandage, apply the
pump,
wear tight elastic sleeve or exercise
excessively. Avoid the
blood pressure
and
blood
to be drawn from the involved arm. Keep the limb elevated as much as
possible while resting. Once the symptoms dissipate the treatment
MLD/CDP
should be initiated.
How do we prevent
this infection? The patient should be careful with daily activities and
take all precautions to protect the skin (wear gloves when gardening,
cleaning with detergents, etc... ). If an injury to
skin
occurs on the lymphedema limb it is necessary to clean the wound with
alcohol or hydrogen peroxide and apply antibiotic ointment. If the
symptoms progress seek the attention of a physician immediately.
It is so very important to avoid getting
cellulitus as it further destroys the
lymphatic system.
Allowed to spread or continue it can
become
systemic
and can lead to
gangrene,
amputation of the limb or even death.
Clinical
Cellulitis is clinically a spreading infection
involving both the dermis and
subcutaneous
tissues. Unlike
erysipelas,
it will not have a clear raised border.
Other features may include red streaking
from the infected area, regional
lymphadenopathy.
Symptoms
Symptoms include all over body ache, fever, severe pain of the infected
area, chills, weakness. The skin color will be red, warm and very
tender to the touch.
Causes
The most common
bacteria
responsible for
cellulitis infections are
staph aureus
and strep A.
Other less common bacterial agents include Strep B,
gram-negative bacteria,
and immunocompromised
patients pneumococcus. Less common bacteria such as Hemophilus
influenzae, Pasturella multocide, and erysipelothrix rhusiopathiae can
cause it as well.
Entry foci for the bacteria includes nasal cavities, wound, cuts,
scrapes (any type of skin break). Insect bites (especially spider) can
cause the condition. Cat scratches, animal bites are another source of
bacteria.
Risk Factors
Patients with any of the following disorders are more at risk for
developing serious and or life threatening cellulitis:
Lymphedema,
Diabetes,
immunodeficiency
(of any type),
Varicella
(cellulitis as a complication of),
chemotherapy
patients,
venous insufficiency
or venous stasis, chronic steroid users, post surgical patients,
individuals with
edema
and finally age may also be a factor with infants
and the elderly more susceptible to infections.
Complications
Complications can
include septicemia
(sepsis),
tissue
necrosis,
gangrene,
amputation of the affected limb, death. It should be noted also
that cellulitis causes further damage to the
lymphatics
and thereby makes lymphedema worse. Other complications include
lymphangitis, skin
abscesses.
In compromised
patients, physicians must be careful to observe for a complicating
gram-negative super infection that can accompany regular
gram-positive bacteria.
This can occur as a result of the
even further depletion of the body's
immune system.
Other
complications include
bacteremia,
septic shock,
meningitis
(if cellulitis is on the face), and lymphangitis.
It
is critical for patients with lymphedema to understand that every
cellulitis infection further damages and scars the lymphatics and
thereby worsens lymphedema.
Treatment
Cellulitis responds well to antibiotic therapy.
Generally, a ten day course of treatment is prescribed. Antibiotics
used to treat cellulitis include
Keflex,
Augmentin,
penicillins.
Unasyn
and
vancomycin
are standard IV antibiotics. In situations of a gram negative
infection,
Gentamicin
is used.
For special at risk patients, blood work may also be indicated to assure
the infection has not become systemic.
This group, which includes lymphedema patients may need extended IV
antibiotic therapy.
Prognosis
With early diagnosis and subsequent rapid treatment the outcome is
actually excellent with the overwhelming number of patients making full
recovery. In special risk groups however, there is a heightened risk of
complication and morbidity.
How can you prevent
cellulitis?
Preventative Antibiotic Therapy
If you are
particularly susceptible to infections, you may wish to discuss with
your doctor about undertaking preventative antibiotic therapy. There are
a couple ways of doing this.
Either an oral antibiotic or if you are not allergic to penicillin, you
may well consider taking long acting penicillin injections. This worked
wonderfully for me during the 1970's. Until my family allergy to
penicillin raised its ugly head, this was perhaps the most successful
therapy I have had in preventing cellulitis.
Remember one important point regarding cellulitis. With
fibrosis
the bacteria is able to "hide" in pockets and may escape the antibiotic
or the fibrosis will make it much more difficult for the antibiotic to
be effective. Doing all you can to prevent infections is critical.
