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We report three cases of septic scarlet fever due to Streptococcus pyogenes Group A (serotype M1/T1/OF-) cellulitis in healthy young adults. Despite prompt treatment two of the patients died. Such cases of cellulitis associated with scarlet fever, severe toxaemia and septicaemia have not been reported in the post-antibiotic era.
A case of orbital cellulitis in which the causative organism was Streptococcus faecalis--the first such case to the authors' knowledge--is reported. Although Hemophilus influenzae and pneumococci are most frequently encountered in orbital cellulitis, this case shows that Streptococcus faecalis may also be responsible. Prompt identification of the bacteria is urged.
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 prospective microbiological evaluation of 87 patients with acute cellulitis was performed. Adult patients with cellulitis with diabetes mellitus or malignant disorders had a greater frequency of positive cultures. Qualitative leukocyte disorders associated with these underlying disease states was hypothesized as a contributing factor to this higher yield.
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.
Infections associated with marine activities, particularly work or recreation in salt water, present unique diagnostic challenges for the infectious disease practitioner. Those caused by halophilic, non-cholera Vibrio species are increasingly being recognized in clinical practice. They typically follow saltwater injuries, especially those associated with coral. Because these infections can be both severe and life-threatening, a consideration of halophilic Vibrio species in the differential diagnosis of marine-acquired infections is important. In this case report, we discuss the diagnosis and treatment of cellulitis in a patient with a Caribbean coral injury associated with Vibrio alginolyticus cellulitis.
Among 78 cases of group B streptococcal infections in children hospitalized at our institution during 1981 to 1985, five cases of cellulitis in infants were identified. Age at onset was 4 to 11 weeks. Group B streptococci were isolated from each of two aspirate cultures, all four blood cultures obtained before administering antibiotics, and none of four spinal fluid cultures obtained. All five infants had previously been treated with IV antibiotics in the hospital. Two infants had been previously treated for group B streptococcal infections (one each meningitis and neonatal sepsis). In contrast, among the 29 other patients with late-onset (2 weeks of age or older) group B streptococcal infection, four had prior treatment with IV antibiotics (P less than .001). These data suggest that hospitalization and/or parenteral antibiotic therapy may be a risk factor for development of group B streptococcal cellulitis.
Three cases of ecchymotic cellulitis in 7 to 11 month old infants are reported. Haemophilus influenzae was isolated from blood in two cases. Ecchymotic cellulitis in infants should, in the first place, evoke an Haemophilus influenzae infection. Bacteremia being frequent in this condition, blood cultures should be performed.
The authors report 3 cases of young infants with B streptococcal cellulitis revealed by submandibular inflammatory induration. The clinical findings, similar to the cases reported in literature, were characteristic, due to the infants' ages, the aspect and localization of the cellulitis. Bacteriologic diagnosis relies on blood cultures and aspiration of the lesion.
Orbital cellulitis is a rare complication of extraocular muscle surgery. Two cases have been reported since 1935. No report of this sight-threatening and life-threatening complication of strabismus surgery has appeared since computerized tomography became readily available. The following is a report of a case of orbital cellulitis occurring unilaterally following bilateral strabismus surgery in which computerized tomography was helpful in verification and management. Early antibiotics resulted in a favorable outcome. The case is compared to those reported by von Noorden.
Cellulitis and subcutaneous abscess formation was diagnosed in a 3-month-old Thoroughbred filly. Clinical signs consisted of a large ulcerated plaque, with satellite pustules on the medial aspect of the right hock and subcutaneous abscesses in the right inguinal and mammary gland areas. Laboratory analysis revealed mature neutrophilia. Rhodococcus equi was isolated from the cellulitis and the subcutaneous abscess. Oral administration of erythromycin and rifampin for 35 days resulted in a clinical cure.
There has been a question about the etiology and pathogenesis of recurrent cellulitis of the lower leg in patients following coronary artery bypass graft surgery. We observed a similar patient who had gram-positive cocci in chains, consistent with streptococci, within the dermis in a tissue biopsy specimen taken from the site of cellulitis. In addition, our patient had a second skin infection, namely, tinea pedis, which may be the portal of entry for streptococci. Concurrent treatment with a systemic antibiotic and a topical antifungal cream was effective in clearing both infections.
The authors report what they believe to be the first case of a blepharoplasty procedure complicated by an acute postoperative dacryocystitis that precipitated orbital cellulitis. The patient had a preoperatively compromised nasolacrimal drainage system. Because acute dacryocystitis and resulting orbital cellulitis are potential postoperative complications of a blepharoplasty, blepharoplasty candidates should undergo preoperative evaluation of their nasolacrimal drainage systems.
The association of pneumonia and submandibular cellulitis in the case of group B streptococcal LOD (Late Onset Disease) is rare. Concerning the possible nosocomial infection of a 31/2 months infant the authors compare the pulmonary disease with that of the EOD (Early Onset Disease) and like other authors recommend considering GBS as the main cause of any cellulitis for an infant under 4 months.
In a previous work, Segers and adl., the histological and histochemical study of the features of cellulitis is performed, expliciting the importance in this lipodystrophy of microangiopathy PAS positive. As a complement of that work, we study a group of 254 patients, all females, which came to us to be treated for their cellulitis, general clinical and local laser therapy. All of these patients presenting microangiopathy of their dermohipodermic capillary vessel confirmed by biopsy. These cases were divided in four groups according to the existence or not family antecedents of diabetes mellitus, and positivity or negativity to the test of glucose overcharge, sensibilized with corticoid (Fajans-Conn). The results are extensively described and discussed, and considerations are made referring to the aetiopathogenesis of both entities, diabetes and micro-pathological angiopathy, that could be generically and/or immunologically related.
Fifty patients with cellulitis were evaluated prospectively using cultures of aspirates from the advancing edge of cellulitis, skin biopsy specimens, and blood. Potential microbial pathogens were isolated in 13 patients. Biopsy specimen cultures were positive in ten patients, while aspirate and blood cultures were positive in five and two, respectively. Aspirate, biopsy, or blood cultures were more often positive in patients with apparent primary lesions than in patients without such lesions. Apparent primary sites of infection were identified and cultured in 24 patients. beta-Hemolytic streptococci were isolated from 17 primary lesions, and coagulase-positive staphylococci were present in 13. Both organisms were isolated from ten primary lesions. Among patients with positive aspirate, biopsy, and/or blood cultures, the same pathogens were also isolated from primary sites in ten of ten patients. Clinical features, including temperature, white blood cell count, and erythrocyte sedimentation rate, were not predictive of positive aspirate, biopsy, or blood cultures. These cultures provided no microbiologic information that was not obtainable from culture of primary lesions.
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.