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The authors report about 2-year-old female affected by orbital cellulitis. The most recent advances about physiopathology, diagnosis and therapy of orbital cellulitis are described.
Irregular results sometimes found during antibiotic treatment of perimaxillar cellulitis, conducted the authors to study bacteriology of these infections from dental origin. This study confirmed the aero and anerobic polymicrobism of these cellulitis. Antibiograms realised in 49 cases showed occurrence of streptococcal and anaerobic germs resistance to antibiotics usually prescribed. A nearly constant success of other antibiotics allowed the authors to define a first intention antibiotherapy for the treatment of these infections.
INTRODUCTION: The pathogenesis of necrotizing cellulitis remains uncertain. Factors that enhance clot formation may contribute to tissue necrosis. CASE REPORT: A case of necrotizing cellulitis of the penis in a patient with a transient protein S deficiency, is reported. CONCLUSION: The responsibility of this transient hypercoagulable state in the occurrence of tissue necrosis in this patient is discussed.
Involvement of aerobic bacteria, especially Escherichia coli, in lesions of cellulitis in broiler chickens was investigated. Samples of subcutaneous caseous material for bacteriological examination were collected aseptically at the slaughterhouse from 109 broilers with lesions. Skin tissue was taken from five of these birds for histopathological examination. In 96 of the 109 (88.1%) broilers sampled, E. coli was isolated from the lesion, and in 60 of these birds it was the only bacterial species found. In 33 broilers, Streptococcus dysgalactiae was found along with E. coli. Although serotype O78 was isolated the most frequently, numerous other serotypes were found; no correlation could be established between the size of the lesions and the serotype isolated. The microscopic lesions were characterized by thickening of the dermis with a granulomatous inflammatory reaction. This study confirms the frequent association of E. coli with cellulitis lesions in broiler chickens and reports the frequent isolation of S. dysgalactiae from the lesion.
We reported 2 patients with malignant lymphoma complicated by hemophagocytic syndrome. Their clinical signs at onset were those of orbital cellulitis. Lymphoma complicated with hemophagocytosis is called lymphoma-associated hemophagocytosis syndrome (LAHS) and its prognosis is reported to be very poor. So far as we know, this is the first report in the ophthalmological field. In our patients, we suspected that the lesions occurred from the orbit or skin of this area. The first patient was a 22-year-old man and the second patient a 16-year-old girl. The diagnosis was very difficult at the onset of disease. Within 6 months after the first opthalmological examination, both died. When orbital cellulitis is suspected and antibiotic therapy is ineffective, we should suspect hemophagocytic syndrome (HPS) and should examine serum ferritin which is a good markers of HPS. Early biopsy and consultation with a hematologist are very important.
Cellulitis occurring in the lower extremity is encountered frequently and results from a breach of the skin and inoculation of opportunistic bacteria. It has been shown that when web space dermatophytosis is present, changes may occur in normal skin morphology and bacterial flora that can result in severe infection. Knowledge of the pathophysiology of interdigital dermatophytosis allows the clinician to choose the most appropriate empiric antibiotic therapy when treating a secondarily caused cellulitis of the lower extremity.
Melioidosis is known to present with many diverse manifestations but orbital cellulitis from melioidosis has never been described. We report a case of melioidosis in a 42-year-old diabetic male who presented with orbital cellulitis. He succumbed to recurrent empyema of the paranasal sinuses, rupture of an intracranial mycotic aneurysm and pulmonary empyema despite early antibiotic treatment.
This is a retrospective study of 17 patients who were admitted for orbital cellulitis between August 1989 and February 1994. The epidemiology, possible source of infection, the causative organisms and effectiveness of treatment were reviewed. The results showed that one-third of the cases occurred in the first decade of life. Paranasal sinusitis was the main source of infection in 11 (65%) patients. Thirteen patients (76.5%) developed orbital and periocular abscesses requiring surgical drainage. Two out of 17 eyes lost vision despite intensive treatment. Orbital cellulitis is a blinding ocular emergency associated with high morbidity. Immediate treatment is necessary to avoid devastating complications such as optic nerve compression, panophthalmitis or intracranial spread of infections. Cases with abscess formation required early surgical drainage. Combined orbito-otorhinolaryngologic approach is recommended for drainage of orbital abscess with associated paranasal sinus infection.
A homogeneous series of 15 cases of diffuse cervical cellulitis originating in the oropharyngeal area were collected from December 1990 to April 1995. Despite early management, diffusion of the infectious processus was rapid with extension and development of severe mediastinal or pulmonary complications. When diffuse cervical cellulitis is suspected, early and adapted aggressive treatment must be initiated immediately: suppression of the causal factor, surgical exploration with repeated drainage depending on the clinical course assessed on CT scans, antibiotics effective against the aero-anaerobic flora. This aggressive attitude is required to avoid potentially severe morbidity. Anti-inflammatory drugs, taken alone or with unadapted antibiotics was implicated in 11 cases as a favoring factor.
INTRODUCTION: Only a few cases of Haemophilus influenzae type B cellulitis have been reported in adult patients. They generally involve immunocompromised patients, and are located in the cervico-facial areas. CASE-REPORT: We report a 43 year-old immunocompetent patient who presented a cellulitis of the leg. No cutaneous or upper respiratory pathways entry portal was found. Abcedation of cutaneous lesions allowed the isolation of numerous colonies of Haemophilus influenzae type B from a subcutaneous fluid aspirate. COMMENTS: The unusual site of the infection, the age and the immunocompetent status of the patient, the lack of initial infectious localisation and the slow healing of lesions despite appropriated antibiotic therapy, are of particular interest.
OBJECTIVE: Peritonsillar sepsis (PTS) can be divided into abscess and cellulitis. It is the most common deep neck infection in the paediatric age group. In this article we discuss the clinical issues related to peritonsillar sepsis in children. METHOD: This study involves 185 cases of peritonsillar that were treated at the Montreal Children's Hospital in the last 10 years. The symptoms, signs, laboratory and radiological data as well as the medical and surgical therapies are included. RESULTS: Seventy-five cases were peritonsillar cellulitis (PTC) and the rest were abscesses. The age at presentation varied between 2.5 months and 18 years. The majority of the cases diagnosed as peritonsillar abscess (PTA) occurred from age 12 to 18 years. Trismus was the only complaint that was statistically associated with PTA. Uvular deviation combined with trismus was also important in differentiating PTA from PTC. Our data revealed a lower percentage of anaerobic bacteria and the majority of cultures grew Streptococcus pyogenes group A. CONCLUSIONS: Clinical picture is important in differentiating PTA from PTC. Recurrence of peritonsillar sepsis was higher in children with a history of recurrent tonsillitis. Needle aspiration of PTA resulted in a higher incidence of recurrence compared to incision and drainage. A management algorithm is suggested for the child presenting with peritonsillar sepsis.
This case report describes an uncommon cellulitis caused by Serratia plymuthica in a patient treated with steroids. The evolution was favorable after surgical exploration with debridement and antibiotic treatment. This is the first case of necrotic cellulitis caused by S. plymuthica described in the literature.
Recurrent retropharyngeal cellulitis and recurrent suppurative thyroiditis are rare entities that share a common cause. A congenital fistula from the pyriform sinus apex to the thyroid gland has been identified in approximately 23 cases of suppurative thyroiditis and now has been implicated in a case of retropharyngeal abscess and repeated episodes of cellulitis. Virtually all reported cases have been on the left side, and the fistula is usually identified with a barium swallow study. When the esophagogram fails to demonstrate a fistula, a careful endoscopic search in the area of the left pyriform sinus should be actively pursued. An external surgical approach, which includes resection of the entire tract and involved area of the left thyroid, has been curative in all reported cases subjected to definitive surgical exploration.
Orbital cellulitis due to presumed gas-producing organisms has been associated with poor visual prognosis. We report successful visual recovery in a 14-year-old boy with orbital cellulitis and gas in the orbit on CT scan. The patient was treated with intravenous antibiotics and prompt orbital decompression. Pus from the sinus aspirate and orbital drain grew H. influenzae and Gram-negative bacilli. Repeat orbital surgery with drainage of residual abscess was performed and the patient made a complete recovery.
OBJECTIVE: To study changes of DNA content in the kidney cellule of rats and relationship with the postmortem interval. METHODS: This experiment chose seven parameter of cell nuclear, including the area and integral optical density, determined the changes of DNA content in the kidney cellule of 15 rats at different intervals between 0 and 48 h postmortem with auto-TV-image system. RESULTS: The degradation rate of DNA in nuclear has a certainty relationship to early PMI(in 48 h) of rat, and get binomial regress equation. CONCLUSION: Determining the quantity of DNA in nuclear should be an objective and exact way to estimate the PMI.
Cutaneous biopsy specimens from two patients with localized, bacterial, necrotic cellulitis showed a neutrophilic vasculitis with fibrin thrombi, changes indistinguishable from those seen in a third patient with bacterial septicemia. Additional clinical information may be needed before a definitive diagnosis of localized or systemic septic vasculitis can be made with certainty. The clinical and microscopic features of the lesions and their pathologic mechanisms are discussed.
Five case reports of perianal cellulitis caused by group A beta-hemolytic streptococci are presented. These reports illustrate delays in diagnosis and therapy of this condition that may present as chronic diaper dermatitis, perirectal fissures, painful defecation, fecal hoarding behavior, or proctocolitis. One patient had associated guttate psoriasis. In children especially, guttate psoriasis should alert physicians to culture perirectal as well as pharyngeal sites for group A streptococci.
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.