Cellulitis: signs of infection were common.

Clinical bottom line (level 4)

  1. The commonest clinical features in patients with cellulitis were pain or tenderness, erythema, swelling, and increased warmth.
  2. Fine needle aspiration provided a microbiologic diagnosis of cellulitis in 10% of patients with cellulitis.
Newell and Norden: Journal of Clinical Microbiology 1988; 26 (3): 401-404
Expires November 2004

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, USA

30 patients (aged range 16 to 92 years; mean 54, 60% male) cellulitis (defined as an acute spreading inflammation of the skin and subcutaneous tissues characterised by three or more of: tenderness, erythema, swelling or increased warmth)

Excluded if
  • <16 years old
  • inflammation associated with iv catheter, or obvious phlebitis
  • on antibiotics unless condition had worsened or antibiotics were for another reason


    • All patients had clinical features noted. All patients had fine needle aspiration (central (fluctuant or maximally inflamed areas, etc) and leading edge in all cases, povidone-iodine then alcohol swab, 21g needle, dry aspiration first, if no visible material, then 0.5cc saline)


    Outcomes studied:
  • positive culture from needle aspirate
  • primary lesion: fungal skin infection
  • cutaneous ulceration
  • traumatic wound
  • callus
  • psoriatic lesion
  • skin pustules
  • clinical finding: pain or tenderness
  • erythema
  • increased warmth
  • swelling
  • temperature = 37.7 C
  • white cell count > 10
  • regional adenopathy

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    positive culture from needle aspirate ? 3/30 10%
    (0.0% to 21%)
    primary lesion: fungal skin infection ? 11/30 37%
    (19% to 54%)
    cutaneous ulceration ? 6/30 20%
    (5.7% to 34%)
    traumatic wound ? 5/30 17%
    (3.3% to 30%)
    callus ? 1/30 3.3%
    (0.0% to 9.8%)
    psoriatic lesion ? 1/30 3.3%
    (0.0% to 9.8%)
    skin pustules ? 1/30 3.3%
    (0.0% to 9.8%)
    clinical finding: pain or tenderness ? 29/30 97%
    (90% to 100%)
    erythema ? 29/30 97%
    (90% to 100%)
    increased warmth ? 28/30 93%
    (84% to 100%)
    swelling ? 27/30 90%
    (79% to 100%)
    temperature = 37.7 C ? 17/30 57%
    (39% to 74%)
    white cell count > 10 ? 15/30 50%
    (32% to 68%)
    regional adenopathy ? 8/30 27%
    (11% to 43%)

    Citation

    1. Newell PM, and Norden CW: Value of needle aspiration in bacteriologic diagnosis of cellulitis in adults. Journal of Clinical Microbiology 1988; 26 (3): 401-404
    Search Terms: diagnosis cellulitis
    Contributor: John Epling and Chris Ball, November 2000
    Reviewer:

    Clinical Question.
    Patient cellulitis
    Intervention or Exposure prevalence
    Outcome clinical features