Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study

Abstract Background Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventi...

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Main Authors: Tsi Njim, Leopold Ndemnge Aminde, Valirie Ndip Agbor, Louise Daniele Toukam, Sara Saheb Kashaf, Eric O. Ohuma
Format: Article
Language:English
Published: BMC 2017-06-01
Series:BMC Infectious Diseases
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12879-017-2519-1
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spelling doaj-db84c8f1280b4977a065830f59ebb9b92020-11-25T03:42:28ZengBMCBMC Infectious Diseases1471-23342017-06-011711710.1186/s12879-017-2519-1Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control studyTsi Njim0Leopold Ndemnge Aminde1Valirie Ndip Agbor2Louise Daniele Toukam3Sara Saheb Kashaf4Eric O. Ohuma5Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Old Road Campus, University of OxfordSchool of Public Health, Faculty of Medicine, University of QueenslandIbal sub – Divisional HospitalFaculty of Health Sciences, University of BamendaCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Old Road Campus, University of OxfordCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Old Road Campus, University of OxfordAbstract Background Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventive strategies in Cameroon. Methods This was a hospital–based case-control study carried out in the Bamenda Regional Hospital (BRH) between September 2015 and August 2016. Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature ≥ 38 °C) and/or chills of sudden onset. Controls were adults hospitalised for diseases other than cellulitis, necrotising fasciitis, myositis, abscess or other variants of dermo-hypodermitis. Cases and controls were matched (1:2) for age and sex. Results Of the 183 participants (61 cases of cellulitis and 122 controls) included in the study, the median age was 52 years [Interquartile range (IQR): 32.5–74.5]. After controlling for potential confounders, obesity [adjusted odds ratio (AOR) = 4.7, 95% CI (1.5–14.7); p = 0.009], history of skin disruption [AOR = 12.4 (3.9–39.1); p < 0.001], and presence of toe-web intertrigo [AOR = 51.4 (11.7–225.6); p < 0.001] were significantly associated with cellulitis. Median hospital stay was longer (14 days [IQR: 6–28]) in cases compared to the controls (3 days [IQR: 2–7]). Among the cases, Streptococci species were the most frequent (n = 50, 82%) isolated germ followed by staphylococci species (n = 9, 15%). Patients with cellulitis were more likely to undergo necrosectomy (OR: 21.2; 95% CI: 7.6–59.2). Toe-web intertrigo had the highest (48.9%) population attributable risk for cellulitis, followed by history of disruption of skin barrier (37.8%) and obesity (20.6%). Conclusion This study showed a high disease burden among patients with cellulitis. While risk factors identified are similar to prior literature, this study provides a contextual evidence-base for clinicians in this region to be more aggressive in management of these risk factors to prevent disease progression and development of cellulitis.http://link.springer.com/article/10.1186/s12879-017-2519-1Lower limb cellulitisRisk factorsDisease burdenCameroon
collection DOAJ
language English
format Article
sources DOAJ
author Tsi Njim
Leopold Ndemnge Aminde
Valirie Ndip Agbor
Louise Daniele Toukam
Sara Saheb Kashaf
Eric O. Ohuma
spellingShingle Tsi Njim
Leopold Ndemnge Aminde
Valirie Ndip Agbor
Louise Daniele Toukam
Sara Saheb Kashaf
Eric O. Ohuma
Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study
BMC Infectious Diseases
Lower limb cellulitis
Risk factors
Disease burden
Cameroon
author_facet Tsi Njim
Leopold Ndemnge Aminde
Valirie Ndip Agbor
Louise Daniele Toukam
Sara Saheb Kashaf
Eric O. Ohuma
author_sort Tsi Njim
title Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study
title_short Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study
title_full Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study
title_fullStr Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study
title_full_unstemmed Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study
title_sort risk factors of lower limb cellulitis in a level-two healthcare facility in cameroon: a case-control study
publisher BMC
series BMC Infectious Diseases
issn 1471-2334
publishDate 2017-06-01
description Abstract Background Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventive strategies in Cameroon. Methods This was a hospital–based case-control study carried out in the Bamenda Regional Hospital (BRH) between September 2015 and August 2016. Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature ≥ 38 °C) and/or chills of sudden onset. Controls were adults hospitalised for diseases other than cellulitis, necrotising fasciitis, myositis, abscess or other variants of dermo-hypodermitis. Cases and controls were matched (1:2) for age and sex. Results Of the 183 participants (61 cases of cellulitis and 122 controls) included in the study, the median age was 52 years [Interquartile range (IQR): 32.5–74.5]. After controlling for potential confounders, obesity [adjusted odds ratio (AOR) = 4.7, 95% CI (1.5–14.7); p = 0.009], history of skin disruption [AOR = 12.4 (3.9–39.1); p < 0.001], and presence of toe-web intertrigo [AOR = 51.4 (11.7–225.6); p < 0.001] were significantly associated with cellulitis. Median hospital stay was longer (14 days [IQR: 6–28]) in cases compared to the controls (3 days [IQR: 2–7]). Among the cases, Streptococci species were the most frequent (n = 50, 82%) isolated germ followed by staphylococci species (n = 9, 15%). Patients with cellulitis were more likely to undergo necrosectomy (OR: 21.2; 95% CI: 7.6–59.2). Toe-web intertrigo had the highest (48.9%) population attributable risk for cellulitis, followed by history of disruption of skin barrier (37.8%) and obesity (20.6%). Conclusion This study showed a high disease burden among patients with cellulitis. While risk factors identified are similar to prior literature, this study provides a contextual evidence-base for clinicians in this region to be more aggressive in management of these risk factors to prevent disease progression and development of cellulitis.
topic Lower limb cellulitis
Risk factors
Disease burden
Cameroon
url http://link.springer.com/article/10.1186/s12879-017-2519-1
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