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We describe a case of Vibrio fluvialis hemorrhagic cellulitis and cerebritis following multiple fire-ant stings and wading in brackish water. A high index of suspicion is required for diagnosis of this specific pathogen and concordant infection. This is, to our knowledge, the first report of this type of wound infection.
We describe a patient with facial cellulitis/erysipelas due to cowpox virus inoculation in the respiratory epithelium of the nose. A cytopathic agent was isolated in cell culture, and the diagnosis of cowpox was confirmed by electron microscopy and polymerase chain reaction. The most likely source of infection was exposure to the family cats. In addition to the severe edematous cellulitis of the face, the clinical course was dominated by several areas of subcutaneous, necrotizing lymphadenitis, from one of which a huge abscess formed that had to be incised. Hyperbaric oxygen treatment was provided to prevent development of dermal necrosis. The healing process in the numerous areas of lymphadenitis was markedly protracted, and 1 persisting node (which yielded positive results on polymerase chain reaction) had to be excised 2 years after onset of disease. This is the first reported case of inoculation of cowpox virus in the respiratory mucosa of the nose. It resulted in a clinical course totally different than that for inoculation in the skin. We also present a short review of findings on orthopoxvirus infection that focuses on the chain of transmission.
A new transdermal delivery system that controls cellulitis is evaluated using reversed-phase high-performance liquid chromatography coupled with photodiode array detection. An extraction procedure and the validation of the analytical method to assay the active excipients from the Centella asiatica plant (asiaticoside, madacessic acid, and asiatic acid) are described. Excellent results ae obtained in terms of linearity, accuracy, and specificity of the analytical method.
We report a case of a 75-year-old woman who died of pulmonary thromboembolism following a dog bite to the calf. The bite caused laceration of the skin and gangrenous cellulitis of leg soft tissues. Six days after hospitalization, the patient died suddenly, despite early antibiotic and heparin administration. Postmortem examination revealed extensive thrombosis of the deep veins of the calf and massive thromboembolism of the main pulmonary arteries.
Toxic shock syndrome is a febrile, multiorgan illness related to toxins elaborated by staphylococcal or streptococcal infections. In the 1980s, most cases were associated with menstruation. More recently, many cases now are unrelated to menses. In this article, the authors describe a case of a nonmenstruating woman with toxic shock syndrome, associated with cellulitis of her arm. Cultures of the arm grew Staphylococcal aureus, which produced enterotoxin B.
The pathophysiology and treatment of hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp, which constitute the follicular occlusion triad, are reviewed. The unusual occurrence of all three components in a single patient resistant to medical management is presented with a review of the literature. This patient's course was complicated by multiple synchronous squamous cell carcinomas developing in a localized area where his acne conglobata was most pronounced. Although one lesion was clinically obvious, the majority were less suspicious for cancer. Occult cancer should be considered in recalcitrant cases of acne conglobata where isolated areas fail to respond to medical management, particularly when 13-cis-retinoic acid has been used.
Computed tomography (CT) is far superior to plain radiography or xeroradiography in the detection of orbital foreign bodies and in defining altered anatomic relationships in this region. We present a case in which CT was instrumental in the management of orbital cellulitis in a patient who had forgotten that an eye prosthesis had been inserted in the past. We stress the importance of CT in our case and discuss its usefulness in other reported clinical situations involving the orbit.
Most choroidal melanomas are diagnosed when the tumor is still relatively small and confined to the globe. Rarely, these tumors can escape detection and extend through the sclera. They can reach a large size and create significant orbital inflammation. The authors describe a 71-year-old man with orbital cellulitis secondary to a necrotic choroidal melanoma that invaded the orbit. This tumor had minimal intraocular involvement with a large extrascleral component. On histopathologic analysis, the lesion was best classified as a spindle B melanoma with epithelioid areas (mixed melanoma). The patient was treated with an enucleation and postoperative radiation. This report demonstrates that malignancies in the orbit can present as acute infections. Early suspicion, diagnosis, and treatment of these lesions offer the best chance for survival.
Two patients originally diagnosed as having cellulitis involving the dorsum of the foot actually had bacterial arthritis of an underlying joint. In both patients, even after pyarthrosis was suspected, the wrong joint was aspirated. The arthropathies were located by subsequent 99mTc-phosphate bone imaging at a time when roentgenograms were normal. Early diagnosis and aggressive therapy of septic arthritis are essential to prevent joint destruction and osteomyelitis. Radionuclide bone imaging can identify inflammatory joint disease but it cannot specify etiology. In our patients, however, the differential diagnosis was between skin and joint infection. Radionuclide imaging was of great help in making this distinction.
Ga-67 scintigraphy is performed routinely in the anterior and posterior views. A lateral view in the cases presented here enabled differentiation between osteomyelitis and cellulitis.
By a retrospective chart review patients with buccal cellulitis were divided into groups with and without a probable portal of entry of infection at the time of diagnosis. Tooth abscesses or breaks in the skin were the usual portals of entry. Patients with a portal of entry were significantly older (P less than 0.001), had lower white blood cell counts on admission (P less than 0.01) and recovered more rapidly (P = 0.001). Haemophilus influenzae type b was recovered only from those with no portal of entry. Staphylococcus aureus and Streptococcus pyogenes caused infection in both groups but were more frequent in those with a portal of entry. Bacteremia was proved only in the group with no portal, and H. influenzae b grew from 14 to 15 positive blood cultures. All cultures of cerebrospinal fluid yielded no growth. We suggest that patients with no portal of entry on presentation receive initial parenteral therapy for H. influenzae b and Gram-positive cocci. Our current regimen is a combination of a semisynthetic penicillinase-resistant penicillin such as oxacillin and chloramphenicol. Oxacillin alone is indicated for those with a break in the skin leading to infection, whereas penicillin is appropriate for patients with dental infection. This initial therapy should be altered depending upon culture results when available.
Although infectious complications of nephrotic syndrome are common, group B Streptococcus is a rare pathogen in these patients. We present a 4-year-old child with nephrotic syndrome who developed group B streptococcal cellulitis and bacteremia, an association not previously discussed in the literature, and review the factors that predispose patients with nephrotic syndrome to infection.
A previously healthy 13-year-old boy developed extensive subcutaneous emphysema of the lower limb after a penetrating injury to the knee. Clostridium perfringens was isolated from the wound. Despite surgical debridement and appropriate antibiotics, the emphysema recurred, and prolonged antibiotic treatment was required. This case highlights the distinction between gas gangrene and the lesser known entity of clostridial crepitant cellulitis.
An unusual case of orbital cellulitis following blepharoplasty, with resultant blindness in that eye, is presented. The cause is unknown, but the pathogenesis and treatment of this rare complication are discussed. Unilateral severe headache may alert one to the possibility of this rare, but grave, complication.
Dissecting cellulitis of the scalp or perifolliculitis capitis abscedens et suffodiens is a rare, chronic, progressive, suppurative disease of the scalp of unknown etiology. It is characterized by painful nodules, purulent drainage, burrowing interconnecting abscesses, and cicatricial alopecia. The pathogenesis is unknown, although it is probably related to follicular occlusion, secondary infection, and deep inflammation. Black men in their second to fourth decade are predominantly affected. Treatment varies from systemic antibiotics to incision and drainage, x-ray epilation of the affected areas, systemic steroid administration, and surgical excision. Our experience with four patients with extensive scalp disease is presented. Wide excision of the affected areas and splitthickness skin graft are favored as our treatment of choice.
An unusual case of beta-lactamase positive Haemophilus influenzae type b infection is reported. Clinical manifestations included meningitis, a left ankle subcutaneous abscess, and bilateral hand cellulitis. Discussion and review of literature are presented for the previously unreported association of this common childhood pathogen.
Eikenella corrodens was isolated from an orally contaminated hand wound which resulted in cellulitis, osteomyelitis, and arthritis. E corrodens is a gram-negative, microaerophilic bacillus which only lately has received attention as a possible pathogen. The organism grows characteristically as small, corroding, or pitting colonies on blood agar. It typically requires hemin or blood for reliable aerobic growth. Oral contamination of wounds predisposes to infection with E. corrodens. The management of these infections includes treatment with an effective antibiotic and surgical debridement. Because it is gram-negative, microaerophilic, and often difficult to isolate, infections caused by E corrodens may mimic those caused by gram-negative obligate anaerobes. However, E corrodens is resistant to clindamycin and lincomycin and sensitive to most other commonly used antimicrobial agents.
We have described a 2-week-old infant with cellulitis in the left submandibular region due to beta hemolytic Streptococcus, group B, and presented 16 additional cases compiled from the literature.