Celulitis y erisipelas
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- aparición aguda de piel roja, dolorosa, caliente e hinchada (celulitis)
- piel levantada bien delimitada y de color rojo brillante (erisipela)
Otros factores de diagnóstico
- apariencia de piel de naranja
- ampollas
- sangrado
- Linfangitis
- unilateralmente
- fiebre
- malestar general
- linfadenopatía
- alteraciones en la membrana del dedo del pie
- Factores de riesgo
- Otros síntomas constitucionales
- Fuente de infección
- Factores inmunocomprometidores
- viajes recientes
- fluctuación profunda a la celulitis
- necrosis dérmica
- signos de sepsis
- signos de fascitis necrotizante
- signos de celulitis orbitaria o periorbitaria
Factores de riesgo
- diabetes
- edema crónico e insuficiencia venosa
- Eczema
- linfedema
- episodios previos de celulitis
- alteraciones en la membrana del dedo del pie
- consumo de drogas ilícitas por vía intravenosa
- obesidad
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- hemograma completo
- velocidad de sedimentación globular (VSG)
- proteína C-reactiva
- urea y electrolitos
- hemocultivo y sensibilidades
Pruebas diagnósticas que deben considerarse
- hisopo de piel
- aspirado de piel
- biopsia de piel
- procedimientos de diagnóstico molecular
- Ecografía en el punto de atención (POCUS)
- radiografía simple
- Resonancia magnética (IRM)
- ultrasonido
- pruebas de función hepática
Algoritmo de tratamiento
Sospecha de sepsis
grave: cualquier sitio (excepto cerca de los ojos o la nariz)
cualquier gravedad: sitio cerca de los ojos o la nariz
no grave: cualquier sitio (excepto cerca de los ojos o la nariz)
pacientes con recidivas frecuentes
Colaboradores
Consejeros especializados
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
UK
Divulgaciones
AA declares that he has no competing interests.
Jamie Scott, MB BCh, BAO, MSc, FRCEM
Emergency Medicine Consultant
Newham Hospital
Barts Health NHS Trust
Physician Response Unit Senior Fellow
London’s Air Ambulance
Royal London Hospital
Flight Doctor
Essex and Herts Air Ambulance Trust
UK
Divulgaciones
JS declares that he has no competing interests.
Ram Narayanan, MBBS, MEM, MRCEM
ST5 in Emergency Medicine
Whipps Cross Hospital
Barts Health NHS Trust
London
UK
Disclosures
RN declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge previous expert contributors to this topic, whose work has been retained in parts of the content:
Matthew C. Robinson, MD
Infectious Disease Physician
Austin Infectious Disease Consultants
Austin
TX
Disclosures: MCR declares that he has no competing interests.
Johann Grundlingh MBChB, FCEM, FFICM, EDICM, DFMS, DipMedTox, MMedTox, MSB, ERT, MEWI, MBA
Emergency Medicine Consultant
Royal London Hospital
Barts Health NHS Trust
Honorary Senior Lecturer
Queen Mary University
London
UK
Disclosures: JG declares that he has no competing interests.
Peer reviewers
Susan Croft, MBChB, MRCP, FRCEM
Emergency Medicine Consultant
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield
UK
Disclosures
SC declares that she delivered two paid presentations to local general practitioners on acute exacerbations of long-term conditions in March and April 2018 (supported by Astra-Zeneca).
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg. 2022 Jan 15;17(1):3.Full text Abstract
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.Full text Abstract
National Institute for Health and Care Excellence. Cellulitis and erysipelas: antimicrobial prescribing. Sep 2019 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Fascitis necrosante
- Tromboflebitis, superficial
- Trombosis venosa profunda
More DifferentialsGuidelines
- Guidelines on the management of cellulitis in lymphoedema
- WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections
More GuidelinesPatient information
Celulitis y erisipelas
More Patient information
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