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A three and one-half year-old female who presented with orbital cellulitis and leukocoria is described. Enucleation was performed as the eye was microophthalmic, blind, and painful. Histopathologic study revealed uveitis with total retinal detachment. The etiology of the retinal detachment was indeterminable. The differential diagnosis of orbital cellulitis in children is reviewed.
A 21-year-old patient had six admissions to hospital for recurrent cellulitis over a 6-month period. She underwent extensive investigations, which failed to reveal any underlying predisposing factors. On the final admission she admitted to injecting herself subcutaneously with milk to induce the lesion. Self-inoculation with foreign material must be considered in patients presenting with recurrent cellulitis.
Streptococcus pneumoniae as a cause of cellulitis is rarely reported in children and adults. We report on an infant with facial cellulitis due to pneumococci and review already described cases since 1975. The main features of this infection, underlying diseases and problems of diagnostics and therapy are discussed.
Cellulitis due to Haemophilus influenzae type B in adults has only recently been reported. We report a case in which the patient's antibody levels documented an immunologic response to the organism. The efficacy of a new cephalosporin antibiotic, cefoxitin sodium, in treating this infection also was established. Cefoxitin has activity against ampicillin-resistant H influenzae and would be an alternative in treating H influenzae cellulitis.
A fatal case of crepitant cellulitis with myonecrosis, the first caused by Klebsiella pneumoniae, is reported. The infection started in the left thigh but progressed rapidly despite appropriate antibiotics and surgery, which included incision and drainage and later a left-hip disarticulation. This case emphasizes that nonclostridial crepitant cellulitis is potentially severe and that the presence of myonecrosis is an indication for early radical surgery.
A case of myiasis due to the northern cattle grub (Hypoderma bovis) in a 2 1/2-year-old girl presenting as cellulitis of the cheek and periorbital cellulitis is detailed in this report. A literature review of similar cases reported over the past five years is included.
The clinical histories of 180 cases of cellulitis or phlegmona diffusa were studied at the Hospital de Pediatría del Centro Medico Nacional. The disease prevailed in infants and preschool children. Staphylococcus aureus was the etiological agent most frequently found, but with the presence of enterobacteriaceae in 39% of patients under 2 years of age. One third of the children with cellulitis showed one or several complications. Lethality reached 5% (9 cases), but always related to septicemia from S. aureus. In 14.4%, osteoarthritis was present; frequently there was: fever for over 5 days in spite of adequate treatment, a history of late initiation of the antimicrobial drug (over 1 week) and phlogosis or functional limitation. The radiological picture that shows the bony lesion was evident only after two weeks. One half these cases remained with sequelae. Considerations are made on the adequate plans for antibiotic treatment and the early diagnosis of the osteoarticular complication.
While the term cellulitis is incorrect, it is commonly used and deserves a nosological classification. "Cellulitis is a dermohypodermosis and an oedemato-sclerous panniculopathy- It is indeed a true histangiography in which the fibroblastic reaction predominates over capillaro-veinular changes. Adipocytes of exaggerated size interpenetrate into micro- and later into macronodules marked off by more or less structured conjunctive fibrilla, thereby making treatment difficult.
The authors report 6 cases of acute osteomyelitis of the leg, presenting with a very severe subcutaneous cellulitis and progressing to sub-periosteal abscess, then pandiaphysitis with major bone destruction at the 15th day, despite antibiotics. However, all these children recovered without sequelae, apart from one case. Early diagnosis was difficult and treatment started after an excessive delay in the majority of cases. If it can be performed on an emergency basis, Technetium bone scan is useful in making the diagnosis. In the absence of the type of examination, any case of severe subcutaneous cellulitis in a child must be considered as a potential osteomyelitis and treated as such.
Many reports have documented serious pelvic infection associated with an IUD. A case of ligneous pelvic cellulitis with cutaneous sinus tract formation, hydronephrosis, and ureteral obstruction in a patient with an IUD is presented. This is an uncommon manifestation of chronic pelvic infection and responded to antibiotics and steroid administration. The origin and treatment of ligneous cellulitis are discussed.
A review of 104 patients with acute orbital cellulitis during the past decade showed that the frequency of hospital admissions for this disease has increased recently. Roentgenograms showed paranasal sinus in 77 of 91 patients. Haemophilus influenzae and Diplococcus pneumoniae were recovered from the blood of 20 and 6 patients, respectively. Four children had concomitant H influenzae meningitis. Bacteremia was demonstrated in 29% and more common in those with extensive orbital involvement, those not receiving antibiotics at the time of culture, and those less than 2 years old. Some of the 26 patients with less extensive involvement were bacteremic (17%), had leukocytosis, or roentgenographic evidence of sinusitis. Most children received large doses of ampicillin sodium and methicillin sodium intravenously until signs and symptoms had almost abated. With this regimen, there were no orbital, ocular, or other complications.
Orbital cellulitis due to Neisseria gonorrhoeae developed in an adolescent girl in a previously enucleated socket. Since this organism also was isolated from her pharynx, the orbital infection probably resulted from contamination of the prosthesis by gonococci from her mouth, either directly or by transfer from her fingers.
Cellitis that is caused by Haemophilus influenzae demonstrates a unique predilection for the faces of young children. Although previously considered a rare entity, it is currently being recognized more frequently. Despite the importance of early recognition and treatment in preventing potentially fatal complications, it has been noticeably neglected in the otolaryngologic literature. We report a case and discuss the diagnosis and management of H influenzae cellulitis.
A 53-year-old woman had a spontaneous nontraumatic rupture of the globe secondary to severely increased orbital pressure from an orbital cellulitis. To our knowledge this is the first such case reported.
A wide spectrum of microbes has been demonstrated as etiologic factors in the severest form of acute pulpal-alveolar infection; acute cellulitis. An appreciation of the pathogenic potential or oral microorganisms has been gained. Streptococci have been substantiated as the major group of microbes associated with acute odontogenic infection. Anaerobes, primarily gram-negative, are also significant factors. A culture technique for specific microbial growth has been demonstrated and discussed. A simple and economical procedure has been suggested for transport of culture and office study.
Two patients originally diagnosed as having cellulitis involving the dorsum of the foot actually had bacterial arthritis of an underlying joint. In both patients, even after pyarthrosis was suspected, the wrong joint was aspirated. The arthropathies were located by subsequent 99mTc-phosphate bone imaging at a time when roentgenograms were normal. Early diagnosis and aggressive therapy of septic arthritis are essential to prevent joint destruction and osteomyelitis. Radionuclide bone imaging can identify inflammatory joint disease but it cannot specify etiology. In our patients, however, the differential diagnosis was between skin and joint infection. Radionuclide imaging was of great help in making this distinction.
An unusual case of orbital cellulitis following blepharoplasty, with resultant blindness in that eye, is presented. The cause is unknown, but the pathogenesis and treatment of this rare complication are discussed. Unilateral severe headache may alert one to the possibility of this rare, but grave, complication.
Eikenella corrodens was isolated from an orally contaminated hand wound which resulted in cellulitis, osteomyelitis, and arthritis. E corrodens is a gram-negative, microaerophilic bacillus which only lately has received attention as a possible pathogen. The organism grows characteristically as small, corroding, or pitting colonies on blood agar. It typically requires hemin or blood for reliable aerobic growth. Oral contamination of wounds predisposes to infection with E. corrodens. The management of these infections includes treatment with an effective antibiotic and surgical debridement. Because it is gram-negative, microaerophilic, and often difficult to isolate, infections caused by E corrodens may mimic those caused by gram-negative obligate anaerobes. However, E corrodens is resistant to clindamycin and lincomycin and sensitive to most other commonly used antimicrobial agents.