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Cefadroxil in the management of facial cellulitis of odontogenic origin.

The objectives of this prospective single-blind trial were to compare the efficacy and safety of cefadroxil, 1 gm/day, and cephalexin, 250 mg four times a day, in the treatment of facial cellulitis of odontogenic origin. One hundred sixteen patients were screened for sensitivity to the assigned antibiotic and then randomly assigned treatment groups. Fifty-eight (100%) of the cefadroxil-treated patients and 57 (98%) of the cephalexin-treated patients were considered cured. Adverse reactions were noted in only two cefadroxil-treated patients and one cephalexin-treated patient. One patient from each group discontinued therapy prematurely; the patient who discontinued cephalexin was the only treatment failure in this study. This study found that cefadroxil administered once a day was therapeutically equivalent to cephalexin given four times a day.

Adolescent↗

Recurrent acute leg cellulitis in patients after radical vulvectomy.

Recurrent acute leg cellulitis (ALC) known to occur in patients with impaired venous or lymphatic circulation was studied in 126 patients after radical vulvectomy with lymphadenectomy through the years 1973 to 1985. Among these patients surveyed for a total period of 6153 patient months, 33 (26%) experienced 75 episodes of ALC. Recurrent attacks were frequently observed. Although antimicrobial treatment was often started, clinical signs resolved also in 9 patients without antimicrobial treatment. To prevent recurrencies penicillin prophylaxis was given to 23 patients. Only 1 of them had once a mild attack of ALC, whereas recurrent attacks occurred frequently in those patients not receiving penicillin prophylaxis. Although penicillin prophylaxis was successful in preventing the recurrence of ALC the risk-benefit ratio of this approach has not been ascertained. The etiology and pathogenesis of recurrent ALC is discussed. Analysis of a number of assumed risk factors for ALC showed that the frequency of ALC was significantly higher in patients colonized with beta-hemolytic streptococci, mainly group B, than in patients not colonized with these microorganisms just prior to surgery. This suggests that non-group A beta-hemolytic streptococci are involved in the onset of ALC in patients after radical vulvectomy. However, portals of entry for microorganisms were not apparent in any of our patients.

Acute Disease↗

Group A streptococcal cellulitis-adenitis in a patient with acquired immunodeficiency syndrome.

A rapidly enlarging left inguinal adenitis, with positive groove sign, and fever, chills, malaise, hypotension, headache, scarlatiniform rash, choleroid diarrhea, and proteinuria developed in an homosexual man who was positive for human immunodeficiency virus. The needle aspiration of the inguinal mass showed group A beta-hemolytic streptococci and the blood cultures were negative, suggesting group A streptococcal cellulitis-adenitis with toxic strep syndrome. Treatment with penicillin and surgical drainage was successful. Bacterial infections associated with defective humoral immunity appear to be common in patients with acquired immunodeficiency syndrome (AIDS), and some of these infections have a remarkable extensive and lethal evolution. Therefore streptococcal adenitis should be considered in any patient with AIDS or AIDS-related syndrome in whom rapidly enlarging inguinal nodes develop.

Acquired Immunodeficiency Syndrome↗

Post-surgical nasal cellulitis outbreak due to Mycobacterium chelonae.

An outbreak of post-rhinoplasty nasal cellulitis due to Mycobacterium chelonae in a secondary care centre is described. A case-control study demonstrated that the use of inadequately sterilized surgical equipment in the Otorhinolaryngology Department was a risk factor. The causal organism was cultured from the equipment, from the surface of the operating theatre lamp, adhesive tape and from two of the hospital's general water tanks. Introduction of effective instrument sterilization methods, monitored with biological controls, the use of new air filters and cleansing and disinfection of hospital water tanks, were sufficient to control the outbreak. The antimicrobial susceptibilities of the causal organism were consistently different from those previously reported in M. chelonae.

Case-Control Studies↗

Pneumococcal cellulitis.

A 42-year-old man with pneumonia was admitted for rhabdomyolysis. Streptococcus pneumoniae was isolated from the cellulitis surrounding the muscular necrosis. Subcutaneous localisation of S. pneumoniae in the course of a septicemia has never been described, although rhabdomyolysis may be associated with bacterial infections.

Adult↗

Facial and periorbital cellulitis in children.

Facial and periorbital cellulitis require emergent recognition and treatment. Hemophilus influenzae type B is the most common pathogen, with Streptococcus pneumoniae being cultured less frequently. Infections following injury are usually caused by Staphylococcus aureus and group A streptococci. Initial evaluation must exclude more severe orbital involvement. Appropriate bacteriological specimens should be obtained. Management requires parenteral antibiotics and careful monitoring for a clinical response or dissemination to other sites of infection.

Anti-Bacterial Agents↗

Nasal septal abscess complicated with acute sinusitis and facial cellulitis in a child.

Non-traumatic nasal septal abscess is rare, commonly seen in patients with poor immunity, and presents as isolated nasal septal abscess. Further, nasal septal abscess complicated with acute sinusitis is rather rare. Very little literature has been generated for non-traumatic nasal septal abscess complicated with acute sinusitis in healthy patients. Prompt diagnosis and adequate treatment will help to prevent the complications associated with nasal septal abscess such as saddle nose and intracranial involvement. Herein, to our knowledge, we present the first case involving an otherwise healthy little girl with nasal septal abscess complicated with acute sinusitis and facial cellulitis.

Abscess↗

[Complication of tracheal intubation: severe cervical cellulitis].

A 40-year-old man, victim of a traffic accident has been hospitalized for a severe head trauma. His trachea has been intubated under general anaesthesia with an 8.0 mm ID tube (Vygon). The cerebral scan revealed a surgical subdural haematoma. In the postoperative period, the patient was admitted in surgical intensive care, under sedation and mechanically ventilation. At day 12 the patient developed a cervical cellulitis complicated of a septic shock. The cervical scan showed an important dilatation of the trachea in the site of the tube cuff. The surgical exploration discovered a complete destruction of the anterior face of de trachea on several centimetres of height. The patient died 24 hours later by multiple organ failure.

Accidents, Traffic↗

Surgical and traumatic wound infections, cellulitis, and myositis in horses.

Surgical site infections (SSIs) and traumatic wound management remain challenging clinical scenarios. The prevention of SSIs involves meticulous surgical technique and aftercare. Traumatic wounds require thorough evaluation to assess the involvement of synovial structures and radiographs to check for fractures. Chronic wounds can require a biopsy and histologic evaluation to obtain a diagnosis, because many underlying pathologic processes grossly appear similar but different treatment regimens are required. Early recognition and diagnosis of cellulitis and myositis enable the rapid aggressive intervention necessary for a positive outcome. Any delay in diagnosis and treatment increases the complication and mortality rates and makes these conditions difficult to treat successfully.

Animals↗

Perineal cellulitis following trans-obturator sub-urethral tape Uratape.

OBJECTIVE: We report two cases of perineal cellulitis due to the surgical treatment of female stress urinary incontinence with a trans-obturator sub-urethral tape of Uratape (Porgés). METHODS: Treatment and follow up of their complication were performed at the CHRU of Lille. RESULTS: In both cases, this complication is related to prolonged vaginal exposition of the tape. Vaginal erosion always occurs next to the silicon coated section of the tape. CONCLUSION: Such a complication has never been described yet. It shows a lack of data concerning human tissue tolerance of sub-urethral tapes constituents. Such examples should call for caution against new materials, all the more so as they have not yet been validated by large scale studies.

Adult↗

Delayed breast cellulitis: an evolving complication of breast conservation.

PURPOSE: Delayed breast cellulitis (DBC) is characterized by the late onset of breast erythema, edema, tenderness, and warmth. This retrospective study analyzes the risk factors and clinical course of DBC. METHODS AND MATERIALS: From 1985 through 2004, 580 sequential women with 601 stage T0-2N0-1 breast cancers underwent breast conserving therapy. Cases of DBC were identified according to accepted clinical criteria: diffuse breast erythema, edema, tenderness, and warmth occurring >3 months after definitive surgery and >3 weeks after radiotherapy. Potential risk factors analyzed included patient comorbidity, operative technique, acute complications, and details of adjunctive therapy. Response to treatment and long-term outcome were analyzed to characterize the natural course of this syndrome. RESULTS: Of the 601 cases, 16%, 52%, and 32% were Stage 0, I, and II, respectively. The overall incidence of DBC was 8% (50/601). Obesity, ecchymoses, T stage, the presence and aspiration of a breast hematoma/seroma, removal of >5 axillary lymph nodes, and arm lymphedema were significantly associated with DBC. The median time to onset of DBC from the date of definitive surgery was 226 days. Ninety-two percent of DBC patients were empirically treated with antibiotics. Fourteen percent required more invasive intervention. Twenty-two percent had recurrent episodes of DBC. Ultimately, 2 patients (4%) underwent mastectomy for intractable breast pain related to DBC. CONCLUSION: Although multifactorial, we believe DBC is primarily related to a bacterial infection in the setting of impaired lymphatic drainage and may appear months after completion of radiotherapy. Invasive testing before a trial of antibiotics is generally not recommended.

Adult↗

Cellulitis-like cutaneous metastasis of uterine cervical carcinoma.

Metastasis to the skin from cervical carcinoma is relatively uncommon. Herein we present a 41-year-old woman with a history of cervical carcinoma with severe facial erythematous swelling and telangiectasia. She was initially treated for cellulitis without improvement. A skin biopsy specimen revealed widespread intravascular tumor emboli in the dermis and subcutis, resembling the so-called inflammatory carcinoma of the breast. As this is an unusual clinical presentation for the metastasis of cervical carcinoma, this case is reported.

Adult↗

Neutrophilic eccrine hidradenitis masquerading as facial cellulitis.

Neutrophilic eccrine hidradenitis typically manifests as erythematous plaques on the face, trunk, or extremities. This eruption has been associated with numerous factors, but most commonly is seen with chemotherapy, particularly cytarabine. We report a 73-year-old woman with acute myelogenous leukemia who developed rapidly expansive neutrophilic eccrine hidradenitis mimicking facial cellulitis only after a course of cytarabine was followed by granulocyte-colony stimulating factor. Prompt diagnosis is imperative to prevent prolonged antimicrobial therapy.

Aged↗

Acute acquired comitant esotropia after orbital cellulitis.

Acute extraocular muscle restriction in children is a rare condition; orbital myositis is the most common cause. Most neuropathic or myopathic causes of strabismus present as an incomitant deviation. We report a case of orbital cellulitis preceding acute comitant esotropia in a patient showing no evidence of myositis or neurologic pathology.

Cellulitis↗

Erysipelas and cellulitis: clinical and microbiological spectrum in an Italian tertiary care hospital.

Patients hospitalized in the authors' institution for erysipelas or cellulitis between January 1995 and December 2002 were included in this retrospective review. Two hundred cases of soft tissue infections were hospitalized during the study period. The mean age of the patients was 58 years. The most commonly involved site was the leg (66%), followed by the arm (24%) and face (6%). Most patients (71%) had a recognized risk factor for soft tissue infection. Fever was present in 71% of cases, with a mean duration of 3 days. Blood cultures were positive in 3 out of 141 (2%) cases, whereas cutaneous swabs were positive in 73 out of 92 (79%) cases. On admission, white blood cells counts (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were elevated above normal levels in 100 out of 191 (50%) cases, 151 out of 176 (85%) cases, and 150 out of 154 (97%) cases, respectively. Patients with a hospital stay of more than 10 days had significantly higher CRP and ESR values than patients hospitalized for 10 days or less (P<0.01). A single antibiotic was used as treatment in 115 cases, whereas in the remaining 85 cases a combination of two antibiotics was administered. The most commonly used antibiotics were amoxicillin-clavulanic acid as single agent and penicillin with clindamycin as combination therapy. The mean duration of hospitalization was 7 days for patients treated with a single antibiotic and 11 days for patients treated with an antibiotic combination. A recurrence of infection occurred in 34 (17%) patients. Soft tissue infections are common and have a high degree of morbidity and require prolonged hospitalization and antibiotic treatment. Microbiological diagnosis is difficult and treatment is based on empiric evidence. ESR and CPR levels on admission may predict the severity of the disease and duration of hospitalization.

Adolescent↗