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A case of panfacial cellulitis with contralateral orbital cellulitis and blindness after extraction of a tooth has been reported. Contralateral orbital involvement, with sparing of the ipsilateral eye, constituted the unusual feature. This was considered to be a result of hematogenous spread rather than of direct extension.
Computed tomography (CT) was used in the management of four patients with periorbital inflammation. These patients were selected for CT scanning because of the difficulty, on clinical examination alone, in determining the degree of orbital disease. The CT scans confirmed the presence and defined the location of an orbital abscess in three patients and eliminated the presence of an abscess in the fourth. On the basis of this experience, CT scanning is recommended in the evaluation of children with periorbital inflammation in whom proptosis, ophthalmoplegia, or loss of visual acuity develops, or in whom severe eyelid edema prevents adequate eye examination.
Described herein are three patients over the age of 50 years who had cellulitis of the neck and the upper portion of the chest, associated with Hemophilus influenzae type B bacteremia and respiratory tract infection--particularly that of the upper airway. Only one of the patients with cellulitis had the classic bluish-purple hue commonly seen in children affected with this syndrome. In the other two, the H. influenzae type B cellulitis could not be distinguished clinically from the more common group A streptococcal or staphylococcal cellulitis. Since the antibiotics employed in treating patients with infection due to the latter two organisms differ significantly from those used to treat patients with H. influenzae type B infection, the possibility of disease due to H. influenzae type B must be considered in any adult or child in whom cellulitis of the neck, chest and possibly face is associated with a respiratory tract infection, especially of the upper airway.
The available hospital records of all pediatric patients diagnosed as having periorbital, preseptal or orbital cellulitis over a five-year period were reviewed and compared to previously reported series. Only two of 39 patients had orbital cellulitis. The 37 patients with preseptal cellulitis had two characteristic clinical presentations. Twenty-two children had local trauma, abscesses, insect bites, or impetigo as the inciting event for their cellulitis. Infection was usually caused by staphylococci or streptococci. In contrast, 15 children, 12 of whom were under 36 months, had associated upper respiratory tract infections and otitis. Haemophilus influenzae was the most commonly implicated pathogen and the children were at risk of bacteremia and metastastic infection. Determination of the location of the infection in the orbit and consideration of the clinical presentation of the patient with infection in and about the orbit are of assistance in choosing appropriate therapy. Young children who have upper respiratory tract symptoms in association with preseptal cellulitis should receive antibiotic coverage for Haemophilus.
The clinical and laboratory data on 87 cases of orbital and periorbital cellulitis were reviewed. Two distinct clinical presentations were encountered. One group of 45 patients had no history of trauma or apparent focus of infection. Blood cultures on these patients were positive in 34%. Haemophilus influenzae accounted for 82% of the positive blood cultures. This group of patients shares common features with children who have facial cellulitis due to H. influenzae type b. The second group consisted of 42 patients with adjacent soft tissue focus of infection. There was only one positive blood culture in this group. Staphylococcus aureus and/or group A beta-hemolytic Streptococcus were isolated from conjunctival or wound exudate in the majority of these patients. Thirteen patients with orbital cellulitis were encountered among the 87 cases. These patients were older and had a higher incidence of demonstrable sinus disease when compared with the overall group. The pathophysiology of orbital and periorbital cellulitis is reviewed and an approach to the management of these disorders is formulated.
Three children, 8 months to 2 years of age, demonstrated unusual manifestations in association with Haemophilus influenzae septicemia and meningitis. After one child had been diagnosed as having orbital cellulitis in conjunction with H influenzae meningitis, a second child, with orbital cellulitis and no clinical evidence of meningitis, had a lumbar tap indicative of a meningitis. A third child developed a hypopyon in association with H influenzae meningitis and septic arthritis of several joints. We report the problem of diagnosis and treatment of orbital cellulitis in the context of our cases and those previously reported.
Sixty-seven cases of orbital cellulitis from BGSM are reported and 247 cases from the literature reviewed. Staphylococcus aureus was the predominant pathogen except in the age group from three months to three years where a significant number of cases yielded Hemophilus influenzae and Diplococcus pneumoniae. The frequent association of paranasal sinus involvement and orbital cellulitis has been confirmed. Orbital cellulitis is a multifaceted disease which, for proper management, requires close cooperation among pediatricians, ophthalmologists, and nursing service as a multidisciplinary approach for optimal therapy and decreased frequency of complications and sequelae.
Two patients with periobital cellulitis, one of whom also had buccal cellulitis, had violaceous discoloration of the skin. Blood cultures from both patients yielded Streptococcus pneumoniae. Therefore, pneumococci should be considered, in addition to Haemophilus influenzae, as possible causes of cellulitis with violaceous or bluish-red discoloration.
Patients with palpebral cellulitis may turn in the first place to a skin clinic. The clinical picture and the course of disease are illustrated here by four case histories. The importance of differentiating between collateral orbital edema, palpebral cellulitis and orbital cellulitis is stressed.
Progressive gangrenous cellulitis due to Rhizopus arrhizus following colostomy destroyed the entire abdominal wall of a young woman and caused her death. A similar infection in an 11-year-old kidney transplant recipient was diagnosed more promptly and treated successfully with extensive debridement and amphotericin B. Nine similar cases found in the literature were reviewed. All 11 patients appeared to have had prior tissue injury at the original site of infection, and seven had diabetes mellitus. The disease was initially misdiagnosed in most of the patients, progressed rapidly in eight, and was fatal in four. Phycomycotic gangrenous cellulitis should be included in the differential diagnosis of progressive necrotizing lesions of the skin, especially in diabetic patients, but it can be identified promptly only by histologic examination of the infected tissue. Urgent radical excision and amphotericin therapy are recommended.
A 3-month-old infant being treated for bronchitis developed a rapid onset but otherwise typical orbital cellulitis. Because gram-negative infections and septicemia are common occurrences in the newborn nursery, this patient was given systemic gentamicin and ampicillin. Sinus x-rays were not attempted. Two days after treatment the eyelids were opened. A strikingly large corneal ulcer with perforated globe and endophthalmitis was found. Pseudomonas aeroginosa was cultured from the blood, conjunctiva, and throat. A diagnosis of Pseudomonas orbital cellulitis with secondary corneal perforation and endophthalmitis was made. The source of infection was believed to be the respiratory tract.
Gingivitis occurring with a cystic lesions in young patients with facial cellulitis is highly suggestive of a pneumococcal etiology. Two cases of pneumococcal cellulitis and gingivitis with bacteremia are reported, and the pertinent literature is reviewed.
Hemophilus influenzae f was responsible for cellulitis with bacteremia, pleuritis, and peritonitis in an adult patient with the nephrotic syndrome. The patient rapidly responded to ampicillin. H influenzae f has previously been rarely found to cause pleuritis and bacteremia, but has not been reported as a cause of cellulitis or primary peritonitis. Patients with the nephrotic syndrome are prone to serious infection with encapsulated bacteria. The relative frequency of infection with the various encapsulated bacteria most likely parallels that of colonization by these organisms.
A retrospective review of blood and wound cultures obtained from adult patients admitted for acute cellulitis revealed positive culture rates of 0.77% of 86% respectively. Organisms from wound cultures were predominantly Staphylococcus aureus and Streptococcus pyogenes. The majority of our patients were otherwise healthy. Our study suggests that blood cultures are not necessary in acute cellulitis in adults without serious underlying diseases.
Bacterial orbital cellulitis is a feared complication of paranasal sinus infection. Staphylococcus and Streptococcus species are the commoner pathogens involved in these cases. However, anaerobic bacteria and unusual Gram-negative organisms should be suspected as well. We treated a case of bacterial orbital cellulitis due to foci of infected paranasal sinuses caused by Eikenella corrodens, a Gram-negative rod. The patient was managed with intensive antibiotic coverage and surgical intervention.
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.
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.