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At least 307 records · Page 17Linked to original sources

Cutaneous cryptococcosis mimicking bacterial cellulitis in a liver transplant recipient: case report and review in solid organ transplant recipients.

Cutaneous cryptococcosis is an uncommon manifestation of disseminated cryptococcal disease. We report a liver transplant recipient presenting with onset over 3 days of progressive pain and swelling of the lower extremity and foot with erythema and heat. Cryptococcal cellulitis was documented, but in retrospect the clinical presentation was indistinguishable in presentation and appearance from acute bacterial cellulitis. The patient also proved to have concomitant cryptococcal septic arthritis; the presence of cryptococcal antigen in the synovial fluid allowed a rapid and definitive diagnosis. Subsequently, cultures of skin, synovial fluid, and blood were all positive for cryptococci. Cryptococcus should be considered in the differential diagnosis of bacterial cellulitis in a liver transplant recipient not responding to antibacterial therapy.

Ankle Joint↗

Bacteremic cellulitis caused by non-O1 Vibrio cholerae: report of a case.

A 44-year-old man presented with a fever of a two-day duration and bullous cellulitis of the lower extremities. He had prepared and eaten saltwater fish three days prior to admission. Both blood and bullous fluid cultures showed non-O1 Vibrio cholerae. The bacteremic cellulitis resolved gradually after four weeks of intravenous cefamandole therapy and surgical debridement. Non-O1 V. cholerae bacteremia is rarely reported in the English-language literature and is almost always associated with saltwater exposure, ingestion of seafood, or immunocompromised hosts, particularly those with hematologic malignancies, or liver cirrhosis. Our patient was an alcoholic, but there was no evidence of liver cirrhosis from the physical examination or abdominal sonogram. He is the fourth reported case of non-O1 V. cholerae bacteremic cellulitis in the English-language literature and the first proven case in Taiwan.

Adult↗

Diffuse abdominal wall cellulitis in ascending omphalitis--a lethal association in neonatal necrotizing fasciitis.

Necrotizing fasciitis is a grave complication of ascending omphalitis in the neonate, but because it is rare some of the signs are not well documented. Rapidly progressive anterior abdominal wall edema and cellulitis were noted in 16 patients who were clinically diagnosed with necrotizing fasciitis. Fifteen of these patients died soon after emergence of anterior abdominal wall edema and cellulitis. The appearance of anterior abdominal edema and cellulitis in a patient with ascending omphalitis has serious implications and demands intensive care if the patient is to survive.

Abdominal Muscles↗

Group B streptococcal cellulitis of perineum and lower abdomen: report of one case.

This report describes a 4-week-old female baby with disseminated group B streptococcus (GBS) infection. The illness began as a swelling with violaceous hue of perineum and lower abdomen, a manifestation that may be falsely attributed to a traumatic injury. GBS septicemia, meningitis and cellulitis of lower abdomen was confirmed by cultures. This case illustrated an unusual presentation of GBS infection as cellulitis of lower abdomen. The presence of concurrent septicemia and meningitis in this case indicated that a more extensive diagnostic work-up and a more aggressive therapeutic approach are needed for young infants with cellulitis.

Ampicillin↗

Asymptomatic posterior orbital cellulitis resulting from ethmoid/maxillary sinusitis.

BACKGROUND: Although vision-threatening sinusitis complications are not uncommon, an unusual case of asymptomatic posterior orbital cellulitis resulting from maxillary and ethmoidal sinus infection is presented. METHODS, RESULTS: An 11-year-old girl was brought to us for a routine optometric examination, reporting only blurred distance vision. A mild afferent pupillary defect was the key to detection and diagnosis of a vision-threatening posterior orbital cellulitis. CONCLUSIONS: A literature review of relevant anatomic and pathologic mechanisms, as well as radiologic recommendations, follows. This case appears to be a new clinical entity, an asymptomatic variant of posterior orbital cellulitis.

Cellulitis↗

Pre-septal cellulitis--varied clinical presentations.

Preseptal cellulitis has a typically benign course when treated with antibiotics, the clinical course depending on age of the patient, aetiology and the causative organism. In this study, 14 cases of preseptal cellulitis are documented with the age ranging from 2 to 55 years. The organisms isolated were Staphylococcus aureus (7 cases), Streptococcus pyogenes (2 cases) and Pseudomonas aeruginosa (1 case). In the remaining four patients no organism could be identified. All except four patients were cured within 6 weeks. Complications seen included lagophthalmos, lid abscess, cicatricial ectropion and lid necrosis in one patient each. The prognosis for preseptal cellulitis is good with appropriate antibiotics and surgical therapy.

Adolescent↗

[Orbital cellulitis. A case report].

This study describes the case of a 6 years old child, male, with orbital cellulitis and underlines the importance of an early diagnosis and therapy to avoid severe complications often present in this disease. Swelling and redness of the eyelid, pain and ophthalmoplegia are the first sign of an orbital cellulitis and they require rapid diagnostic procedure such as ultrasound and TC scan of the orbital region to evaluate the integrity of the profound orbital tissues. The child was admitted at the Department of Pediatrics, University "La Sapienza" of Rome and underwent an ultrasound, TC scan and serum exams which demonstrated the elevation of the sedimentation rate, reactive C protein and WBC plus the interesting of the profound orbital tissues. The child was treated with antibiotic and antiinflammatory therapy showing a complete recovery within 7 days. An ultrasound performed 7 days later demonstrated a complete resolution of the inflammatory process. In summary, this study would like to stress the necessity of an early diagnosis and an appropriate therapy in order to avoid the severe complications often present in children with orbital cellulitis.

Anti-Bacterial Agents↗

Cellulitis caused by Citrobacter diversus in a patient with multiple myeloma.

The most common cause of cellulitis is streptococci. Coagulase-negative staphylococci and gram-negative bacteria, such as Serratia spp., Proteus spp., and other Enterobacteriaceae may produce cellulitis in the immunocompromised patient. We report a case of Citrobacter diversus-induced cellulitis, resembling streptococcal infection, in a patient with multiple myeloma.

Anti-Infective Agents↗

Cellulitis of the eyelids associated with sinusitis and brain abscess.

Erythema in the orbital area can indicate systemic and life-threatening diseases. We experienced an unusual and serious case of orbital cellulitis that was difficult to distinguish from a case with good prognosis. A 21-year-old man developed an erythema around his eyes. He exhibited no symptoms that would suggest lesions in deep tissues, but his condition turned out to be cellulitis retrogradely metastasized from an odontogenic sinusitis traced to a dental treatment problem. Computed tomography revealed complication of a large abscess in the frontal lobe. Cellulitis of the orbital area requires particular clinical discretion.

Adult↗

Recent Considerations in Recurrent Cellulitis.

Cellulitis is a frequently diagnosed syndrome that causes considerable morbidity. For a subset of patients, recurrent bouts of infection impact their quality of life. Most cases are due to beta-hemolytic streptococci or Staphylococcus aureus. Inclusion of interdigital space (toe web) or mucosal (anal) swab cultures may increase the ability to define pathogens among patients with lower extremity cellulitis. The pathogenesis of cellulitis is complex, and more work is needed so that novel therapies and vaccines can be developed to improve treatment and prevention of this disorder.

Journal Article↗

Gastric carcinoma presenting with cellulitis-like cutaneous metastasis.

INTRODUCTION: A case of carcinoma of the stomach presenting with cellulitis-like cutaneous metastasis is reported. CLINICAL PICTURE: This patient was diagnosed to have early stage carcinoma of the prostate (T1bN0M0), which was treated with radiotherapy and hormonal therapy. He presented with an erythematous area of induration over the right neck a few weeks after the completion of radical radiotherapy. The CT scan of the neck showed features suggestive of cellulitis of the right cervical region. Due to the lack of response to intravenous antibiotics, a fine needle aspiration biopsy of the indurated area was done. This confirmed the presence of adenocarcinoma. Due to the presence of iron-deficiency anaemia and the positive occult blood test in the stool, an upper gastrointestinal endoscopy was done. This confirmed the presence of adenocarcinoma of the stomach of the signet-ring cell type. OUTCOME: He had a rapid downhill course after the diagnosis and died four weeks after the diagnosis was made. CONCLUSION: Carcinoma of the stomach can rarely present with cutaneous metastasis as a cellulitis-like picture.

Aged↗

[Cellulitis. Histopathologic and histochemical study of 100 cases].

An analysis of the bibliographical background is made. A study of 100 cases of cellulitis from the histopathologic and histochemical features is performed. The biopsies were done on patients of the feminine sex as a start of a whole treatment. It is inferred that in cellulitis pathologic, metabolic, hormonal and may be immunological factors, are linked to the malfunction of the vascular changes (micro-pathological angiopathy) in the form of thickening of the walls of capillaries and arterioles, that would generate a muco-edema in the dermo-hypodermic tissues. The cellulitis owing to its typical histological characteristics might be considered as a dystrophic capillary connective mucoidotic edema predominant in the skin of the root of the lower limbs.

Adipose Tissue↗

Nasolacrimal duct obstruction and orbital cellulitis associated with chronic intranasal cocaine abuse.

OBJECTIVE: To report the association of acquired nasolacrimal duct obstruction and orbital cellulitis in patients with a history of chronic intranasal cocaine abuse. METHODS: Retrospective, consecutive case series. Results of imaging, histopathologic examinations, and clinical courses of these patients were studied. RESULTS: Five women and 2 men (mean age, 41 years) with a history of chronic intranasal cocaine abuse (mean, 11 years; range, 5-20 years) presented with epiphora and in some cases acute onset of periorbital pain, edema, and erythema associated with fever. The suspicion of intranasal cocaine abuse was made on anterior rhinoscopy with the detection of an absent nasal septum and inferior turbinate. Computed tomographic and magnetic resonance imaging findings in 4 patients included extensive bony destruction of the normal orbital wall architecture, opacification of the sinuses, and the presence of an intraorbital tissue mass. Histopathologic examination of the nasolacrimal duct in 2 patients and of the orbital mass in a third patient revealed marked chronic inflammation with fibrosis causing secondary nasolacrimal duct obstruction. Six patients were treated with systemic antibiotics followed by dacryocystorhinostomy in 3 patients, and a pericranial flap to insulate the exposed orbit in 1 patient. CONCLUSIONS: Chronic intranasal cocaine abuse can result in extensive bony destruction of the orbital walls with associated orbital cellulitis, and should be included in the differential diagnosis of acquired nasolacrimal duct obstruction. Anterior rhinoscopy is very helpful in establishing the correct diagnosis in these patients.

Administration, Intranasal↗

Acute severe irreversible visual loss with sphenoethmoiditis-'posterior' orbital cellulitis.

Orbital cellulitis secondary to adjacent paranasal sinusitis presents with marked proptosis, ophthalmoplegia, eyelid edema, chemosis, and/or conjunctival hyperemia. These conditions often precede visual dysfunction. "Posterior" orbital cellulitis secondary to sphenoethmoidal sinusitis may be defined as the clinical syndrome in which early severe visual loss overshadows or precedes accompanying inflammatory orbital signs. The visual loss may be attributed to involvement of the intracanalicular or orbital apical segment of the optic nerve. Total irreversible unilateral visual loss developed in three patients with this syndrome. Severe visual loss was preceded by diplopia in one patient and by bilateral eyelid edema in another. One patient with chronic panparanasal sinusitis with acute visual loss presented with isolated optic disc edema. Proptosis and ductional restriction subsequently developed. The irreversible blindness in these cases may be due to a combination of intracanalicular edema and vasculitis causing optic nerve infarction.

Acute Disease↗

Group B streptococcal cellulitis-adenitis in infants.

Seven infants with group B streptococcal (GBS) cellulitis-adenitis were compared with nine previously described patients. The clinical features of infection included a mean age at onset of five weeks, a male predominance (75%), a history of poor feeding or irritability (94%), and a rapid resolution with appropriate antimicrobial therapy. Bacteremia occurred in 94% of the patients. Type III GBS were associated with 75% of these infections; no antibody response to the capsular antigen of these organisms was detected in convalescent sera. Two of our cases had previously unreported sites of involvement, inguinal lymph nodes and a thyroglossal duct cyst. Four infants (80%) with typical facial or submandibular GBS cellulitis had ipsilateral otitis media at the time of admission. Otitis media with subsequent lymphatic spread to facial or submandibular areas, rather than primary bacteremia, may explain the pathogenesis of these unusual infections.

Cellulitis↗

Periorbital cellulitis. Clinical and laboratory findings in 146 episodes, including tear countercurrent immunoelectrophoresis in 89 episodes.

Medical records of 144 children hospitalized for 146 episodes of periorbital cellulitis were reviewed. During 44 episodes, systemically administered antibiotics were given before hospitalization. Bacterial pathogens were isolated in only two (5%) of 44 episodes in pretreated patients compared with 33 (32%) of 102 episodes in patients who were not pretreated. Thirty-one children who were not pretreated were bacteremic. Compared with nonbacteremic children who were not pretreated, bacteremic children were younger, more often had a history of upper respiratory tract infection and fever, had a higher white blood cell count and temperature at admission, and more often had a violaceous cellulitis. No difference between groups existed in the frequency of a history of trauma or a local lesion near the affected eye. Tear specimens from 13 of 89 children tested by countercurrent immunoelectrophoresis (CIE) to detect Haemophilus influenzae type b capsular polysaccharide were positive. Compared with positive blood culture results, tear CIE has a sensitivity of 50% and a specificity of 93%. Streptococcus pneumoniae infections were not detected by CIE.

Cellulitis↗

Phycomycotic gangrenous cellulitis. A report of two cases and a review of the literature.

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.

Abdominal Muscles↗

Clinical features and aerobic and anaerobic microbiological characteristics of cellulitis.

OBJECTIVES: To investigate the aerobic and anaerobic microbiological characteristics of cellulitis and correlate them with the infection site. DESIGN: Of 342 specimens, 64 obtained using needle aspiration and 278 using swabs were studied over 10 years. RESULTS: Bacterial growth was noted in 15 (23%) of the 64 needle aspirates and 259 (93%) of the 278 swab aspirates. The microbial results of the 15 specimens obtained through needle aspiration are separately presented. Aerobic or facultative bacteria only were present in 138 (53%) of swab samples, anaerobic bacteria only in 69 (27%), and mixed aerobic-anaerobic flora in 52 (20%). In total, there were 582 isolates, 247 aerobic or facultative and 335 anaerobic bacteria, with an average of 2.2 isolates per specimen. The predominance of certain isolates in different anatomical sites correlated with their distribution in the normal flora adjacent to the infected site. The highest recovery rates of anaerobes was from the neck, trunk, groin, external genitalia, and leg areas. Aerobes outnumbered anaerobes in the arm and hand. The predominant aerobes were Staphylococcus aureus, group A streptococci, and Escherichia coli. The predominant anaerobes were Peptostreptococcus sp, Bacteroides fragilis group, Prevotella and Porphyromonas sp, and Clostridium sp. Certain clinical findings correlated with the following organisms: swelling and tenderness with Clostridium sp, Prevotella sp, S aureus, and group A streptococci; regional adenopathy with B fragilis group; bulbous lesions with Enterobacteriaceae; gangrene and necrosis with Peptostreptococcus sp, B fragilis group, Clostridium sp, and Enterobacteriaceae; foul odor with Bacteroides sp; and gas in tissues with Peptostreptococcus sp, B fragilis group and Clostridium sp. Certain predisposing conditions correlated with the following organisms: trauma with Clostridium sp; diabetes with Bacteroides sp, Enterobacteriaceae, and S aureus; and burn with Pseudomonas aeruginosa. CONCLUSION: These data highlight the polymicrobial nature of cellulitis.

Adolescent↗