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PubMed1999

Clinical and microbiologic findings in cellulitis in Thai patients.

BACKGROUND: Cellulitis is an inflammation of subcutaneous tissue in which infective, generally bacterial cause is proven or assumed. However, attempts to culture bacteria from lesions are often unsuccessful. METHOD: One hundred and fifty cases diagnosed as cutaneous cellulitis at Siriraj Hospital between 1992 and 1995 were retrospectively studied. RESULTS: Our study in 150 adult Thai patients with cellulitis showed that the most common site of infection was the lower extremity. Forty two per cent of the patients had history of preceding local trauma. Fever and regional lymphadenopathy were detected in 77.3 per cent and 22.6 per cent respectively. Sixty nine per cent of patients had leukocytosis with a mean neutrophil ratio of 79.7 per cent of patients with underlying diseases predisposed to the infection, 61.6 per cent had positive lesional culture results in contrast to 31.6 per cent in patients without. Needle aspiration and blood gave low positive culture yields. The common organisms detected were S.aureus and Streptococcus group A (83%) in immunocompetent patients. Of immunocompromised patients, in one half of the cases gram negative bacteria were found. CONCLUSIONS: This study showed that in immunocompetent patients, the major bacterial isolated in cellulitis were S.aureus and Streptococcus group A. In immunocompromised patients, gram negative bacteria were found in one half. These findings may help in the selection of antimicrobials before the results of bacterial cultures are available or in culture negative cases.

Adolescent↗

PubMed2000

[Orbital cellulitis in childhood. Medical-surgical treatment].

Orbital cellulitis is an uncommon complication resulting from a spectrum of disorders commonly found in pediatric practice. It usually occurs as a complication of infection of the paranasal sinuses, although it also can be caused by eyelid or dental juries, dental infection and external ocular infection. We studied the clinical, microbiological, and therapeutic features of 152 children diagnosed as periorbital cellulitis and 27 children with orbital cellulitis admitted to our hospital in a 16-year period from January 1983 to December 1998. Twenty-four percent of patients (43 cases) had positive cultures. Thirty children with septal or preseptal cellulitis developed neurological or ophthalmological complications. Intravenous or oral antibiotic administration was effective in 150 patients, but a significant proportion required surgery of the paranasal sinus or orbit (16%).

Algorithms↗

PubMed2000

Refractory facial cellulitis following cosmetic rhinoplasty after cord-blood stem cell transplantation.

We report a case of a 38-year-old female patient who developed facial cellulitis after cord-blood stem cell transplantation (CBT). The cellulitis was refractory to treatment with antibiotics and antifungal agents. Because facial cellulitis is rare after transplantation, its mechanism could not be determined exactly. On day 40 after CBT, a nurse with expertise in cosmetic surgery attended our rounds and correctly assumed that the patient had received cosmetic rhinoplasty. Although conventional x-rays of the head were normal, a computed tomographic (CT) scan of the brain disclosed the presence of a foreign body over the nasal dorsum. As a result, the patient's symptoms were diagnosed as facial cellulitis associated with foreign material that had been implanted at the time of cosmetic surgery. At a pretransplantation interview, the patient did not mention her history of rhinoplasty. Even after she was shown the head CT scans that revealed the presence of nasal implants, she denied that she had received rhinoplasty before CBT. Unless we realize that patients may have received cosmetic surgery before transplantation, it is difficult to make a diagnosis of infection associated with foreign implants. To our knowledge this is the first report after transplantation of infection associated with cosmetic surgery. Such infections should be included on the list of complications after bone marrow transplantation.

Adult↗

PubMed2000

Erysipelas-like cellulitis with Pasteurella multocida bacteremia after a cat bite.

A 73-year-old female patient presented with Pasteurella multocida erysipelas-like cellulitis, bacteremia, and shock. The onset of the disease occurred 24 h after a cat bit her to the right lower leg. Initially, the picture of bacteremia and shock developed, with minimal local cellulitis. Pasteurella multocida grew in blood culture. A combination of amoxicillin and clavulanic acid was therapeutically successful in respect that the signs of bacteremia and shock disappeared. However, extensive erysipelas-like cellulitis developed on the bitten leg within the next 2 days. The disease was efficiently treated with penicillin G combined with netilmicin and administered for 10 days. This report documents the first case of Pasteurella multocida erysipelas-like cellulitis with bacteremia and shock.

Aged↗

PubMed2001

Case report. Cryptococcal cellulitis showing necrotizing vasculitis.

A 65-year-old woman with refractory anaemia who had been treated with systemic corticosteroids for several months developed cryptococcal cellulitis of the right cubital fossa. She was treated empirically for a presumed bacterial cellulitis with little response. Histological examination of debrided tissue revealed Cryptococcus as the causative organism. The tissue reaction involved suppurative inflammation with abscess formation in the dermis and subcutaneous adipose tissue. Necrotizing vasculitis, which has rarely been described in cryptococcosis, was seen in this case. Although the cellulitis was cured by local treatment in this patient, most previous reports recommended systemic antifungal therapy to treat cryptococcal cellulitis.

Aged↗

PubMed2003

Development of a clinical severity score for preseptal cellulitis in children.

PURPOSE: There is a need for a valid and reliable method to describe the severity of preseptal cellulitis. METHODS: Items of a scoring system were derived by an expert group and evaluated using a retrospective chart review. The results were used to construct the final Severity Index. Validity and reliability of the Severity Index was evaluated by prospective assessment of 17 children. The Severity Index was compared with a Global Score, a score based on clinical impression. RESULTS: The average Severity Index score was 2.0 for patients treated with oral antibiotics alone and 6.0 for patients treated with intravenous antibiotics. The Severity Index correlated well with the Global Score (Spearman rank correlation coefficient rS = 0.60, P = 0.01). Ranked clinical photographs of preseptal cellulitis correlated moderately to the Severity Index (rS = 0.66, P = 0.02). The Severity Index score after 24 hours of treatment was significantly lower than at presentation (P = 0.004). The agreement between paired Severity Index scores [intraclass correlation coefficient (ICC) = 0.80, P = 0.001] was better than the agreement between paired Global Scores (ICC = 0.45, P = 0.03). CONCLUSIONS: The Severity Index is an objective clinical tool for evaluating severity of preseptal cellulitis in children. It correlates well with clinical constructs for severity and is sensitive to small changes in clinical status. It has better reliability than overall clinical impression. The Severity Index will also be valuable as an outcome measure for future therapeutic trials for preseptal cellulitis in children.

Administration, Oral↗

PubMed2004

Toxic scarlet fever complicating cellulitis: early clinical diagnosis is crucial to prevent a fatal outcome.

We describe a case of toxic scarlet fever in a healthy adult with streptococcal cellulitis of the right elbow as a result of skin abrasion. The clinical picture mimicked that of drug eruption after treatment of cellulitis with antibiotics. Among the five cases of scarlet fever complicating cellulitis, including the present one, reported in the English literature, four had severe systemic complications and two died. As a result of re-emergence of invasive streptococcal infections, clinicians should be aware of the differential diagnosis of scarlet fever in patients presenting with cellulitis and skin rash. Early clinical diagnosis is crucial to exclude drug eruptions, prompt initiation of antibiotic treatment, and prevention of the potentially fatal outcome.

Adult↗

PubMed2004

Cryptococcal cellulitis in a patient on prednisone monotherapy for myasthenia gravis.

The development of cutaneous cryptococcosis is extremely rare in the human immunodeficiency virus-negative population. The cutaneous manifestations vary greatly, with the rarest presenting as cellulitis. We report a unique case of a 64-year-old woman who had been on prednisone monotherapy for the treatment of myasthenia gravis and subsequently developed cryptococcal cellulitis. This case provides an opportunity to discuss the importance of including cryptococcal cellulitis in the differential diagnosis of cellulitis in a patient on low-dose prednisone who is not responding to empiric antibiotic therapy. Early recognition is crucial as cutaneous manifestations are usually the first sign of disseminated cryptococcosis.

Administration, Cutaneous↗

PubMed2004

Facial cellulitis associated with Pseudomonas aeruginosa complicating ophthalmic herpes zoster.

Cellulitis is a rare and severe soft-tissue infection characterized by acute, diffuse, spreading inflammation, often associated with systemic symptoms such as malaise and fever. Surgery of the head and neck, dental infections, sinusitis, upper respiratory tract infections, and trauma are the most common portal of entry for pathogens in facial cellulitis. A very unusual case complicating an ophthalmic herpes zoster in a 74-year-old woman was observed at the department of dermatology, Cagliari University (Italy). Culture of skin swabs showed growth of numerous Gram-negative bacilli, further identified as Pseudomonas aeruginosa. Therapy with intravenous ciprofloxacin was promptly instituted on the basis of the culture and sensitivity report. She was initially treated with daily drainage and twice-daily topical fusidic acid. The lesion completely resolved in 4 weeks, and no general complications or recurrence have been observed for 6 months. Early recognition and management of facial cellulitis is mandatory to avoid serious and generalized complications. Pseudomonas aeruginosa is rarely reported in facial cellulitis; there are apparently no reports of this infection occurring as a complication of ophthalmic herpes zoster. Herpetic damage of the anatomic barrier as well as impairment of defense mechanisms because of decompensated diabetes mellitus may have facilitated the colonization and proliferation of this opportunistic pathogen in our patient.

Aged↗

PubMed2005

The utility of blood cultures in the management of non-facial cellulitis appears to be low.

AIM: To assess the utility of blood cultures in the management of patients presenting to the Emergency Department at Christchurch Hospital from the community with non-facial cellulitis (or soft tissue infection) and no other morbidity. METHODS: A multidisciplinary team formulated the search protocol. A systematic review methodology was used. Seven electronic databases were searched for clinical studies of blood culture utility in patients with non-facial cellulitis. Relevant studies were appraised using predetermined validity assessment criteria. Conclusions were presented based on an assessment of the validity and applicability of the evidence. RESULTS: Seventeen studies were identified as addressing the topic at least as part of a secondary objective for the study. All were retrospective reviews or case series and were often associated with significant methodological limitations. CONCLUSIONS: Blood cultures are rarely positive in patients presenting from the community with non-facial cellulitis. When they are positive, initial empiric therapy is usually adequate to treat pathogenic bacteria. The available evidence does not support the routine use of blood cultures in the clinical management of healthy adults presenting with non-facial cellulitis at the Emergency Department.

Adult↗

PubMed1990

Clinical management of orbital cellulitis in children.

A prospective study was carried out by the Department of Ophthalmology and the Division of Infectious Disease at the Children's Hospital of Eastern Ontario to assess the outcome of our medical management of orbital cellulitis in children using a predetermined antibiotic regimen and to determine whether computed tomographic (CT) evidence of a subperiosteal abscess alone was an indication for surgical drainage. Between February 1985 and January 1988, 23 patients with true orbital cellulitis were admitted. CT scans were ordered routinely at the time of admission. The scans were cancelled for 13 children because they responded rapidly to medical management. CT showed edema nasal to the medial rectus, or thickening or displacement of the muscle in 8 of the 10 children who underwent the procedure. Three children required sinus and orbital drainage, but frank purulent material was found subperiosteally in only one. The results suggest that most children with orbital cellulitis can be managed with the prompt use of the appropriate intravenous antibiotics. Therapy with cloxacillin sodium and chloramphenicol or, in children under age 6 years, cefuroxime best covers the spectrum of organisms responsible for most cases of orbital cellulitis in children. CT should be used as an ancillary guide to the need for surgical exploration of the orbit in patients who do not rapidly respond to medical management.

Abscess↗

PubMed1989

Streptococcal cause of erysipelas and cellulitis in adults. A microbiologic study using a direct immunofluorescence technique.

We prospectively studied 42 adult patients with acute dermis and soft-tissue infections (27 with erysipelas and 15 with acute cellulitis) involving the lower limb in all except one case. Streptococcus organisms (groups A, C, D, and G) were researched in skin biopsy specimens by a direct immunofluorescent (DIF) technique using commercially available antibodies. Our results showed that DIF gives a sensitivity of 0.70 for the in situ detection of streptococci in cases of erysipelas and cellulitis. With the obvious contribution of this DIF technique, streptococcal pathogens could be detected in situ and grouped in 19 of 27 cases of erysipelas (group A, 13; group B, 1; group C, 1; and group G, 4) and in ten of 15 cases of cellulitis (group A, 9; group B, 1). Combined data, including conventional cultures, DIF studies, and serologic findings, established that Streptococcus organisms, especially Streptococcus pyogenes (A), were, in nearly all cases, responsible for both erysipelas (26/27 cases) and acute cellulitis (11/15 cases) involving the lower limb in adults.

Adult↗

PubMed1978

Periorbital and orbital cellulitis in children.

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.

Adolescent↗

PubMed1983

Anaerobic orbital cellulitis.

A 10-year-old boy with orbital cellulitis died seven weeks after admission to the hospital despite intensive surgical intervention and medical therapy. We isolated many anaerobic bacteria from the orbit, frontal sinus, and epidural space. Orbital cellulitis, which often occurs by direct extension from infected paranasal sinuses, commonly affects children and young adults, and is a potentially lethal disease, if left untreated. Heightened awareness of the role of anaerobes in chronic sinusitis and of the possibility of an anaerobic orbital cellulitis may lead to the identification of more cases. Penicillin G appears to be the first drug of choice in cases with suspected anaerobic orbital cellulitis. Chloramphenicol and clindamycin should be considered, if treatment with penicillin fails. Antibiotics alone should not be considered as a panacea, and surgical drainage is often the most compelling consideration.

Anaerobiosis↗

PubMedDate not supplied

Facial cellulitis associated with fowl cholera in commercial turkeys.

Severe cephalic swelling and facial cellulitis in turkeys associated with fowl cholera were present in seven accessions submitted to two laboratories in a 2-year period. Flocks ranged in age from 6 to 18 weeks and included both toms and hens. Interestingly, turkeys with facial cellulitis had no gross internal lesions of fowl cholera, whereas birds with gross lung, liver, and air-sac lesions did not have swollen heads. Histologically, the facial cellulitis was characterized by extensive fibrinonecrotic inflammation of the deep dermis with heterophilic perivasculitis and thrombosis. Additional characterization of Pasteurella multocida isolates from these cases was conducted retrospectively from lyophilized cultures. Serogrouping, serotyping, and an enzyme-linked immunosorbent assay (ELISA) for dermonecrotic factor were performed. All isolates were serogroup A or unencapsulated. Serotype 1 was the most prevalent serotype isolated in association with facial cellulitis. ELISA results for dermonecrotic toxin were inconclusive.

Animals↗

PubMed1996

[Orbital and periorbital cellulitis in childhood. A review of 116 cases].

Orbital and periorbital cellulitis, which can result from a spectrum of disorders that are commonly encountered in pediatric practice, usually develops as a complication of paranasal sinus infection, and also can result from dental infection, trauma to the eyelids or external ocular infection. The clinical features, microbiological data and treatment of 97 children with periorbital cellulitis and 19 children with orbital cellulitis, admitted to our hospital from January 1983 through December 1993, are reported here. Twenty-three percent of the children (27 cases) had positive cultures, 7 cases with orbital cellulitis developed neurological or ophthalmological complications. Antibiotic therapy alone was effective in 97 patients, but a significant proportion required paranasal sinus or orbital surgery (16%).

Anti-Bacterial Agents↗

PubMedDate not supplied

Farm management risk factors associated with cellulitis in broiler chickens in southern Ontario.

A mail survey of 171 farms with broiler chicken flocks processed in a single processing plant in southern Ontario was conducted during the period July-August 1993 as part of a retrospective study. The population farm prevalence of cellulitis was 31/10,000 birds. The survey provided information about the management of broiler chickens in southern Ontario and allowed investigation of the association between cellulitis and management risk factors. Univariate and multivariate analyses were performed to examine the relationship between a binary outcome (high/low prevalence) and management risk factors using logistic regression. Cellulitis was positively associated (P < or = 0.05) with male and mixed (males and females) flocks, use of straw as litter, certain feed companies, use of zinc bacitracin as a growth promoter, and other diseases diagnosed at the processing plant. Total down time was negatively associated with cellulitis.

Animal Feed↗

PubMed1998

Spontaneous cellulitis in adults with idiopathic nephrotic syndrome.

BACKGROUND: Susceptibility to infection is a common problem in a patient with nephrotic syndrome. The spontaneous cellulitis is not uncommon in pediatric patients with nephrotic syndrome, whereas there have been few cases reported in adults. In order to clarify the clinical course of this complication, we present 17 adult idiopathic nephrotic patients with spontaneous cellulitis. MATERIALS AND METHODS: A series of 17 adult idiopathic nephrotic patients with spontaneous cellulitis were retrospectively reviewed in Chang Gung Memorial Hospital, Kaohsiung from 1986 through 1996. We analyzed their physical conditions, clinical manifestations, and outcome. All patients received renal biopsies and had pathologic diagnoses. RESULTS: The medical records of 17 patients were collected, 12 men and 5 women, with ages ranging from 16 to 63 years (mean 29.5 years). The pathologic diagnoses of renal biopsies included minimal change disease (13/17), membranous glomerulonephritis (2/17), mesangioproliferative glomerulonephritis (1/17) and focal/segmental glomerulosclerosis (1/17). All patients had generalized edematous state. The clinical presentations of these patients were variable. The mean serum albumin and daily urinary protein excretion were 1.28+/-0.64 g/dl and 8.75+/-5.16 g, respectively. The results of blood cultures were E. coli (3/17), Gram-negative bacilli (1/17), Streptococcus viridans (1/17), Streptococcus pneumoniae (1/17) and no growth (11/17). All patients responded to antibiotic treatment except one patient who died due to overwhelming sepsis. CONCLUSION: The related factors of spontaneous cellulitis in patients with nephrotic syndrome are edematous skin, hypoalbuminemia, immunosuppressive drugs and defective immunity. Our patients had accordant conditions. The prognosis was good if diagnosis and treatment are made early.

Adolescent↗