DISPOSITION

..... Admission

Patients with cellulitis or abscesses should be admitted if

there is an extensive area of involvement or if they are

systemically ill, have significant comorbid illness, or are

immune-compromised. All patients with necrotizing

infections should be admitted to an intensive care unit

for broad-spectrum antibiotic therapy after surgical

debridement.

..... Discharge

Patients with cellulitis or a drained abscess with limited

area of involvement, no or minimal systemic symptoms,

and no significant comorbidities may be discharged.

SUGGESTED READING

Chambers HF, Moellering RC Jr, Kamitska P. Clincal decisions.

Management of skin and soft-tissue infection. N Eng! l Med.

2008;359: 1063.

Dewitz F. Soft tissue. In: Ma OJ, Mateer JR, Blaivas M. Emergency

Ultrasound. 2nd ed. New York, NY: McGraw-Hill, 2008,

pp. 441-444.

Infectious Diseases Society of America. Practice Guidelines for

the Diagnosis and Management of Skin and Soft-Tissue

Infections. http://www.idsociety.org/uploadedFiles/IDSN

Guidelines-Patient_ Care/PDF _Library I Skin o/o20and %20

Softo/o20Tissue.pdf. CID 2005:41.

Kelly EW, Magliner D. Soft tissue infections. In: Tintinalli JE,

Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD.

Tintinalli's Emergency Medicine: A Comprehensive Study

Guide. 7th ed. New York, NY: McGraw-Hill, 20 1 1,

pp. 1014-1024.

Wang CH, Khin LW, Heng KS, Tan KC, Low CO. The

LRINEC ( Laboratory Risk Indicator for Necrotizing

Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections. Grit Care Med.

2004;32: 1 535-1541 .

H uman Imm unodeficiency

Virus

Sorabh Khandelwal, MD

john Davis, MD

Key Points

• A high index of suspicion is needed fo r the initial

diagnosis of human immu nodeficiency virus (H IV),

particula rly in the context of atypical presenting

symptoms. Consider acute HIV in the patient who

presents with a mononucleosis-like i nfection, but

with negative monos pot testing.

• CD4 T-cell count is correlated with risk for opportunistic

infection.