Medical history
Taking a thorough comprehensive medical history is key to diagnosing cellulitis and determining risk factors and comorbidities.Onset of symptoms should be defined together with the original starting point of inflammation. History of any trauma to the area, even minor, should be ascertained andcircumstances identified as this may help decide on antibiotic management. Injury, if any, may have occurred several days before symptoms, but patients may not relate the
injury to the onset of cellulitis. Cuts and wounds obtained via water environments such as lakes, streams, sea and ponds
(brackish water) may be contaminated with bacteria. Water-borne bacteria should be considered if patients fail to respond to conventional antibiotic treatments.Fever, malaise, nausea, shivering and rigors may accompany or precede skin
changes. Lymphangitis (infection of lymph vessels) can also present in more severe cases, appearing as a red line originating from the cellulitis and leading to tender swollen lymph glands draining the affected area (for example, in the groinwith leg cellulitis). Progression of symptoms, especially if this is rapid, can be a sign of a more acute
and deeper infection such as necrotising fasciitis, and should be fast-tracked to acute care. Other systemic symptoms such
as tachycardia and increased respirations may indicate sepsis and should be carefully monitored. Cellulitis that has spread
to an adjacent structure (such as osteomyelitis) or through the blood (bacteraemia)is a serious cause for concern and requires immediate hospital admission. Patients with mild or moderate cellulitis without systemic symptoms should be managed in primary care. Wingfield (2009) contains auseful step-by-step guide on diagnosing, assessing and managing cellulitis (seetinyurl.com/Wingfield-cellulitis).