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PubMed2006

Cellulitis in childhood invasive pneumococcal disease: a population-based study.

AIM: There are few detailed data on the age-specific incidence and clinical pattern of pneumococcal cellulitis in children. We conducted a retrospective review of cellulitis as a subset of prospectively collected laboratory-identified invasive pneumococcal disease (IPD) and performed a systematic review of published literature. METHODS: Prospective laboratory surveillance in urban regions of New South Wales, Australia, 1 June 1997-31 December 2001. Medical notes reviewed for each identified case and defined literature search strategy applied. RESULTS: There were 1067 cases of IPD in children aged 0-17 years; 38 (3.3%) were cellulitis (32 periorbital, 6 buccal). Compared with other types of IPD, a greater proportion of cellulitis cases occur in children<2 years (30/38, 79% vs. 617/1029, 60.0%; P=0.004) in whom underlying illness was less common (0/30, 0% vs. 53/590, 9%; P=0.06). Initially, another diagnosis was made in 13 (34%) of cases; only five had a lumbar puncture, all normal. Of the 239 cases of pneumococcal cellulitis documented in the literature, 28 (11.7%) had the diagnosis made by means other than positive blood culture and 95% were facial or orbital with underlying illness (6%) and associated meningitis (1.9%) uncommon. CONCLUSION: Cellulitis is an uncommon focus in IPD in children, and is almost always facial. Most cases occur under 2 years of age, are seldom associated with meningitis or other complications, and are frequently not recognised on admission.

Adolescent↗
PubMed2004

Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital.

OBJECTIVES: To compare the efficacy, safety, and acceptability of treatment with intravenous antibiotics for cellulitis at home and in hospital. DESIGN: Prospective randomised controlled trial. SETTING: Christchurch, New Zealand. PARTICIPANTS: 200 patients presenting or referred to the only emergency department in Christchurch who were thought to require intravenous antibiotic treatment for cellulitis and who did not have any contraindications to home care were randomly assigned to receive treatment either at home or in hospital. MAIN OUTCOME MEASURES: Days to no advancement of cellulitis was the primary outcome measure. Days on intravenous and oral antibiotics, days in hospital or in the home care programme, complications, degree of functioning and pain, and satisfaction with site of care were also recorded. RESULTS: The two treatment groups did not differ significantly for the primary outcome of days to no advancement of cellulitis, with a mean of 1.50 days (SD 0.11) for the group receiving treatment at home and 1.49 days (SD 0.10) for the group receiving treatment in hospital (mean difference 0.01 days, 95% confidence interval -0.3 to 0.28). None of the other outcome measures differed significantly except for patients' satisfaction, which was greater in patients treated at home. CONCLUSIONS: Treatment of cellulitis requiring intravenous antibiotics can be safely delivered at home. Patients prefer home treatment, but in this study only about one third of patients presenting at hospital for intravenous treatment of cellulitis were considered suitable for home treatment.

Adolescent↗
PubMed2007

Analysis of empiric antimicrobial strategies for cellulitis in the era of methicillin-resistant Staphylococcus aureus.

BACKGROUND: The rise in community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections potentially complicates the empiric management of cellulitis. The threshold at which drugs active against MRSA, such as clindamycin and trimethoprim/sulfamethoxazole (TMP/SMX), should be incorporated into empiric therapy is unknown. OBJECTIVE: To evaluate the cost-effectiveness of using cephalexin, TMP/SMX, or clindamycin for outpatient empiric therapy of cellulitis, given various likelihoods of infection due to MRSA. METHODS: A decision analysis of the empiric treatment of cellulitis was performed from the perspective of a third-party payer. The model included initial therapy with cephalexin, clindamycin, or TMP/SMX, followed by treatment with linezolid in cases of clinical failure. Probability and cost estimates were obtained from clinical trials, epidemiologic data, and publicly available cost data and were subjected to sensitivity analysis. RESULTS: Under the base-case scenario (37% probability of infection by S. aureus and a 27% MRSA prevalence), cephalexin was the most cost-effective option. Clindamycin became a more cost-effective therapy at MRSA probabilities from 41-80% when the probability of staphylococcal infection was greater than 40%. TMP/SMX was cost-effective only at very high likelihoods of MRSA infection. Variables with the most influence in the model were probability of S. aureus being methicillin-resistant, cost of linezolid, probability of a cure with cephalexin for a non-MRSA infection, and probability of infection due to S. aureus. CONCLUSIONS: Cephalexin remains a cost-effective therapy for outpatient management of cellulitis at current estimated MRSA levels. Cephalexin was the most cost-effective choice over most of the modeled range of probabilities, with clindamycin becoming more cost-effective at high likelihoods of MRSA infection. TMP/SMX is unlikely to be cost-effective for treatment of simple cellulitis. Further studies of the microbiology of cellulitis, the epidemiology of MRSA, and the clinical effectiveness of clindamycin and TMP/SMX in skin and soft tissue infections are needed.

Anti-Infective Agents↗
PubMedDate not supplied

Computed tomographic patterns of orbital cellulitis due to sinusitis.

PURPOSE: To describe the CT findings of orbital cellulitis due to sinusitis. METHODS: The records and CT scans of 45 consecutive patients with orbital cellulitis due to sinusitis treated at the Hospital of the Medical School of Ribeirão Preto were analyzed by a radiologist and two orbital surgeons. RESULTS: Three major types of CT changes were observed: diffuse fat infiltration, subperiosteal abscess and orbital abscess. Diffuse fat infiltration (characterized by an increased density of the extra- or intraconal fat) was seen in 11 patients (24.44%). A subperiosteal abscess was diagnosed in 28 patients (62.23%). A surgically proved orbital abscess was detected in 6 patients (13.33%). CONCLUSIONS: In all cases of orbital cellulitis due to sinusitis intraorbital changes can be detected by CT scans either as a diffuse infiltration of the orbital fat or as a detachment of the periorbita (subperiosteal abscess) or a true orbital abscess. Category I of Chandler orbital cellulitis classification (inflammatory edema) must be understood as a stage of a process that is already happening within the orbit and, as the term "preseptal cellulitis" means a palpebral infection, this designation should not be used to stage orbital cellulitis.

Adolescent↗
PubMed1992

Escherichia coli cellulitis: two cases.

We report two cases of cellulitis of the legs occurring in adults where Escherichia coli (E. coli) was, or probably was, the causative bacterial agent. E. coli and other gram-negative bacilli cellulitis are rarely reported. However, in cellulitis, the causative microorganism is rarely identified, and some cases of E. coli cellulitis could be unrecognized. Furthermore, classical risk factors for gram-negative sepsis are characterized by a state of leucocyte dysfunction which could explain the possibility of a severe, even lethal, course of gram-negative cellulitis. Therefore, the occurrence of cellulitis in patients with risk factors should prompt attempts at isolating the pathogenic microorganism, and a broad spectrum of antibiotic therapy should be initiated.

Aged↗
PubMed2001

[Cellulitis and soft tissue infection in patients with HIV disease: epidemiological and microbiological features].

In order to assess the epidemiological, microbiological, and clinical features of cellulitis and soft tissue infection occurring during the course of HIV disease, clinical and laboratory data of 2221 hospitalizations carried out since 1991 were retrospectively examined, and 67 bacteriologically-proven episodes of cellulitis-soft tissue infection were identified (3.02% of overall admissions). Among the 92 cultured pathogens, Staphylococcus aureus was the most frequent (46 cases), followed by Pseudomonas spp., Escherichia coli, and Streptococcus pyogenes; 38.1% of patients had a polymicrobial infection. i.v. drug use (p<.02) and the male gender (p<.05), were significantly associated with the occurrence of these complications, while a great variation in the severity of underlying immunodeficiency was shown. An elevated rate (83.6%) of episodes of cellulitis or soft tissue infection were community-acquired in origin; the comprehensive frequency of these episodes significantly dropped during the highly active antiretroviral therapy (HAART) era (p<.01). Limbs were involved in over 80% of episodes, and an hematogenous dissemination of bacterial infection (which occurred in 25.4% of cases), proved significantly related to a CD4+ lymphocyte count <100 cells/microL (p<.03), and an absolute neutrophil count <1000 cells/microL (p<.05). S. aureus strains showed an elevated in vitro resistance rate to penicillin, ampicillin, and rifampin, and a 21.7% rate of methicillin-resistance, while among the 29 gram-negative microorganisms, resistance to ampicillin and first-generation cephalosporins, and that to amoxycillin-clavulanate and second-generation cephalosporin, occurred in over 90% and 60% of tested strains, respectively. All episodes of HIV-associated cellulitis and soft tissue infection were favorably treated in 5-16 days, in over 60% of cases with associated beta-lactam and aminoglycoside antibiotics; a recurrence of staphylococcal cellulitis occurred in 4 patients only, 6-17 months after the initial episode. Cellulitis and soft tissue infection are underestimated complications of HIV disease, but they have a broad etiological and clinical spectrum, are predominantly community-acquired, and are responsible for an appreciable morbidity, due to the supporting role of i.v. drug addiction, and the frequent hematogenous dissemination (which proved to be significantly related to the progression of immunodeficiency and underlying disease). The frequent polymicrobial etiology requires a combination antimicrobial therapy (to be guided by in vitro susceptibility studies), which may avoid a complicated and recurrent disease course in the great majority of cases.

Adult↗
PubMedDate not supplied

Cellulitis resulting from infection by Haemophilus influenzae type b: report of two cases.

Cellulitis resulting from infection by Haemophilus influenzae type b (Hib) is uncommon but may be a characteristic of such infection. Especially in the post-Hib vaccine era, such infection represents a potentially life-threatening infectious process due to the relatively high incidence of accompanying bacteremia and meningitis. Here, we report on two apparently previously healthy children who developed Hib cellulitis, one of whom revealed lower-leg cellulitis while the other exhibited buccal cellulitis associated with an oral ulcer. To the best of our knowledge, there have been no formal reports pertaining to buccal cellulitis following infection by Hib yet published in Taiwan, and reports of Hib cellulitis of the extremities still appear to be rare, hence we report on these two cases.

Amoxicillin↗
PubMed2005

Rapid resolution of cellulitis in patients managed with combination antibiotic and anti-inflammatory therapy.

There is some evidence to suggest that host inflammatory response has some effect on the clinical manifestations of cellulitis. The objective of this pilot study was to investigate whether the addition of oral nonsteroidal anti-inflammatory (NSAI) therapy to antibiotic treatment hastens resolution of cellulitis-related inflammation. Patients presenting in the emergency department with signs and symptoms of class II cellulitis were assigned to receive treatment with either antibiotic therapy alone (intravenous, supplemented with oral cephalexin or an equivalent) for 10 days (n = 33) or antibiotic therapy for 10 days plus an oral anti-inflammatory (ibuprofen 400 mg every 6 hours) for 5 days (n = 31). Patients were discharged as soon as possible to complete their therapy on an outpatient basis. The addition of an oral anti-inflammatory agent significantly (P < .05) shortened the time to regression of inflammation and complete resolution of cellulitis. Twenty-four of 29 evaluable patients (82.8%) who received supplemental anti-inflammatory treatment showed regression of inflammation within 1 to 2 days compared with only 3 of 33 patients (9.1%) treated without an anti-inflammatory in the same time frame. All patients receiving adjunctive anti-inflammatory treatment experienced complete resolution of cellulitis in 4 to 5 days or less, while 24.2% (8/33) of patients treated with antibiotic alone required 6 to 7 days, and 6.1% (2/33) required 7 days or more (P < .05). This small preliminary study provides some promising data, suggesting that the supplemental use of anti-inflammatory therapy may hasten the time to regression of inflammation and complete resolution of cellulitis.

Anti-Bacterial Agents↗
PubMed1982

[Phlegmona ("cellulitis") and Haemophilus influenzae meningitis].

Soft tissue inflammation is a rare manifestation of H. influenzae infection. It is known in the anglo-american literature as "cellulitis". Usually there is concomitant bacteremia or septicemia. The combination of cellulitis and meningitis is rare and not well known in German pediatric literature. Three children with facial cellulitis together with H. influenzae meningitis are described. In comparison to the literature some unusual observations were made: Early appearance of cellulitis at the age of six weeks in two infants, cellulitis of the lower extremities at the same time in one, and biphasic course with cellulitis and meningitis secondary to mastoiditis in another infant.

Ampicillin↗
PubMed1996

[Severe orbital cellulitis: therapeutic results in 9 patients and review of the literature].

BACKGROUND: Orbital cellulitis can produce severe neuromeningeal infections. Modern antimicrobial agents such as imipenem can be a valid therapeutical choice. METHODS: Patients with severe or complicated orbital cellulitis admitted to our hospital from 1986 through 1994 were retrospectively studied. RESULTS: Nine patients with severe orbital cellulitis, seven of them older than 14 years, are reported. Cellulitis was secondary to different forms of sinusitis in five of them. The incriminated microorganisms were: Streptococcus viridans alone or combined to gram negative bacilli (3 cases), Prevotella melaninogenica and other anaerobes (2 cases), Enterococcus faecalis and Staphylococcus aureus (one case each). Three patients developed brain abscesses, one an acute bacterial meningitis and another a subdural empyema. Eight patients underwent a surgical drainage. Seven patients were treated with IV imipenem at doses of 2-3 g/day with complete cure of the orbital cellulitis and of the associated infectious complications and no secondary effects. Two patients died. CONCLUSIONS: Imipenem is an effective antibiotic in the combined medical-surgical treatment of the severe or complicated orbital cellulitis.

Adolescent↗
PubMedDate not supplied

A reproducible model for the induction of avian cellulitis in broiler chickens.

Avian cellulitis was reproduced in 39-day-old broilers by subcutaneous injection of Escherichia coli originally isolated from a cellulitis lesion. One hundred percent of the birds injected with the isolate on the dorsal and ventral surfaces developed characteristic fibrino-caseous plaques. A slightly lower percentage (90%) of the birds injected subcutaneously in the inguinal area developed the same lesions. Only 30% of the birds that had been inoculated by scratching the skin and swabbing the bacterial inoculum onto the wound developed the lesion. No birds inoculated by swabbing the inoculum onto a feather follicle, from which the feather had been pulled, developed cellulitis. Characteristic cellulitis plaques could be produced as early as 18 hr postinfection (PI). Lesions, consisting of a serosanguinous, yellow-pink-to-orange-tinged fluid appeared as early as 6 hr PI. The lesions progressed, changing to a more thin, yellow, purulent fluid by 12 hr PI followed by plaque formation. Although there was a trend for lesion size to diminish with time, the majority of the challenged birds, examined as late as 3 wk PI, still had prominent cellulitis plaques. Lesions in birds injected subcutaneously on the dorsal surface sometimes extended into other regions of the body, including the abdominal region, and thereby resembled the type of lesions that have previously been described as type I or hatchery-borne cellulitis.

Animals↗
PubMedDate not supplied

Cellulitis in broiler chickens: epidemiological trends, meat hygiene, and possible human health implications.

The present work evaluates trends in the incidence of cellulitis during the last decade using Canadian National Poultry Condemnation Records. In 1986, only 0.048% of the total slaughter broilers were condemned as a result of cellulitis lesions. Over the next 10 yr, steady increments in cellulitis condemnations were observed, and between 1986 and 1996, the percentage of cellulitis condemnation increased 11.8-fold. In 1996, more than 2.6 million broilers (0.568% of total slaughter) were condemned due to cellulitis; this constituted 30.1% of total condemnations, making it the number one condemnation category in 1996. In the context of dynamic increase in cellulitis, the problems concerning meat hygiene and possible health risk to the consumer are deliberated.

Abattoirs↗
PubMed1976

Cellulitis due to Haemophilus influenzae type B. Antigenemia and antibody responses.

The techniques of serum countercurrent immunoelectrophoresis, hemagglutinating (HA), and bactericidal (BC) antibody determinations were applied to seven patients with Haemophilus influenzae type B cellulitis. Capsular antigen was detected (greater than or equal to 10 ng/ml) in two patients at the time of admission and was found in two additional patients two days following hospitalization. Antibody responses in the patients with cellulitis were deficient, similar to those in children under 2 years of age with H influenzae type B meningitis. One of the patients with cellulitis had HA and BC antibody present in convalescent serum, and two additional patients demonstrated BC activity. The clinical presentations of our patients were typical except that violaceous discoloration of overlying skin was noted in only one of the seven. Two additional patients had atypical facial swelling that closely resembled angioneurotic edema and initially led to incorrect diagnosis. Countercurrent immunoelectrophoresis may be helpful in the diagnosis of patients with Haemophilus cellulitis, particularly if serial serum determinations are performed. Bacterial cultures obtained from blood and aspirates of the lesion appear to be more sensitive in determining the cause of H influenzae type B cellulitis.

Antibodies, Bacterial↗
PubMed1998

Delayed cellulitis associated with conservative therapy for breast cancer.

BACKGROUND AND OBJECTIVES: Delayed breast cellulitis is an infrequently reported entity after conservation therapy for breast cancer. We describe our experience with this entity at Naval Medical Center, San Diego. METHODS: Eight patients who presented with delayed cellulitis after wide local excision/axillary dissection and breast radiotherapy (RT) are presented. Their clinical characteristics and therapy are described and possible causative factors are analyzed. RESULTS: The latency of breast cellulitis is variable after breast conservation therapy, although most cases in our experience and in the literature occur within a year post-RT. These infections are frequently refractory to a single course of antibiotics (n = 4 cases in our experience). Some patients suffer multiple episodes separated by months. CONCLUSIONS: Breast cancer patients are at risk for delayed cellulitis after conservative surgery and RT. The mechanism of such events probably involves lymph stasis, however, therapy is no different from the more frequently occurring cases of cellulitis presenting perioperatively.

Aged↗
PubMed2006

Risk factors for bacteremia in patients with limb cellulitis.

The aim of this study was to identify the risk factors for bacteremia in patients with limb cellulitis. Using the administrative and microbiology laboratory databases of a community teaching hospital, a review was conducted of all cases of community-acquired limb cellulitis that occurred during the period 1997-2004 and in which blood cultures had been performed. A comparison of demographical, clinical, and analytical data of patients with bacteremia versus patients without bacteremia was performed by univariate and multivariate analyses. Of 2,678 patients with cellulitis who presented to the hospital's emergency department, 308 were diagnosed with limb cellulitis and had blood cultures. Of these, 57 (18.5%) had bacteremia. In 24 of the 57 (42.1%) patients with bacteremia, the microorganism isolated in blood cultures was non-group-A beta-hemolytic Streptococcus, and in another 14 (24.6%), the microorganism identified was a gram-negative bacterium. Staphylococcus aureus was determined as the cause of bacteremia in just 6 (10.5%) patients and group A Streptococcus in 2 (3.5%). By logistic regression analysis, the following factors were associated with bacteremia: absence of previous antibiotic treatment (OR 5.3, 95% CI 1.4-20.3), presence of two or more comorbid factors simultaneously (OR 4.3, 95% CI 1.6-11.7), length of illness<2 days OR 2.44, 95% CI 1.07-5.56), and proximal limb involvement (OR 6, 95% CI 3.03-12.04). Patients with limb cellulitis who exhibit any of these characteristics are at increased risk of bacteremia. In such patients, it is imperative that blood cultures be performed.

Adolescent↗
PubMed2001

Spontaneous gram-negative cellulitis in a liver transplant recipient.

A 47-year-old liver transplant recipient developed fever and cellulitis on the 8th post-transplant day. The clinical appearances were of a rapidly advancing cellulitis. The patient had a past history of severe peripheral edema and hypoalbuminemia. Blood cultures and skin biopsy grew Escherichia coli. To our knowledge, this is the first reported case of E. coli cellulitis in a liver transplant recipient. However, cases have previously been described in patients with cirrhosis or idiopathic nephritic syndrome, conditions which share predisposing features of peripheral edema and hypoalbuminemia. Bacteremic gram-negative cellulitis should be considered in compromised patients with unusual presentations of cellulitis.

Biopsy↗
PubMed1977

Bacteremic hemophilus influenzae type B cellulitis in the adult.

Described herein are three patients over the age of 50 years who had cellulitis of the neck and the upper portion of the chest, associated with Hemophilus influenzae type B bacteremia and respiratory tract infection--particularly that of the upper airway. Only one of the patients with cellulitis had the classic bluish-purple hue commonly seen in children affected with this syndrome. In the other two, the H. influenzae type B cellulitis could not be distinguished clinically from the more common group A streptococcal or staphylococcal cellulitis. Since the antibiotics employed in treating patients with infection due to the latter two organisms differ significantly from those used to treat patients with H. influenzae type B infection, the possibility of disease due to H. influenzae type B must be considered in any adult or child in whom cellulitis of the neck, chest and possibly face is associated with a respiratory tract infection, especially of the upper airway.

Aged↗
PubMed1985

Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise.

Cellulitis occurring in the limbs of patients who have previously undergone saphenous venectomy and coronary bypass surgery has been the subject of several recent reports. Although isolation of pathogenic microorganisms from these lesions has been uncommon, this report describes three patients who had undergone venectomy previously and in whom non-group A beta-hemolytic streptococci were recovered either during acute episodes of cellulitis or during quiescent intervals. There are to date only four other reported cases of post-venectomy cellulitis from which beta-hemolytic streptococci were isolated: one was non-group A and the others were not serologically characterized. Moreover, studies in patients without bypass who have experienced cellulitis in extremities with compromised venous and/or lymphatic circulation have also yielded a substantial number of non-group A streptococci. The data thus far implicate non-group A beta-hemolytic streptococci as a major cause of cellulitis, especially in the setting of circulatory compromise.

Adult↗