Beta-hemolytic streptococci are the predominant pathogen in the majority of patients with non-purulent cellulitis.
The most likely causative pathogen of erysipelas is Group A streptococcus (Streptococcus pyogenes).
Erysipelas is an infection confined to the superficial epidermis and lymphatics.
It is generally bright red, painful - “burning”, sharply demarcated, with a raised edge and induration.
Classic areas include the face and bridge of nose, but often occurs on the extremities, particularly in the setting of impaired lymphatic damage.
Recurrence is common.
Blood cultures are often negative and of low yield in the absence of systemic signs of inflammation.
Bilateral lower limb cellulitis is rare. Consider alternative etiologies such as venous stasis or dependent rubor.
Erythema associated with cellulitis should NOT resolve with elevation of the limb as opposed to chronic venous stasis.
Guidelines