Pediatric emergency medicine trisk 2375 2375

Scenario Etiologies Facial cellulitis (buccal, S aureus, GAS, periorbital) pneumococcus Erysipelas Predominantly GAS Odontogenic Usually polymicrobial: viridans group streptococci, Prevotella, Fusobacterium Cellulitis in patients with lymphedema GAS most common, S aureus Trunk or extremities Perineal Perianal cellulitis S aureus, GAS Often polymicrobial: S aureus, GAS, enteric GNRs, Bacteroides and other anaerobes GAS Cellulitis after water exposure S aureus, GAS, Vibrio vulnificus, Comments Hib cellulitis rare in vaccinated children Raised, beefy red, very well-demarcated borders; most common on the legs; if see involvement of the ear (Milian ear sign), likely erysipelas Abscess drainage essential; one complication can be Ludwig angina, a rapidly progressive cellulitis of the floor of the mouth that can result in airway obstruction Some patients may benefit from oral PCN VK prophylaxis if have recurrent episodes Over 70% are S aureus One risk factor in adolescents is shaving the genital area Rapid strep swabs, while not licensed outside the nasopharynx, can help guide initial therapy Vibrio causes rapidly progressive cellulitis with bullae formation