Signs of a more severe infection such as necrotizing fasciitis or gas gangrene that would require prompt surgical intervention include purple bullae, skin sloughing, subcutaneous edema, and systemic toxicity. Misdiagnosis can occur in up to 30% of people with suspected lower-extremity cellulitis, leading to 50,000 to 130,000 unnecessary hospitalization and $195 to $515 million in avoidable healthcare spending annually in the United States. Evaluation by dermatologists for cases of suspected cellulitis has been shown to reduce misdiagnosis rates and improve patient outcomes.Associated musculoskeletal findings are sometimes reported. When it occurs with acne conglobata, hidradenitis suppurativa, and pilonidal cysts, the syndrome is referred to as the follicular occlusion triad or tetrad.Lyme disease can be misdiagnosed as cellulitis. The characteristic bullseye rash does not always appear in Lyme disease (the rash may not have a central or ring-like clearing, or not appear at all). Factors supportive of Lyme include recent outdoor activities where Lyme is common and rash at an unusual site for cellulitis, such as armpit, groin, or behind the knee. Lyme can also result in long-term neurologic complications. The standard treatment for cellulitis, cephalexin, is not useful in Lyme disease. When it is unclear which one is present, the IDSA recommends treatment with cefuroxime axetil or amoxicillin/clavulanic acid, as these are effective against both infections. Prevention
In those who have previously had cellulitis, the use of antibiotics may help prevent future episodes. This is recommended by CREST for those who have had more than two episodes.
Hesiod in Theogony narrates that the Muses brought to people forgetfulness, that is, the forgetfulness of pain and the cessation of obligations.For Alcman and Mimnermus, they were even more primordial, springing from the early deities Ouranos and Gaia. Gaia is Mother Earth, an early mother goddess who was worshipped at Delphi from prehistoric times, long before the site was rededicated to Apollo, possibly indicating a transfer to association with him after that time. Sometimes the Muses are referred to as water nymphs, associated with the springs of Helicon and with Pieris. It was said that the winged horse Pegasus touched his hooves to the ground on Helicon, causing four sacred springs to burst forth, from which the Muses, also known as pegasides, were born. Athena later tamed the horse and presented him to the Muses (compare the Roman inspiring nymphs of springs, the Camenae, the Völva of Norse Mythology and also the apsaras in the mythology of classical India). Classical writers set Apollo as their leader, Apollon Mousēgetēs (Apollo Muse-leader). In one myth, the Muses judged a contest between Apollo and Marsyas. They also gathered the pieces of the dead body of Orpheus, son of Calliope, and buried them in Leivithra. In a later myth, Thamyris challenged them to a singing contest. They won and punished Thamyris by blinding him and robbing him of his singing ability.