What is the history of lower limb cellulitis?

From the Guidelines

When taking a history for lower limb cellulitis, focus on the onset, duration, and progression of symptoms including redness, warmth, swelling, and pain, as this comprehensive approach helps determine the likely causative organisms and guides antibiotic selection, according to the most recent guidelines 1.

Key Components of History Taking

• Onset, duration, and progression of symptoms
• Potential entry points such as trauma, insect bites, ulcers, or pre-existing skin conditions
• Risk factors including diabetes, venous insufficiency, lymphedema, obesity, immunosuppression, and previous episodes of cellulitis
• Recent travel, water exposure, and animal contact
• Current medications, allergies, and any self-treatment attempts
• Previous treatments, their effectiveness, and any prophylactic measures for recurrent cellulitis
• Functional impact, including mobility limitations, pain levels, and ability to perform daily activities

Importance of Identifying Causative Organisms

Identifying the likely causative organisms, commonly Streptococcus or Staphylococcus species, is crucial for guiding antibiotic selection, as noted in the guidelines 1.

Antibiotic Selection

Antibiotic selection should be based on the severity of the infection and the likely causative organisms, with flucloxacillin 500mg four times daily for 5-7 days often recommended for mild cases, and broader coverage for severe cases, as suggested by the guidelines 1.

Distinguishing Cellulitis from Mimics

A thorough history also helps distinguish cellulitis from mimics such as deep vein thrombosis, contact dermatitis, or stasis dermatitis, ensuring appropriate management and preventing unnecessary treatments, as emphasized in the guidelines 1.

From the Research

History Taking for Lower Limb Cellulitis

When taking a history for lower limb cellulitis, several key points should be considered:

• A thorough assessment of the patient's symptoms, including the onset and duration of symptoms, is essential 2
• The patient's medical history, including any previous episodes of cellulitis, should be reviewed 3
• The presence of any underlying conditions, such as lymphedema or venous stasis eczema, should be noted 3, 2
• The patient's current medications and any potential allergies should be documented 4, 5

Clinical Features of Lower Limb Cellulitis

The clinical features of lower limb cellulitis may include:

• Increased limb circumference 3
• Abnormal C-reactive protein (CRP) level 3
• Erythema, warmth, and swelling of the affected limb 2
• The presence of any open wounds or skin lesions should be noted 3, 2

Microbiological Epidemiology

The microbiological epidemiology of lower limb cellulitis may involve:

• Streptococcus agalactiae as the most commonly isolated bacterium 3
• Methicillin-resistant Staphylococcus aureus (MRSA) as a potential cause of cellulitis 4, 6
• The use of empiric antibiotic therapy, with coverage for Streptococcus species and MRSA, may be necessary 3, 4

Management of Lower Limb Cellulitis

The management of lower limb cellulitis may involve:

• Empiric antibiotic therapy, with the choice of antibiotic depending on the severity of the infection and the presence of any underlying conditions 3, 4, 5
• The use of oral antibiotics, such as trimethoprim-sulfamethoxazole or clindamycin, may be effective in treating cellulitis 4, 5
• The duration of antibiotic therapy may vary, with shorter courses of treatment potentially being effective in some cases 5