Adult Cellulitis in Somalia: Prospective Assessment of Clinical Presentation, Predisposing Factors, and Outcomes at a Tertiary Teaching Hospital

Adult Cellulitis in Somalia: Prospective Assessment of Clinical Presentation, Predisposing Factors, and Outcomes at a Tertiary Teaching Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adult Cellulitis in Somalia: Prospective Assessment of Clinical Presentation, Predisposing Factors, and Outcomes at a Tertiary Teaching Hospital Abdullahi Ahmed Ahmed, Salad Mohamud Mohamed Hassan, Idil hirsi ali, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8487605/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Cellulitis is a common medical emergency associated with substantial morbidity and significant financial implications for healthcare systems worldwide. Method This prospective cross-sectional study included 100 adult patients diagnosed with cellulitis who presented to the emergency department of a tertiary teaching hospital in Somalia between August 1, 2021, and July 30, 2022. Clinical characteristics, risk factors, and outcomes were analyzed. Results Of the 100 patients, 74% were male and 26% were female, with a mean age of 56.71 ± 19.94 years. The largest age group was patients ≥ 70 years (27%). Diabetes was the most frequently reported comorbidity (51%). The most common risk factors were mechanical trauma (20%) and a previous history of cellulitis (20%). The lower extremity was the predominant site of infection (90%). Regarding management, 47% of patients were hospitalized and received intravenous antibiotics, 45% were treated as outpatients, and 8% required intensive care unit (ICU) admission. Additionally, 11% underwent drainage in combination with IV antibiotics. Overall, 96% of patients achieved successful recovery. Conclusion Cellulitis is a major cause of emergency department visits and hospitalization, particularly among elderly patients. It remains a common medical emergency associated with high morbidity and significant healthcare costs. Cellulitis Fever Blisters Ruptured blisters Figures Figure 1 Figure 2 Introduction Cellulitis is an acute, rapidly progressive bacterial infection involving the dermis and subcutaneous tissues and remains one of the most frequent causes of emergency department (ED) visits and unplanned hospital admissions worldwide. Although it may occur on any anatomical site, the lower extremities are disproportionately affected, particularly in regions where environmental exposure, limited access to early healthcare, and high burdens of chronic diseases increase susceptibility. In low-resource settings such as Somalia, cellulitis represents a major public health challenge due to delays in presentation, reliance on traditional treatments, and high prevalence of comorbid conditions that predispose patients to severe disease and complications ( 1 ). Global estimates indicate an incidence of approximately 24–25 cases per 1000 person-years, with cellulitis accounting for 1–14% of all emergency presentations ( 2 ). The burden may be even higher in Somalia, where risk factors—including uncontrolled diabetes, peripheral arterial disease, chronic lymphedema, poor hygiene, and recurrent minor trauma—are common, particularly among older adults and manual laborers. Risk factors for cellulitis are broadly categorized into general and local determinants. General non-modifiable risks include pregnancy and genetic predisposition, whereas modifiable general factors include diabetes mellitus, venous insufficiency, immunosuppression, and chronic edema. Local non-modifiable risks include trauma, animal or insect bites, and tattoos, while ulcers, eczema, burns, and tinea pedis constitute modifiable local risks that are frequently observed among Somali patients due to climatic conditions and limited outpatient dermatologic care ( 3 , 4 ). Clinically, cellulitis is characterized by the classical inflammatory signs of rubor (erythema), dolor (pain), tumor (swelling), and calor (warmth) . Unlike erysipelas, which presents with sharply demarcated borders, cellulitis typically exhibits diffuse, poorly defined margins and may progress to systemic infection if not promptly treated ( 5 ). The clinical spectrum ranges from localized infection to fulminant disease with sepsis or necrotizing fasciitis—an especially concerning scenario in resource-limited contexts where delays in diagnosis can be fatal. Diagnosis is primarily clinical due to the lack of a definitive diagnostic test. In Somalia, where diagnostic resources may be constrained, accurate history-taking and physical examination remain essential to avoid misdiagnosis and unnecessary antibiotic use. Point-of-care ultrasound (POCUS) has emerged as a valuable adjunct, particularly for differentiating cellulitis from abscesses when physical findings are equivocal ( 6 ). Consultation with dermatology specialists, where available, significantly reduces misclassification and inappropriate treatment—common challenges in both emergency and outpatient Somali settings ( 7 ). Routine laboratory tests may assist in ruling out non-infectious mimics; however, they are often unnecessary in mild, clearly uncomplicated cases ( 8 ). Given Somalia’s unique epidemiological landscape—characterized by high prevalence of trauma, chronic illnesses, and limited follow-up care—understanding the clinical profile and outcomes of patients presenting with cellulitis is crucial for optimizing management strategies, reducing recurrence, and improving healthcare resource utilization. Methodology This prospective cross-sectional study was conducted at the Emergency Department of a tertiary teaching hospital in Somalia and included 100 consecutively enrolled adult patients diagnosed with cellulitis between August 1, 2021, and July 30, 2022. The study aimed to evaluate risk factors, clinical characteristics, and outcomes of patients presenting with cellulitis in the Somali setting. Cellulitis of both upper and lower extremities was defined clinically by the presence of localized pain, erythema, warmth, and swelling, affecting either one or both limbs. Patients presenting with cellulitis involving the toe, foot, finger, hand, arm, buttock, or head and neck were included. However, cases complicated by abscess, myositis, or necrotizing fasciitis were excluded to ensure the accuracy of uncomplicated cellulitis profiling. Data were collected on demographic and baseline characteristics, including age, sex, race, insurance status, body mass index (BMI), and BMI classification. Comorbid conditions such as diabetes mellitus, hypertension, and obesity were recorded. Vital signs at admission—temperature, heart rate, and systolic blood pressure—were measured, along with laboratory indicators of infection, including white blood cell count, neutrophil percentage, and serum creatinine. All data were analyzed using SPSS software (version 23.0, IBM Corp., Chicago, IL, USA). Descriptive statistics were used to summarize demographic and clinical variables. Univariate analysis was first performed to identify factors associated with disease severity and hospitalization; variables with statistical significance were subsequently included in a multivariate regression model to determine independent predictors of outcomes. Ethical approval for this study was obtained from the Ethics Committee of Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital (Approval number: MSTH6743, dated July 18, 2021). Informed consent was obtained from all participants or their legal guardians prior to study enrollment. Results A total of 100 patients meeting the study’s eligibility criteria were included. The majority were male (74%, n = 74), while females accounted for 26% (n = 26). The mean age of the cohort was 56.71 ± 19.94 years. The largest age group consisted of patients aged ≥ 70 years (27%, n = 27), followed by those aged 60–69 years (25%, n = 25) and 50–59 years (18%, n = 18). Patients aged 40–49 years, 30–39 years, and ≤ 30 years represented 9% (n = 9), 7% (n = 7), and 14% (n = 14), respectively. Regarding comorbidities, diabetes mellitus was the most frequently reported (51%, n = 51). Thirty-seven patients (37%) reported no chronic medical conditions. Other comorbidities included hypertension (14%, n = 14), ischemic heart disease (3.8%, n = 3), cirrhosis (1.3%, n = 1), stroke (5%, n = 5), and heart failure (4%, n = 4) (Table 1 ). Table 1 Basic Demographic and Clinical Characteristics of Patients with Cellulitis Characteristics N % Age in years 30 23 23.0 Co-morbidities Diabetic 51 51.0 Renal failure 5 5.0 Heart failure 4 4.0 Stroke 5 5.0 Cirrhosis 1 1.0 Ischemic HD ** 3 3.0 Hypertension 14 14.0 Corticosteroid use 8 8.0 *Body Mass Index **Heart disease Multiple risk factors for cellulitis were identified. Mechanical trauma (20%, n = 20) and a previous history of cellulitis (20%, n = 20) were the most common. Additional risk factors included immunocompromised status (19%, n = 19), obesity (16%, n = 16), chronic extremity swelling (11%, n = 11), steroid use (8%, n = 8), recent surgery or procedures within three months (6%, n = 6), skin conditions such as eczema or tinea pedis (5%, n = 5), varicose veins (3%, n = 3), and insect/animal bites (2%, n = 2). Sixteen percent (n = 16) of the patients had no identifiable risk factor (Table 2 ). Table 2 Distribution of Cellulitis Cases by Anatomical Site and Associated Factors Variable Lower extremity Upper extremity Head/face Thoracic Genitalia P-Value Age .197 30 21 1 0 0 1 Risk factors mechanical trauma 20 0 0 0 0 .810 history cellulitis 20 0 0 0 0 .810 circulation problem 13 0 0 0 0 .917 Bite 2 0 0 0 0 .998 Immunocompromised 19 0 0 0 0 .827 Obesity 15 0 0 0 1 .185 Steroid use 6 0 1 1 0 .07 skin conditions 5 0 0 0 0 .987 chronic swelling of extremities 11 0 0 0 0 .940 Surgery/procedure in last 3 month 5 1 0 0 0 .126 varicose vein 2 0 0 1 0 0.09 Comorbidities Diabetic 50 0 0 0 1 .175 heart failure 4 0 0 0 0 .992 renal failure 5 0 0 0 0 .987 cirrhosis 0 0 0 1 0 .06 Hypertension 14 0 0 0 0 .904 Ischemic heart disease 3 0 0 0 0 .995 Stroke 5 0 0 0 0 .987 The lower extremities were overwhelmingly the most affected anatomical site, accounting for 90% of cases (n = 90). Less commonly affected sites included the upper extremity (2%, n = 2), head and face (2%, n = 2), thoracic region (1%, n = 1), and genital area (1%, n = 1) (Fig. 1 ). Vital sign measurements on presentation showed a mean systolic blood pressure of 112.9 ± 15.7 mmHg, diastolic pressure 68.68 ± 10.2 mmHg, pulse rate 75.2 ± 7.11 beats/min, temperature 38.0 ± 0.37°C, oxygen saturation 97.7 ± 3.8%, and random blood glucose 158.8 ± 105 mg/dL. Clinically, all patients presented with swelling (100%, n = 100) and the majority had fever (95%, n = 95). Blisters were observed in 42% (n = 42), while ruptured blisters were documented in 10% (n = 10) (Fig. 2 ). Laboratory findings revealed mean white blood cell count of 15.2 ± 9.5 × 10⁹/L, hemoglobin 11.9 ± 2.1 g/dL, platelet count 330.4 ± 170.5 × 10⁹/L, AST 46.42 ± 94.5 U/L, ALT 31.8 ± 47.4 U/L, serum creatinine 1.31 ± 1.1 mg/dL, urea 45.9 mg/dL, albumin 3.64 ± 2.4 g/dL, and CRP 144 ± 118 mg/L. With regard to management, 47% (n = 47) of patients required hospitalization and were treated with intravenous antibiotics, while 45% (n = 45) were managed on an outpatient basis with oral antibiotics. Eight patients (8%) required intensive care unit (ICU) admission. Additionally, 11 patients (11%) underwent incision and drainage combined with IV antibiotic therapy. Outcomes were favorable for most participants, with 96 patients (96%) making a full recovery. Four patients (4%) died during the course of treatment (Table 3 ). Table 3 Clinical Characteristics, Laboratory Findings, Treatment Disposition, and Outcomes by Affected Body Region Variable Lower extremity Upper extremity Head/face Thoracic Genitalia P-Value Clinical S&S Blisters 39 1 2 0 0 .370 Fever 89 2 2 1 1 .970 Swelling 94 2 2 1 1 .987 Ruptured blisters 10 0 0 0 0 .950 Red skin area 74 2 2 1 1 .810 Laboratory tests WBC (×103/mm3) 16.0 ± 7.5 14.6 ± 6.5 12.9 ± 4.2 10.9 ± 5.8 6.8 ± 1.2 .230 Neutrophil count (%) 81.1 ± 15.7 80.2 ± 10.9 55.7 ± 9.8 53.7 ± 17.6 56.5 ± 360 .987 CRP (mg/dL) 81.8 ± 73.2 88.4 ± 63.8 28.9 ± 33.3 71.0 ± 78.7 88.5 ± 1.2 .095 HB (mg/dL) 12.6 ± 1.6 10.3 ± 2.6 11.2 ± 1.2 11.8 ± 3.5 15.5 ± 2.1 .032 ALT 16.3 ± 1.4 14.0 ± 5.9 12.4 ± 2.9 27.8 ± 4.3 18.5 ± 9.1 .230 AST 28.3 ± 13.7 27.3 ± 10.5 36.8 ± 16.7 63.13 ± 101.4 33.0 ± 7.0 < 0.001 Platelet 580.3 ± 230.7 280.3 ± 130.7 390.3 ± 112.7 389.3 ± 120.7 288 ± 100 .943 Albumin .789 Creatinine .966 Disposition .09 Outpatient 43 1 1 0 0 ICU 4 1 1 1 1 Non-ICU 47 0 0 0 0 Outcome .05 Cured 92 1 2 1 0 Death 2 1 0 0 1 Treatment option .594 Oral antibiotics therapy 43 1 1 0 0 IV antibiotics therapy 41 0 1 1 1 Drainage and IV antibiotics 10 1 0 0 0 Discussion Cellulitis remains a significant public health challenge in low-resource settings such as Somalia, where late presentation, limited access to primary care, and a high burden of chronic diseases contribute to increased morbidity and healthcare utilization ( 8 ). The condition disproportionately affects older adults, particularly those who are bedridden or have functional limitations, leading to recurrent hospitalizations and substantial socioeconomic consequences, including prolonged admissions and increased financial strain on both families and the healthcare system ( 8 ). Consistent with regional infectious disease patterns, our study demonstrated a clear male predominance, aligning with findings from cohort studies conducted in Southeast Asia ( 9 ). This trend may be explained by increased occupational exposure, higher rates of trauma, and greater mobility among males in Somalia’s predominantly manual-labor workforce. A wide range of predisposing factors has been linked to cellulitis, including the presence of Staphylococcus aureus or β-hemolytic streptococci in toe webs, chronic foot ulcers, prior cellulitis episodes ( 10 ), smoking, venous insufficiency, liver disease, homelessness ( 11 ), recent trauma, surgical procedures, elevated body mass index, and diabetes mellitus ( 12 ). Immunosuppression, chronic swelling of extremities, steroid use, and chronic organ dysfunction (liver, renal, and cardiac diseases) are also recognized contributors. In the Somali population, mechanical trauma, previous cellulitis, and immunosuppression emerged as the most prominent risk factors—likely reflecting occupational injuries, limited wound-care practices, and delayed access to appropriate medical treatment. Clinically, cellulitis typically presents with erythema, warmth, swelling, and tenderness. However, these features overlap with numerous dermatologic conditions, making misdiagnosis common—particularly in emergency settings with limited dermatology support ( 13 ). The concept of "pseudo-cellulitides" is therefore crucial. Conditions such as contact dermatitis, hypersensitivity reactions, fixed drug eruptions, venous stasis dermatitis, and deep-vein thrombosis frequently mimic cellulitis and can result in unnecessary antibiotic use and hospitalization ( 14 ). Although fever and leukocytosis are not universal findings, retrospective data indicate that up to 42% of cases may present with systemic inflammatory markers ( 15 ). In our cohort, lower limb involvement was overwhelmingly predominant, consistent with global data showing that approximately 75–90% of cellulitis cases affect the lower extremities ( 16 ). This pattern may reflect a combination of repeated mechanical trauma, bare-foot walking in rural communities, obesity, chronic edema, and recurrent infections—all of which are common in Somalia. The high prevalence of cellulitis among individuals aged ≥ 50 years mirrors trends observed across sub-Saharan Africa ( 17 ). This may be attributed to age-related comorbidities such as diabetes mellitus, hypertension, and peripheral vascular disease, which compromise skin integrity and immune function. Given Somalia’s rising diabetes burden and limited chronic disease management infrastructure, the risk of recurrent cellulitis remains disproportionately high. For uncomplicated cellulitis without systemic manifestations, laboratory testing is generally unnecessary unless comorbidities such as diabetes or immunosuppression are present ( 18 ). Historically, cellulitis carried a mortality rate of 11% in the pre-antibiotic era ( 19 ). Although mortality has dramatically decreased, our findings highlight the continued need for timely diagnosis and adequate antimicrobial therapy. In settings where MRSA prevalence is low, oral agents such as dicloxacillin or cephalexin remain appropriate first-line therapies for outpatient management ( 20 ), whereas severe infections or systemic involvement warrant intravenous therapy. Given the high recurrence rate, economic burden, and substantial risk of complications, early dermatology consultation—when available—is essential to improve diagnostic accuracy and reduce unnecessary admissions ( 21 ). Strengthening community education, early wound-care practices, and chronic disease management programs could significantly reduce cellulitis incidence and improve outcomes in Somalia’s resource-constrained healthcare environment. Conclusion This prospective study provides important insight into the clinical profile, risk factors, and outcomes of cellulitis among patients presenting to a major emergency department in Somalia. Although limited by its single-center design and modest sample size, the findings highlight the substantial burden of cellulitis—particularly among older adults and individuals with diabetes, mechanical trauma, and immunosuppression. The predominance of lower-limb involvement and the high rate of hospital admissions underscore the ongoing need for timely recognition, early intervention, and improved preventive strategies in our setting. Given the rising prevalence of chronic comorbidities in Somalia, larger multicenter studies are recommended to guide context-appropriate diagnostic pathways, optimize antimicrobial stewardship, and reduce recurrence and healthcare costs. Abbreviations ED Emergency Department ICU Intensive Care Unit BMI Body Mass Index WBC White Blood Cell CRP C-reactive protein ALT Alanine aminotransferase AST Aspartate aminotransferase SBP Systolic Blood Pressure DBP Diastolic Blood Pressure SpO₂ Peripheral Oxygen Saturation IV Intravenous POCUS Point-of-care Ultrasound IRB Institutional Review Board Declarations Ethics Approval and Consent to Participate This study was approved by the Ethical Committee of Mogadishu Somali Turkey Recap Tyap Erdogan Training and Research Hospital (Approval ID: MSTH6743; Date: 18 July 2021). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to data collection. All collected data were kept confidential and used exclusively for research purposes. Consent for Publication Not applicable. Availability of Data and Materials The datasets generated and analyzed during the current study are stored within the Mogadishu Somali Turkey Recap Tyap Erdogan Training and Research Hospital information system. Data access is restricted but may be granted to qualified investigators upon reasonable request and with approval from the institutional Education and Research Committee. Competing Interests The authors declare that they have no competing interests. Funding No external funding was received for this study. Authors’ Contributions Salad Mohamud Mohamed Hassan and Idil Hirsi Ali contributed to data collection. Nasteho Mohamed Sheikh Omar and Sahra Ali Yusuf performed the data analysis. Abdullahi Ahmed Ahmed (corresponding author) led the manuscript drafting, editing, supervision, and data interpretation. All authors reviewed and approved the final manuscript, agreed on the target journal, and accepted responsibility for all aspects of the work. 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Howden BP, Grayson ML. 5: Hospital-in-the-home treatment of infectious diseases. The Medical Journal of Australia. 2002;176(7):440-5. Li DG, Di Xia F, Khosravi H, Dewan AK, Pallin DJ, Baugh CW, Laskowski K, Joyce C, Mostaghimi A. Outcomes of early dermatology consultation for inpatients diagnosed with cellulitis. JAMA dermatology. 2018;154(5):537–43. Additional Declarations No competing interests reported. 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08:43:36","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110066,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8487605/v1/fbbe3b39facd81b6f0e06bae.html"},{"id":100560450,"identity":"e8ae8fdd-38d9-48c6-a19d-d982c527b96f","added_by":"auto","created_at":"2026-01-19 08:43:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":136566,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnatomical location of cellulitis in patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8487605/v1/b38a9e208a66e3673f40c8bf.jpg"},{"id":100560280,"identity":"3c5bbf95-123e-43ad-a63c-6086e9b5b719","added_by":"auto","created_at":"2026-01-19 08:43:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1236699,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClinical Presentations Among Patients with Cellulitis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8487605/v1/9d0724b640bcef60400400db.png"},{"id":100563089,"identity":"0c37875f-f246-4a2b-b9ba-014f50dfce86","added_by":"auto","created_at":"2026-01-19 08:45:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2196312,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8487605/v1/06218d22-6227-42c0-bbe6-eb33452bd226.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adult Cellulitis in Somalia: Prospective Assessment of Clinical Presentation, Predisposing Factors, and Outcomes at a Tertiary Teaching Hospital","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCellulitis is an acute, rapidly progressive bacterial infection involving the dermis and subcutaneous tissues and remains one of the most frequent causes of emergency department (ED) visits and unplanned hospital admissions worldwide. Although it may occur on any anatomical site, the lower extremities are disproportionately affected, particularly in regions where environmental exposure, limited access to early healthcare, and high burdens of chronic diseases increase susceptibility. In low-resource settings such as Somalia, cellulitis represents a major public health challenge due to delays in presentation, reliance on traditional treatments, and high prevalence of comorbid conditions that predispose patients to severe disease and complications (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobal estimates indicate an incidence of approximately 24\u0026ndash;25 cases per 1000 person-years, with cellulitis accounting for 1\u0026ndash;14% of all emergency presentations (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The burden may be even higher in Somalia, where risk factors\u0026mdash;including uncontrolled diabetes, peripheral arterial disease, chronic lymphedema, poor hygiene, and recurrent minor trauma\u0026mdash;are common, particularly among older adults and manual laborers. Risk factors for cellulitis are broadly categorized into general and local determinants. General non-modifiable risks include pregnancy and genetic predisposition, whereas modifiable general factors include diabetes mellitus, venous insufficiency, immunosuppression, and chronic edema. Local non-modifiable risks include trauma, animal or insect bites, and tattoos, while ulcers, eczema, burns, and tinea pedis constitute modifiable local risks that are frequently observed among Somali patients due to climatic conditions and limited outpatient dermatologic care (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClinically, cellulitis is characterized by the classical inflammatory signs of \u003cb\u003erubor (erythema), dolor (pain), tumor (swelling), and calor (warmth)\u003c/b\u003e. Unlike erysipelas, which presents with sharply demarcated borders, cellulitis typically exhibits diffuse, poorly defined margins and may progress to systemic infection if not promptly treated (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The clinical spectrum ranges from localized infection to fulminant disease with sepsis or necrotizing fasciitis\u0026mdash;an especially concerning scenario in resource-limited contexts where delays in diagnosis can be fatal.\u003c/p\u003e \u003cp\u003eDiagnosis is primarily clinical due to the lack of a definitive diagnostic test. In Somalia, where diagnostic resources may be constrained, accurate history-taking and physical examination remain essential to avoid misdiagnosis and unnecessary antibiotic use. Point-of-care ultrasound (POCUS) has emerged as a valuable adjunct, particularly for differentiating cellulitis from abscesses when physical findings are equivocal (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Consultation with dermatology specialists, where available, significantly reduces misclassification and inappropriate treatment\u0026mdash;common challenges in both emergency and outpatient Somali settings (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Routine laboratory tests may assist in ruling out non-infectious mimics; however, they are often unnecessary in mild, clearly uncomplicated cases (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven Somalia\u0026rsquo;s unique epidemiological landscape\u0026mdash;characterized by high prevalence of trauma, chronic illnesses, and limited follow-up care\u0026mdash;understanding the clinical profile and outcomes of patients presenting with cellulitis is crucial for optimizing management strategies, reducing recurrence, and improving healthcare resource utilization.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis prospective cross-sectional study was conducted at the Emergency Department of a tertiary teaching hospital in Somalia and included 100 consecutively enrolled adult patients diagnosed with cellulitis between August 1, 2021, and July 30, 2022. The study aimed to evaluate risk factors, clinical characteristics, and outcomes of patients presenting with cellulitis in the Somali setting.\u003c/p\u003e \u003cp\u003eCellulitis of both upper and lower extremities was defined clinically by the presence of localized pain, erythema, warmth, and swelling, affecting either one or both limbs. Patients presenting with cellulitis involving the toe, foot, finger, hand, arm, buttock, or head and neck were included. However, cases complicated by abscess, myositis, or necrotizing fasciitis were excluded to ensure the accuracy of uncomplicated cellulitis profiling.\u003c/p\u003e \u003cp\u003eData were collected on demographic and baseline characteristics, including age, sex, race, insurance status, body mass index (BMI), and BMI classification. Comorbid conditions such as diabetes mellitus, hypertension, and obesity were recorded. Vital signs at admission\u0026mdash;temperature, heart rate, and systolic blood pressure\u0026mdash;were measured, along with laboratory indicators of infection, including white blood cell count, neutrophil percentage, and serum creatinine.\u003c/p\u003e \u003cp\u003eAll data were analyzed using SPSS software (version 23.0, IBM Corp., Chicago, IL, USA). Descriptive statistics were used to summarize demographic and clinical variables. Univariate analysis was first performed to identify factors associated with disease severity and hospitalization; variables with statistical significance were subsequently included in a multivariate regression model to determine independent predictors of outcomes.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for this study was obtained from the Ethics Committee of Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital (Approval number: MSTH6743, dated July 18, 2021). Informed consent was obtained from all participants or their legal guardians prior to study enrollment.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 100 patients meeting the study\u0026rsquo;s eligibility criteria were included. The majority were male (74%, n\u0026thinsp;=\u0026thinsp;74), while females accounted for 26% (n\u0026thinsp;=\u0026thinsp;26). The mean age of the cohort was 56.71\u0026thinsp;\u0026plusmn;\u0026thinsp;19.94 years. The largest age group consisted of patients aged\u0026thinsp;\u0026ge;\u0026thinsp;70 years (27%, n\u0026thinsp;=\u0026thinsp;27), followed by those aged 60\u0026ndash;69 years (25%, n\u0026thinsp;=\u0026thinsp;25) and 50\u0026ndash;59 years (18%, n\u0026thinsp;=\u0026thinsp;18). Patients aged 40\u0026ndash;49 years, 30\u0026ndash;39 years, and \u0026le;\u0026thinsp;30 years represented 9% (n\u0026thinsp;=\u0026thinsp;9), 7% (n\u0026thinsp;=\u0026thinsp;7), and 14% (n\u0026thinsp;=\u0026thinsp;14), respectively.\u003c/p\u003e \u003cp\u003eRegarding comorbidities, diabetes mellitus was the most frequently reported (51%, n\u0026thinsp;=\u0026thinsp;51). Thirty-seven patients (37%) reported no chronic medical conditions. Other comorbidities included hypertension (14%, n\u0026thinsp;=\u0026thinsp;14), ischemic heart disease (3.8%, n\u0026thinsp;=\u0026thinsp;3), cirrhosis (1.3%, n\u0026thinsp;=\u0026thinsp;1), stroke (5%, n\u0026thinsp;=\u0026thinsp;5), and heart failure (4%, n\u0026thinsp;=\u0026thinsp;4) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic Demographic and Clinical Characteristics of Patients with Cellulitis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" 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colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.5\u0026mdash;29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCo-morbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRenal failure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeart failure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStroke\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCirrhosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIschemic HD\u003c/b\u003e**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCorticosteroid use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Body Mass Index **Heart disease\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMultiple risk factors for cellulitis were identified. Mechanical trauma (20%, n\u0026thinsp;=\u0026thinsp;20) and a previous history of cellulitis (20%, n\u0026thinsp;=\u0026thinsp;20) were the most common. Additional risk factors included immunocompromised status (19%, n\u0026thinsp;=\u0026thinsp;19), obesity (16%, n\u0026thinsp;=\u0026thinsp;16), chronic extremity swelling (11%, n\u0026thinsp;=\u0026thinsp;11), steroid use (8%, n\u0026thinsp;=\u0026thinsp;8), recent surgery or procedures within three months (6%, n\u0026thinsp;=\u0026thinsp;6), skin conditions such as eczema or tinea pedis (5%, n\u0026thinsp;=\u0026thinsp;5), varicose veins (3%, n\u0026thinsp;=\u0026thinsp;3), and insect/animal bites (2%, n\u0026thinsp;=\u0026thinsp;2). Sixteen percent (n\u0026thinsp;=\u0026thinsp;16) of the patients had no identifiable risk factor (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Cellulitis Cases by Anatomical Site and Associated Factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower extremity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper extremity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHead/face\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThoracic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGenitalia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP-Value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18.5\u0026mdash;29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emechanical trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehistory cellulitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecirculation problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunocompromised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSteroid use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.07\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eskin conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echronic swelling of extremities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery/procedure in last 3 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evaricose vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.09\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eheart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erenal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.06\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIschemic heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe lower extremities were overwhelmingly the most affected anatomical site, accounting for 90% of cases (n\u0026thinsp;=\u0026thinsp;90). Less commonly affected sites included the upper extremity (2%, n\u0026thinsp;=\u0026thinsp;2), head and face (2%, n\u0026thinsp;=\u0026thinsp;2), thoracic region (1%, n\u0026thinsp;=\u0026thinsp;1), and genital area (1%, n\u0026thinsp;=\u0026thinsp;1) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eVital sign measurements on presentation showed a mean systolic blood pressure of 112.9\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7 mmHg, diastolic pressure 68.68\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2 mmHg, pulse rate 75.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.11 beats/min, temperature 38.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u0026deg;C, oxygen saturation 97.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8%, and random blood glucose 158.8\u0026thinsp;\u0026plusmn;\u0026thinsp;105 mg/dL.\u003c/p\u003e \u003cp\u003eClinically, all patients presented with swelling (100%, n\u0026thinsp;=\u0026thinsp;100) and the majority had fever (95%, n\u0026thinsp;=\u0026thinsp;95). Blisters were observed in 42% (n\u0026thinsp;=\u0026thinsp;42), while ruptured blisters were documented in 10% (n\u0026thinsp;=\u0026thinsp;10) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eLaboratory findings revealed mean white blood cell count of 15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5 \u0026times; 10⁹/L, hemoglobin 11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 g/dL, platelet count 330.4\u0026thinsp;\u0026plusmn;\u0026thinsp;170.5 \u0026times; 10⁹/L, AST 46.42\u0026thinsp;\u0026plusmn;\u0026thinsp;94.5 U/L, ALT 31.8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.4 U/L, serum creatinine 1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 mg/dL, urea 45.9 mg/dL, albumin 3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 g/dL, and CRP 144\u0026thinsp;\u0026plusmn;\u0026thinsp;118 mg/L.\u003c/p\u003e \u003cp\u003eWith regard to management, 47% (n\u0026thinsp;=\u0026thinsp;47) of patients required hospitalization and were treated with intravenous antibiotics, while 45% (n\u0026thinsp;=\u0026thinsp;45) were managed on an outpatient basis with oral antibiotics. Eight patients (8%) required intensive care unit (ICU) admission. Additionally, 11 patients (11%) underwent incision and drainage combined with IV antibiotic therapy.\u003c/p\u003e \u003cp\u003eOutcomes were favorable for most participants, with 96 patients (96%) making a full recovery. Four patients (4%) died during the course of treatment (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Characteristics, Laboratory Findings, Treatment Disposition, and Outcomes by Affected Body Region\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower extremity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUpper extremity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHead/face\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThoracic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGenitalia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP-Value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical S\u0026amp;S\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlisters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.370\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.970\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwelling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRuptured blisters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.950\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRed skin area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory tests\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (\u0026times;103/mm3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophil count (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.7\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.5\u0026thinsp;\u0026plusmn;\u0026thinsp;360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.8\u0026thinsp;\u0026plusmn;\u0026thinsp;73.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.4\u0026thinsp;\u0026plusmn;\u0026thinsp;63.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.9\u0026thinsp;\u0026plusmn;\u0026thinsp;33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.0\u0026thinsp;\u0026plusmn;\u0026thinsp;78.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHB (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.13\u0026thinsp;\u0026plusmn;\u0026thinsp;101.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e580.3\u0026thinsp;\u0026plusmn;\u0026thinsp;230.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e280.3\u0026thinsp;\u0026plusmn;\u0026thinsp;130.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e390.3\u0026thinsp;\u0026plusmn;\u0026thinsp;112.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e389.3\u0026thinsp;\u0026plusmn;\u0026thinsp;120.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e288\u0026thinsp;\u0026plusmn;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.943\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.789\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.966\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisposition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.09\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutpatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-ICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment option\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.594\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral antibiotics therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV antibiotics therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrainage and IV antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCellulitis remains a significant public health challenge in low-resource settings such as Somalia, where late presentation, limited access to primary care, and a high burden of chronic diseases contribute to increased morbidity and healthcare utilization (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The condition disproportionately affects older adults, particularly those who are bedridden or have functional limitations, leading to recurrent hospitalizations and substantial socioeconomic consequences, including prolonged admissions and increased financial strain on both families and the healthcare system (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsistent with regional infectious disease patterns, our study demonstrated a clear male predominance, aligning with findings from cohort studies conducted in Southeast Asia (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This trend may be explained by increased occupational exposure, higher rates of trauma, and greater mobility among males in Somalia\u0026rsquo;s predominantly manual-labor workforce.\u003c/p\u003e \u003cp\u003eA wide range of predisposing factors has been linked to cellulitis, including the presence of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e or β-hemolytic streptococci in toe webs, chronic foot ulcers, prior cellulitis episodes (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), smoking, venous insufficiency, liver disease, homelessness (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), recent trauma, surgical procedures, elevated body mass index, and diabetes mellitus (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Immunosuppression, chronic swelling of extremities, steroid use, and chronic organ dysfunction (liver, renal, and cardiac diseases) are also recognized contributors. In the Somali population, mechanical trauma, previous cellulitis, and immunosuppression emerged as the most prominent risk factors\u0026mdash;likely reflecting occupational injuries, limited wound-care practices, and delayed access to appropriate medical treatment.\u003c/p\u003e \u003cp\u003eClinically, cellulitis typically presents with erythema, warmth, swelling, and tenderness. However, these features overlap with numerous dermatologic conditions, making misdiagnosis common\u0026mdash;particularly in emergency settings with limited dermatology support (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The concept of \"pseudo-cellulitides\" is therefore crucial. Conditions such as contact dermatitis, hypersensitivity reactions, fixed drug eruptions, venous stasis dermatitis, and deep-vein thrombosis frequently mimic cellulitis and can result in unnecessary antibiotic use and hospitalization (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough fever and leukocytosis are not universal findings, retrospective data indicate that up to 42% of cases may present with systemic inflammatory markers (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In our cohort, lower limb involvement was overwhelmingly predominant, consistent with global data showing that approximately 75\u0026ndash;90% of cellulitis cases affect the lower extremities (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This pattern may reflect a combination of repeated mechanical trauma, bare-foot walking in rural communities, obesity, chronic edema, and recurrent infections\u0026mdash;all of which are common in Somalia.\u003c/p\u003e \u003cp\u003eThe high prevalence of cellulitis among individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years mirrors trends observed across sub-Saharan Africa (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This may be attributed to age-related comorbidities such as diabetes mellitus, hypertension, and peripheral vascular disease, which compromise skin integrity and immune function. Given Somalia\u0026rsquo;s rising diabetes burden and limited chronic disease management infrastructure, the risk of recurrent cellulitis remains disproportionately high.\u003c/p\u003e \u003cp\u003eFor uncomplicated cellulitis without systemic manifestations, laboratory testing is generally unnecessary unless comorbidities such as diabetes or immunosuppression are present (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Historically, cellulitis carried a mortality rate of 11% in the pre-antibiotic era (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Although mortality has dramatically decreased, our findings highlight the continued need for timely diagnosis and adequate antimicrobial therapy. In settings where MRSA prevalence is low, oral agents such as dicloxacillin or cephalexin remain appropriate first-line therapies for outpatient management (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), whereas severe infections or systemic involvement warrant intravenous therapy.\u003c/p\u003e \u003cp\u003eGiven the high recurrence rate, economic burden, and substantial risk of complications, early dermatology consultation\u0026mdash;when available\u0026mdash;is essential to improve diagnostic accuracy and reduce unnecessary admissions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Strengthening community education, early wound-care practices, and chronic disease management programs could significantly reduce cellulitis incidence and improve outcomes in Somalia\u0026rsquo;s resource-constrained healthcare environment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis prospective study provides important insight into the clinical profile, risk factors, and outcomes of cellulitis among patients presenting to a major emergency department in Somalia. Although limited by its single-center design and modest sample size, the findings highlight the substantial burden of cellulitis\u0026mdash;particularly among older adults and individuals with diabetes, mechanical trauma, and immunosuppression. The predominance of lower-limb involvement and the high rate of hospital admissions underscore the ongoing need for timely recognition, early intervention, and improved preventive strategies in our setting. Given the rising prevalence of chronic comorbidities in Somalia, larger multicenter studies are recommended to guide context-appropriate diagnostic pathways, optimize antimicrobial stewardship, and reduce recurrence and healthcare costs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eED\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency Department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eICU\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eWBC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWhite Blood Cell\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCRP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eC-reactive protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eALT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlanine aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAST\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAspartate aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSBP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSystolic Blood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDBP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiastolic Blood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSpO₂\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeripheral Oxygen Saturation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntravenous\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePOCUS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePoint-of-care Ultrasound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIRB\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to Participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethical Committee of Mogadishu Somali Turkey Recap Tyap Erdogan Training and Research Hospital (Approval ID: MSTH6743; Date: 18 July 2021). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to data collection. All collected data were kept confidential and used exclusively for research purposes.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of Data and Materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are stored within the Mogadishu Somali Turkey Recap Tyap Erdogan Training and Research Hospital information system. Data access is restricted but may be granted to qualified investigators upon reasonable request and with approval from the institutional Education and Research Committee.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo external funding was received for this study.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; Contributions\u003c/p\u003e\n\u003cp\u003eSalad Mohamud Mohamed Hassan and Idil Hirsi Ali contributed to data collection. Nasteho Mohamed Sheikh Omar and Sahra Ali Yusuf performed the data analysis. Abdullahi Ahmed Ahmed (corresponding author) led the manuscript drafting, editing, supervision, and data interpretation. All authors reviewed and approved the final manuscript, agreed on the target journal, and accepted responsibility for all aspects of the work.\u003c/p\u003e\n\u003cp\u003eClinical Trial Registration\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNot applicable.\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e \u003cli\u003e\u003cspan\u003eCh'ng CC, Johar A. Clinical characteristics of patients with lower limb cellulitis and antibiotic usage in Hospital Kuala Lumpur: a 7-year retrospective study. Int J Dermatol. 2016;55(1):30\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhoenix G, Das S, Joshi M. Diagnosis and management of cellulitis. BMJ. 2012;345.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMadi S, Hillrichs B, Glei\u0026szlig;ner J. Aggressive Necrotizing Fasciitis in a 12-Year-Old Girl of Unknown Etiology: Diagnosis, Therapy, and Prognosis. Int J Foot Ankle. 2022;6:072.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRrapi R, Chand S, Kroshinsky D. Cellulitis: a review of pathogenesis, diagnosis, and management. Med Clin. 2021;105(4):723\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLong B, Gottlieb M. Diagnosis and management of cellulitis and abscess in the emergency department setting: an evidence-based review. J Emerg Med. 2022;62(1):16\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrazzula L, Cotliar J, Fox LP, Hughey L, Shinkai K, Gee SN, Kroshinsky D. Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: a multi-institutional analysis. J Am Acad Dermatol. 2015;73(1):70\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrindle RJ, O\u0026rsquo;Neill LA, Williams OM. Risk, prevention, diagnosis, and management of cellulitis and erysipelas. Curr Dermatology Rep. 2020;9:73\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVinken AG, Li JZ, Balan DA, Rittenhouse BE, Willke RJ, Goodman C. Comparison of linezolid with oxacillin or vancomycin in the empiric treatment of cellulitis in US hospitals. Am J Ther. 2003;10(4):264\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCh'ng CC, Johar A. Clinical characteristics of patients with lower limb cellulitis and antibiotic usage in Hospital Kuala Lumpur: a 7-year retrospective study. Int J Dermatol. 2016;55(1):30\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBj\u0026ouml;rnsd\u0026oacute;ttir S, Gottfredsson M, Th\u0026oacute;risd\u0026oacute;ttir AS, Gunnarsson GB, R\u0026iacute;kardsd\u0026oacute;ttir H, Kristj\u0026aacute;nsson M, Hilmarsd\u0026oacute;ttir I. Risk factors for acute cellulitis of the lower limb: a prospective case-control study. Clin Infect Dis. 2005;41(10):1416\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark SI, Yang EJ, Kim DK, Jeong HJ, Kim GC, Sim YJ. Prevalence and epidemiological factors involved in cellulitis in Korean patients with lymphedema. Annals rehabilitation Med. 2016;40(2):326\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNassaji M, Ghorbani R, Ghashghaee S. Risk factors of acute cellulitis in adult patients: A case-control study. Eastern J Med. 2016;21(1):26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBailey E, Kroshinsky D. Cellulitis: diagnosis and management. Dermatol Ther. 2011;24(2):229\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGunderson CG. Cellulitis: definition, etiology, and clinical features. Am J Med. 2011;124(12):1113\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBailey E, Kroshinsky D. Cellulitis: diagnosis and management. Dermatol Ther. 2011;24(2):229\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodriguez JR, Hsieh F, Huang CT, Tsai TJ, Chen C, Cheng MH. Clinical features, microbiological epidemiology and recommendations for management of cellulitis in extremity lymphedema. J Surg Oncol. 2020;121(1):25\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTianyi FL, Mbanga CM, Danwang C, Agbor VN. Risk factors and complications of lower limb cellulitis in Africa: a systematic review. BMJ open. 2018;8(7):e021175.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorris AD. Cellulitis and erysipelas. BMJ clinical evidence. 2008;2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaff AB, Kroshinsky D. Cellulitis: a review. JAMA. 2016;316(3):325\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowden BP, Grayson ML. 5: Hospital-in-the-home treatment of infectious diseases. The Medical Journal of Australia. 2002;176(7):440-5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi DG, Di Xia F, Khosravi H, Dewan AK, Pallin DJ, Baugh CW, Laskowski K, Joyce C, Mostaghimi A. Outcomes of early dermatology consultation for inpatients diagnosed with cellulitis. JAMA dermatology. 2018;154(5):537\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cellulitis, Fever, Blisters, Ruptured blisters","lastPublishedDoi":"10.21203/rs.3.rs-8487605/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8487605/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCellulitis is a common medical emergency associated with substantial morbidity and significant financial implications for healthcare systems worldwide.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThis prospective cross-sectional study included 100 adult patients diagnosed with cellulitis who presented to the emergency department of a tertiary teaching hospital in Somalia between August 1, 2021, and July 30, 2022. Clinical characteristics, risk factors, and outcomes were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 100 patients, 74% were male and 26% were female, with a mean age of 56.71\u0026thinsp;\u0026plusmn;\u0026thinsp;19.94 years. The largest age group was patients\u0026thinsp;\u0026ge;\u0026thinsp;70 years (27%). Diabetes was the most frequently reported comorbidity (51%). The most common risk factors were mechanical trauma (20%) and a previous history of cellulitis (20%). The lower extremity was the predominant site of infection (90%). Regarding management, 47% of patients were hospitalized and received intravenous antibiotics, 45% were treated as outpatients, and 8% required intensive care unit (ICU) admission. Additionally, 11% underwent drainage in combination with IV antibiotics. Overall, 96% of patients achieved successful recovery.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCellulitis is a major cause of emergency department visits and hospitalization, particularly among elderly patients. It remains a common medical emergency associated with high morbidity and significant healthcare costs.\u003c/p\u003e","manuscriptTitle":"Adult Cellulitis in Somalia: Prospective Assessment of Clinical Presentation, Predisposing Factors, and Outcomes at a Tertiary Teaching Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 08:26:18","doi":"10.21203/rs.3.rs-8487605/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-16T11:05:52+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"247909511159257622421913792818743264278","date":"2026-01-15T12:56:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-14T04:55:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-13T19:56:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195596080378290857258748863912843318858","date":"2026-01-13T19:51:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133788569170931067984520297049031573754","date":"2026-01-13T14:06:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282396088560273409800656749422200863762","date":"2026-01-13T13:37:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-13T12:24:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94038887919692400228942105704451523975","date":"2026-01-13T12:07:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-13T10:59:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-13T10:57:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-13T10:39:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-07T11:11:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Medicine","date":"2026-01-07T10:58:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1258b22-c0ba-484a-b556-e27e7bf296ba","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T18:38:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 08:26:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8487605","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8487605","identity":"rs-8487605","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}