Cellulitis causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Group A streptococcus and [[staphylococcus]are the most common causative agents of cellulitis. These bacteria are part of the normal flora living on the skin.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Less Common Causes

Less common causes of cellulitis include:

Gram-negative aerobic bacilli ^[2]

Causes by Organ System

Cardiovascular	Chronic venous insufficiency, coronary artery bypass graft surgery, lymphatic obstruction, lymphedema, peripheral vascular disease
Chemical / poisoning	No underlying causes
Dermatologic	Acute bacterial dermohypodermatitis, Chediak-Higashi syndrome, dermatitis, erysipelas, hidradenitis suppurativa, insect bites and stings, lymphatic obstruction, lymphedema, non-necrotising cellulitis, paronychia, stasis dermatitis, systemic lupus erythematosus, tattoo, Wells syndrome
Drug Side Effect	Belimumab, corticosteroids, luliconazole, oritavancin, panitumumab, pergolide, romidepsin, tiagabine
Ear Nose Throat	Deep neck space infections
Endocrine	Diabetes mellitus
Environmental	Paronychia
Gastroenterologic	Chronic liver disease, cirrhosis
Genetic	Chediak-Higashi syndrome, Wells syndrome, WHIM syndrome
Hematologic	Wells syndrome
Iatrogenic	Mastectomy, radiation therapy, radical neck surgery, saphenous vein stripping, venectomy
Infectious Disease	Acute bacterial dermohypodermatitis, adenitis, aeromonas hydrophila, animal bite, athlete’s foot, beta-hemolytic streptococci, candida albicans, capnocytophaga canimorsus, citrobacter, clostridium perfringens, clostridium, cryptococcus neoformans, deep neck space infections, dermatitis, eikenella corrodens, enterobacter, erysipelas, erysipelothrix rhusiopathiae, fusarium, group A streptococcus, haemophilus influenzae, helicobacter cinaedi, herpes simplex, HIV, mastitis, meningococcus, MRSA, nocardiosis, non-necrotising cellulitis, orbital cellulitis, pasteurella multocida, pasteurella,periorbital cellulitis, peritonsillar abscess, pneumococcus, pseudomonas aeruginosa, quinsy, serratia, staphylococcus aureus, streptobacillus moniliformis, streptococcus agalactiae, streptococcus iniae, streptococcus pneumoniae, streptococcus, varicella, vibrio vulnificus
Musculoskeletal / Ortho	No underlying causes
Neurologic	Chediak-Higashi syndrome
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	Orbital cellulitis, periorbital cellulitis
Overdose / Toxicity	Substance abuse
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Nephrotic syndrome, systemic lupus erythematosus
Rheum / Immune / Allergy	Eosinophilic cellulitis, systemic inflammatory response syndrome, systemic lupus erythematosus, WHIM syndrome
Sexual	No underlying causes
Trauma	Animal bite, trauma
Urologic	No underlying causes
Dental	Ludwig’s angina, submandibular cellulitis
Miscellaneous	Breast implant infections, mastectomy, pelvic lymph node dissection

Causes in Alphabetical Order

Causes Based on Anatomical Location, Medical and Exposure History

The causative pathogen of cellulitis varies with the anatomical location and the patient’s medical and exposure history.

*Predisposing factor, anatomical location, and likely etiology of cellulitis*^[5]
Predisposing Factor	Anatomical Location	Likely Etiology
Periorbital (preseptal) cellulitis	Eyelid and periocular tissues	Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes
Buccal cellulitis in children without Hib vaccine	Cheek	Haemophilus influenzae
Cellulitis complicated by body piercing	Ear, nose, umbilicus	S. aureus, S. pyogenes
Perianal cellulitis	Perineum	S. pyogenes
Subcutaneous injection of illicit drugs (“skin popping”)	Extremities, neck	S. aureus, Streptococcus (group A, B, C, F, G)
Breast surgert with axillary lymph node dissection	Ipsilateral arm	Non–group A beta-hemolytic Streptococcus
Harvest of saphenous vein	Ipsilateral leg	Beta-hemolytic Streptococcus
Crepitant or gangrenous cellulitis	Extremities, Trunk	Clostridium or non–spore-forming anaerobes; alone or with E. coli, Klebsiella, or Aeromonas
Diabetic foot ulcer	Dorsum of foot or toes	S. aureus, Streptococcus, Enterobacteriaceae, P. aeruginosa, Acinetobacter, or anaerobes
Exposure to salt water at breeches of skin	Extremities	Vibrio vulnificus
Exposure to fresh water at breeches of skin	Extremities	Aeromonas hydrophila
Medicinal leech therapy	Extremities	Aeromonas hydrophila
Working as a butcher, fish or clam handler, veterinarian	Fingers	Erysipelothrix rhusiopathiae

References

↑ ^1.0 ^1.1 Fleisher G, Ludwig S (1980). “Cellulitis: a prospective study”. Ann Emerg Med. 9 (5): 246–9. PMID 6768328.
↑ Raff AB, Kroshinsky D (2016). “Cellulitis: A Review”. JAMA. 316 (3): 325–37. doi:10.1001/jama.2016.8825. PMID 27434444.
↑ Gen R, Horasan EŞ, Vaysoğlu Y, Arpaci RB, Ersöz G, Özcan C (2013). “Rhino-orbito-cerebral mucormycosis in patients with diabetic ketoacidosis”. J Craniofac Surg. 24 (2): e144–7. doi:10.1097/SCS.0b013e31827c7eb8. PMID 23524816.
↑ Ajayan P, Krishnamurthy S, Biswal N, Mandal J (2013). “Clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome”. Indian Pediatr. 50 (8): 779–81. PMID 23502669.
↑ Swartz, MN. (2004). “Clinical practice. Cellulitis”. N Engl J Med. 350 (9): 904–12. doi:10.1056/NEJMcp031807. PMID 14985488. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[pmid6768328-1] 1.0 ^1.1 Fleisher G, Ludwig S (1980). “Cellulitis: a prospective study”. Ann Emerg Med. 9 (5): 246–9. PMID 6768328.

[pmid27434444-2] Raff AB, Kroshinsky D (2016). “Cellulitis: A Review”. JAMA. 316 (3): 325–37. doi:10.1001/jama.2016.8825. PMID 27434444.

[pmid23524816-3] Gen R, Horasan EŞ, Vaysoğlu Y, Arpaci RB, Ersöz G, Özcan C (2013). “Rhino-orbito-cerebral mucormycosis in patients with diabetic ketoacidosis”. J Craniofac Surg. 24 (2): e144–7. doi:10.1097/SCS.0b013e31827c7eb8. PMID 23524816.

[pmid23502669-4] Ajayan P, Krishnamurthy S, Biswal N, Mandal J (2013). “Clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome”. Indian Pediatr. 50 (8): 779–81. PMID 23502669.

[Swartz-2004-5] Swartz, MN. (2004). “Clinical practice. Cellulitis”. N Engl J Med. 350 (9): 904–12. doi:10.1056/NEJMcp031807. PMID 14985488. Unknown parameter |month= ignored (help)

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