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Orbital cellulitis and abscess are known complications of ethmoiditis in children, but they are very rare in the newborn. The authors report a case of orbital abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) in a four-week-old neonate born four weeks prematurely.
We present a case report of an aggressive natural killer T cell lymphoma in a police officer who presented with combined features of orbital cellulitis and mid-facial destruction. However, his initial diagnosis was confused with other disease conditions that had overlapping features. This emphasizes the significance of clinical alertness and adequate tissue sampling; this can have a great impact on early diagnosis and treatment.
We describe a case of preseptal cellulitis that presented initially to the ophthalmology department in our hospital. Neisseria gonorrhoeae, a very rare cause of this common condition, was isolated from a swab and the patient successfully treated with appropriate therapy. We review some aspects of non-sexual transmission as the patient denied recent sexual contact and we were unable to isolate the organism from any other site.
We report 16 cases of erythematous eruption on the skin within the flaps of the surgical incision after primary total hip replacement over an eight-year period. The symptoms began within nine months of operation in 13 hips, and two to three years after in three. Four patients had recurrent episodes. All were treated with antibiotics (15 intravenous, one oral) with complete resolution of the eruption within one to six days. The mean follow-up after the last episode of cellulitis was 27 months (14 to 76). There were no cases of periprosthetic sepsis or other sequelae.
BACKGROUND: Linezolid is an oxazolidinone antimicrobial with excellent oral bioavailability and tissue penetration and is active against multidrug-resistant skin/soft tissue pathogens. OBJECTIVE: To study the pharmacokinetics and antibacterial activity of linezolid against selective skin/soft tissue pathogens in obese patients. METHODS: We obtained multiple serum samples from 7 obese patients (>50% over their calculated ideal body weight) receiving oral linezolid 600 mg every 12 hours for treatment of cellulitis. Following a minimum of 3 doses, serum concentrations of linezolid were measured in each subject prior to (trough) and 1 and 6 hours after a dose. These samples were then tested against clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) (linezolid minimum inhibitory concentrations [MICs] 1.0, 2.0, 4.0 microg/mL) and one strain each of vancomycin-resistant Enterococcus faecium (VRE) (MIC 2.0 microg/mL), Bacteroides fragilis (MIC 2.0 microg/mL), and Peptostreptococcus magnus (MIC 1.0 microg/mL). Serum inhibitory titers (SITs) and bactericidal titers (SBTs) were measured at each time point, and the median activity for these 7 patients was calculated. RESULTS: Mean linezolid serum concentrations were 4.2, 12.3, and 7.2 microg/mL at these respective time points. Median SITs for 12 hours (100% of the dosing interval) were observed against each organism with the exception of the least susceptible strain of MRSA (MIC 4.0 microg/mL); serum inhibitory activity was observed only at the one-hour time point against this isolate. Furthermore, prolonged (> or =6 h) median SBTs were observed against one isolate of MRSA (MIC 1.0 microg/mL) as well as the strain of VRE and P. magnus. CONCLUSIONS: Serum concentrations of oral linezolid in this patient population were diminished compared with those of healthy volunteers, but still provided prolonged serum inhibitory activity against common pathogens associated with skin/soft tissue infections. One treatment concern would be an obese patient receiving oral linezolid who was infected with a less susceptible (MIC > or =4.0 microg/mL) strain of S. aureus. Bactericidal activity was also observed against selective pathogens.
An infant who presents with acute, unexplained crying requires a thorough examination to identify the source of distress. We report the case of a 5-week-old infant who had sudden irritability and was found to have retropharyngeal cellulitis caused by group B Streptococcus.
The variation in the sonographic appearances of superficial soft-tissue infections probably reflects a continuous process that leads from soft-tissue edema, seen in cellulitis, to a fully developed abscess and that depends on the type of infection or the immune status of the host. We describe the sonographic findings seen in this process and the variable appearance of abscesses, with emphasis on scanning techniques that facilitate the diagnosis of liquefaction.
A case of eosinophilic cellulitis (Wells' syndrome) in association with ascariasis is described. The clinical and histopathologic features of the patient responded well to an oral anthelminthic drug. According to our search, this association has not previously been reported.
Two horses were examined for large head wounds suspected to be the result of trauma and characterized by extensive necrosis of the skin and subcutaneous tissue, with abundant purulent exudate. Corynebacterium pseudotuberculosis was isolated from the facial wounds in both horses. Histopathologic examination revealed severe suppurative cellulitis and panniculitis with fistulous tracts and granulation tissue in 1 horse. Both horses were treated with local wound care, nonsteroidal anti-inflammatory drugs, and administration of antimicrobials. The concept of moist wound care was used in the second horse, with products that have recently become available for veterinary wound management. Outcome in both horses was good.
Vibrio vulnificus is a virulent marine organism commonly found in Hong Kong coastal waters which contaminates local sea-food. It may produce a primary septicaemia, often associated with secondary skin lesions, following ingestion of raw shell fish. We report a rapidly fatal case of primary V. vulnificus septicaemia in a 50-year-old housewife with post-hepatitic cirrhosis presenting as spontaneous necrotising cellulitis of the legs. V. vulnificus infection should be considered in patients with a history of liver disease with acute septicaemia and characteristic skin lesions.
A 74-year-old man with multiple myeloma developed facial and cervical cellulitis and severe sepsis as a complication of surgery (alar region basal cell carcinoma). The etiological agent was, surprisingly, penicillin-resistant Streptococcus pneumoniae (PRSP). The patient successfully received 16 days of antibiotics. Amoxicillin was given as monotherapy during the last 14 days of treatment. PRSP can be responsible not only for otitis media, pneumonia or meningitis, but also for various other types of infection in patients with predisposing factors.
We describe a case of rapidly progressive necrotizing cellulitis in an immunocompromised farmer caused by Bacillus cereus, and review 15 additional cases of serious soft tissue infection due to this organism reported in the English language literature. These cases illustrate the potential for B. cereus to cause fulminant soft tissue disease indistinguishable from that caused by clostridia.
Bacteremia caused by Plesiomonas shigelloides is a rare event, often associated with consumption of seafood and fresh or estuarine water in temperate or tropical climates. Most patients have showed underlying health disorders. Here we present a case of P. shigelloides septicaemia and cellulitis of the left hand associated with fish handling in Northern Sweden (65 degrees latitude north). The patient, who suffered from multiple myeloma, recovered uneventfully after initial treatment with intravenous cefuroxime followed by a course of oral ciprofloxacin. P. shigelloides seems to be ubiquitous in freshwater world-wide and may cause invasive infections also in cold climate areas.
Described is an adult with acute epiglottitis, cellulitis of the neck and chest, and Streptococcus pneumoniae bacteremia. Although this syndrome is usually associated with Haemophilus influenzae type b, this case illustrates that in adults a similar syndrome can be produced by S. pneumoniae. The failure to determine an etiologic agent in approximately two thirds of reported adult cases of epiglottitis raises the question as to whether S. pneumoniae, a common adult respiratory pathogen, might fill this etiological void. To establish such an association between S. pneumoniae and acute epiglottitis would be further impetus to immunize patients against S. pneumoniae.
Vibrio vulnificus is a naturally occurring, salt-water bacteria found in estuarine and coastal waters worldwide. It prefers low salinity and warm water temperatures for optimum growth. Infection from Vibrio vulnificus is uncommon, although it has been reported from many locations (e.g. southern United States of America, Israel, Republic of Korea, Japan, Taiwan, Spain, Turkey). It can be serious and life threatening, causing septicaemia and wound infections. This paper reports a case of septicaemia secondary to Vibrio vulnificus cellulitis in an elderly woman. The infection was acquired after wading in a coastal lagoon with a pre-existing superficial leg wound.
A unique case of enterobiasis presenting as recurrent cellulitis and a perianal mass in a six-year-old girl is reported. Complicated perianal lesions due to Enterobius are unusual. Only 10 previous cases are known, with unclear pathogenesis in most of them, although mucosal breaches and perianal crypt or gland entry have been postulated. The association of the mass in this case with a deep crypt, and the histopathologic finding of squamous epithelium focally surrounding the granulomatous reaction to the Enterobius eggs suggest that the worm entered the perianal tissues via a crypt. Local secondary bacterial infection can cause significant morbidity. Surgical excision of such granulomatous mass lesions is necessary in symptomatic or complicated cases.
Necropsy was performed on a sea lion (Zalophus californianus wollebaeki), sacrificed in an advanced (pre-terminal) stage of disease, possibly represenatative of the Galapagos epizootic of 1970-71. Predominant features of the disease were nonumbilicated multiple suppurative cutaneous nodules, debilitation and loss of motor power. Histopathological studies of the skin lesions disclosed suppurative cellulitis, with leucocytic invasion extending, in some instances, to all layers of the epidermis. Pseudomonas aeruginosa was recovered from cultures of blood and pus.
An 83-year-old non-immunocompromised man who developed Haemophilus influenzae cellulitis on his lower left leg is described. H. influenzae type b was isolated by conventional bacteriological cultures from one blood culture and from a cutaneous blister fluid aspirate, and identified within the dermis by immunofluorescence on a punch biopsy of lesional skin. Evolution was characterized by a slow healing during appropriate systemic antibiotherapy, and absence of any significant increase in antibodies to the capsular polysaccharide of H. influenzae type b.