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At least 109 records · Page 6Linked to original sources
PubMed1998

Blood cultures in the evaluation of children with cellulitis.

OBJECTIVE: To evaluate the yield of blood cultures obtained from immunocompetent children admitted for cellulitis in the post-Haemophilus influenzae type b (Hib) vaccine era and to determine whether these cultures are cost-effective. DESIGN: Retrospective case series. SETTING: Urban pediatric emergency department. Study Population. Patients 2 days to 22 years of age admitted with cellulitis from 1994 through 1995. MEASUREMENTS AND RESULTS: Of 381 patients identified, 266 (70%) had blood cultures and 243 of these children were enrolled. Data recorded include demographics, immunization status, initial clinical appearance, antibiotic pretreatment, preexisting illness, location and precipitating cause of cellulitis, white blood cell count, and band-to-neutrophil ratio (BNR). Blood cultures were categorized as positive, negative, or contaminant. Five cultures (2%) were positive, and 13 (5.4%) were contaminants. The positive blood cultures grew streptococcus and staphylococcus organisms, and none of the children were bacteremic with H influenzae. All patients with group A beta-hemolytic streptococcus had active varicella. The mean age was lower (26 vs 75 months) in those with a positive blood culture, and mean BNR was higher (0.32 vs 0.07). Patient management did not change for bacteremic patients with uncomplicated cellulitis. All repeat cultures were negative. The cumulative charge for all blood cultures was $50 986. CONCLUSIONS: Blood cultures are not cost-effective and are more frequently contaminated than positive in the evaluation of a patient with uncomplicated cellulitis. Since introduction of the H influenzae type b vaccine, the most common organisms are streptococci. Using a BNR = 0.20 as a threshold for sending blood cultures, we would have missed one positive culture, but would have avoided blood cultures in 213 patients (88%) with an estimated savings of $42 850.

Adolescent↗
PubMed2000

Pneumococcal facial cellulitis in children.

OBJECTIVE: To review the epidemiology and clinical course of facial cellulitis attributable to Streptococcus pneumoniae in children. DESIGN: Cases were reviewed retrospectively at 8 children's hospitals in the United States for the period of September 1993 through December 1998. RESULTS: We identified 52 cases of pneumococcal facial cellulitis (45 periorbital and 7 buccal). Ninety-two percent of patients were <36 months old. Most were previously healthy; among the 6 with underlying disease were the only 2 patients with bilateral facial cellulitis. Fever (temperature: >/=100.5 degrees F) and leukocytosis (white blood cell count: >15 000/mm(3)) were noted at presentation in 78% and 82%, respectively. Two of 15 patients who underwent lumbar puncture had cerebrospinal fluid with mild pleocytosis, which was culture-negative. All patients had blood cultures positive for S pneumoniae. Serotypes 14 and 6B accounted for 53% and 27% of isolates, respectively. Overall, 16% and 4% were nonsusceptible to penicillin and ceftriaxone, respectively. Such isolates did not seem to cause disease that was either more severe or more refractory to therapy than that attributable to penicillin-susceptible isolates. Overall, the patients did well; one third were treated as outpatients. CONCLUSIONS: Pneumococcal facial cellulitis occurs primarily in young children (<36 months of age) who are at risk for pneumococcal bacteremia. They present with fever and leukocytosis. Response to therapy is generally good in those with disease attributable to penicillin-susceptible or -nonsusceptible S pneumoniae. Ninety-six percent of the serotypes causing facial cellulitis in this series are included in the heptavalent-conjugated pneumococcal vaccine recently licensed in the United States.

Cellulitis↗
PubMedDate not supplied

Cellulitis in Japanese quail (Coturnix coturnix japonica).

A case of cellulitis was observed in Japanese quail (Coturnix coturnix japonica) reared for commercial meat production. This condition in Japanese quail has not been reported in the literature. This incident was the first, and to date only, occurrence of cellulitis in this processing plant. The cellulitis lesions were localized to the subcutis overlying the breast and inner thigh. Carcasses of processed birds and live birds from the affected farm were presented to the Poultry Diagnostic and Research Center, University of Georgia. Escherichia coli was cultured from the lesion. The affected live birds displayed lameness and had osteomyelitis. Pasteurella multocida serotype 3,4 was cultured from the liver and bone marrow of affected birds. Approximately 4.61% of the processed carcasses from the flock were condemned because of cellulitis. This represented a 10fold increase from the typical condemnation rate. Further investigation revealed birds were placed in higher than normal density; therefore, we theorize that the concurrent pasteurellosis and increased placement density resulted in the cellulitis condition.

Animal Husbandry↗
PubMed1996

Case survey of management of cellulitis in a tertiary teaching hospital.

OBJECTIVE: To examine management of cellulitis in a tertiary teaching hospital, identify inefficiencies and suggest revised management guidelines. DESIGN: Retrospective case survey, based on patient hospital records. SETTING: Heidelberg Repatriation Hospital, Melbourne, Victoria (a tertiary teaching hospital), in 1991 and 1992. SUBJECTS: All patients admitted with lower-limb cellulitis as the primary diagnosis. RESULTS: 118 patients were included. Underlying disease predisposing to cellulitis was found in 79%, but was adequately investigated in only 20% of these. Blood cultures were performed in 55%, all with negative results. Other microbiological investigations also had poor yields. Combination therapy with intravenous (i.v.) flucloxacillin and penicillin was given to 76%, with duration varying widely (mean, six days). Where documented (73%), most patients (94%) responded to antibiotics within five days. However, in 40% of patients i.v. therapy was continued for longer and in 10% for 10 days or more, with no significant difference in outcome. Length of hospital stay averaged 13 days, with prolonged stay often associated with surgical intervention or intercurrent problems. However, 15% of patients remained in hospital longer than 10 days for no clear indication. Outpatient review was common (75%), but persistence or relapse of cellulitis was found in only four patients on review. CONCLUSIONS: Management of inpatients with cellulitis is inefficient, with excessive use of microbiological investigations, inadequate investigation and treatment of underlying disease, prolonged use of intravenous antibiotics, unnecessarily long hospital stays, questionable use of combination antibiotic therapy and excessive outpatient review (rather than review by a local medical practitioner).

Adult↗
PubMed1998

Home-based treatment of cellulitis with twice-daily cefazolin.

OBJECTIVE: To assess the clinical outcome and pharmacokinetics of therapy with cefazolin for patients with cellulitis in a hospital-in-the-home (HIH) program. DESIGN: Observational study with outcome data compared with previously published reports of therapy for cellulitis. SETTING: A university teaching hospital and HIH unit, July 1996-December 1997. PARTICIPANTS: Patients with cellulitis were eligible for inclusion provided their medical condition was stable, they did not require surgical intervention, and their social circumstances allowed home-based therapy. INTERVENTION: Cefazolin 2 g intravenously twice daily, with regular nursing and medical assessment. MAIN OUTCOME MEASURES: Clinical efficacy; peak and trough serum concentrations of cefazolin. RESULTS: Fifty-seven patients (37 were men) with a mean age of 48 years (range, 18-90 years) had 61 episodes of moderate to severe cellulitis (41, lower limb; 17, upper limb; and three, face). They received a median of 11 doses of cefazolin (range, 3-27 doses). Clinical outcomes were: cure in 54, improvement in one, treatment failure in three, and in the remaining three episodes the outcome was indeterminate. Cefazolin concentrations were measured in 27 patients. All peak concentrations were more than 40 micrograms/mL, while trough concentrations were all above the MIC90 of the expected pathogens: median, 3.2 micrograms/mL (range: 0.4-18.5 micrograms/mL). Cefazolin was well tolerated. CONCLUSIONS: Twice-daily cefazolin 2 g intravenously is a convenient and effective option for home-based treatment of patients with cellulitis. Its clinical efficacy is comparable with other treatment regimens.

Administration, Oral↗
PubMed2000

Sonographic evaluation of cellulitis in children.

Within a 3 year period from July 1996 to July 1999, a total of 105 children with clinical diagnosis of cellulitis were evaluated by ultrasonography. Eighty-six children (age range, 17 days to 15 years) fulfilling the sonographic criteria for diagnosis of cellulitis were enrolled into the study. The sonographic features were used to correlate with clinical symptoms and their duration, the peripheral leukocyte count, and the serum C-reactive protein level. Pus aspiration for immediate microscopic and later bacteriologic studies was carried out under sonographic guidance. Ultrasonographic features of cellulitis included subcutaneous tissue thickening without distortion and pus (25 cases, 29%), distortion of subcutaneous tissue without pus accumulation (26 cases, 30%), distortion of subcutaneous tissue with pus accumulation (19 cases, 23%), and distortion of tissue with abscess formation (16 cases, 18%). The presence of sonographic features of tissue distortion with or without pus accumulation, including abscess formation in children with cellulitis, correlated with a longer duration of symptoms (greater than 4 days), the presence of high-grade fever, higher peripheral leukocyte count, and higher serum C-reactive protein levels. Those patients who underwent sonographically guided aspiration or surgical intervention showed a shorter hospital stay and fever duration than those without such aspiration. Our results indicated that ultrasonography is of great value in managing cellulitis by providing information regarding the progression of inflammation. Sonographically guided aspiration of pus may be a treatment of choice, as it may decrease the need for operation.

Adolescent↗
PubMedDate not supplied

Evaluation of scratches as an essential element in the development of avian cellulitis in broiler chickens.

Currently, the published cellulitis models do not adequately address the actual pathogenesis as seen in the commercial broiler industry. In this model, small dermal scratches were made on the skin of broiler chickens, which were then placed on litter seeded with avian cellulitis-associated Escherichia coli. The research confirms scratches are required for the induction of avian cellulitis. The research also confirms that "type I" cellulitis lesions or those previously thought to be due to hatchery-borne infections can be induced with scratches. The described methods provide a realistic model for cellulitis development that will improve the reliability of prophylactic and therapeutic-regimen efficacy testing data, thereby providing information more directly useful to the commercial broiler industry.

Animal Husbandry↗
PubMed1999

Preseptal cellulitis secondary to Proteus species: a case report and review.

BACKGROUND: Preseptal cellulitis is a serious ocular condition that--if left untreated--has the potential to cross the septal barrier, spread to the posterior orbit, and may result in fatal complications. Because it is difficult to determine the pathogen responsible for any cellulitis without aspirating a culture sample, treatment is usually instituted by an assumption of the most common causative organisms, Staphylococcus or Streptococcus. CASE REPORT: A 42-year-old black woman manifested signs and symptoms consistent with right preseptal cellulitis. Throughout treatment, visual acuity remained 20/20 for both eyes, extraocular muscles were unrestricted without pain, and anterior globe structures were clear. The patient was started on a regimen of 250-mg oral dicloxacillin four times a day. When no response was seen at 36 hours, the patient was changed to 500-mg oral ciprofloxacin every 12 hours. She responded to the 500-mg ciprofloxacin and recovered with no sequelae. An abscess, which had formed during the cellulitis, self expressed and this material was cultured. The cultures identified the responsible organism as Proteus species, an unexpected pathogen in a well-groomed patient. CONCLUSION: This case demonstrates the need to consider alternate pathogens when treating preseptal cellulitis, change medications accordingly, and consider alternate treatments as needed.

Adult↗
PubMedDate not supplied

Spatial heterogeneity of Escherichia coli DNA fingerprints isolated from cellulitis lesions in chickens.

Avian cellulitis in broiler chickens is characterized by subcutaneous lesions that result in economic losses because of the partial or complete condemnation of the carcasses at processing. Escherichia coli is the primary causative agent of this condition. Previous research with a biotyping system found that the E. coli of cellulitis origin were unique to each ranch, suggesting that these E. coli were endemic within the ranch environment. The objective of our study was to analyze the genetic variability of E. coli isolates associated with cellulitis. We analyzed the genetic relatedness of the isolates in relation to the houses, ranches, and complexes in which the broilers were grown. This analysis enabled us to assess the spatial heterogeneity, or genetic diversity on a spatial scale, of the isolates. Forty-nine broilers with cellulitis lesions were necropsied. These broilers came from six houses on four ranches on three complexes that had been placed with chicks from the same hatchery within a 2-wk period. Isolates of E. coli from the lesions were DNA fingerprinted by pulsed-field gel electrophoresis. Relatedness among isolates was determined with the Dice coefficient and an unweighted pair group method with average linkages cluster analysis. The complexes possessed isolates with a variety of DNA fingerprints, yet each complex appeared to have isolates with a unique set of DNA fingerprints. Isolates from the same complex tended to form clusters with similarity coefficients greater than 90%. Isolates from different complexes were genetically distinct. This heterogeneity at the level of the complex suggests that isolates were not disseminated from a source common to the complexes. The spatial heterogeneity of the E. coli isolates in this study implies an endemic population of cellulitis-associated E. coli exists in the broiler house environment.

Animals↗
PubMed2000

[Orbital and periorbital cellulitis. Review of 107 cases].

AIM: To report the epidemiology, clinical features, management and complications of orbital and periorbital cellulitis; to evaluate the use of imaging tests in the detection of complications. METHODS: Retrospective study of 107 pediatric patients admitted to the San Joan de Déu Pediatric Hospital with orbital or periorbital cellulitis from January 1991 to January 1999. RESULTS: The incidence of cellulitis was highest in the second year of life and during winter. No significant differences were found between the sexes. In 68 patients (63.6%) the cause of cellulitis was identified as sinusitis. The most frequently identified organisms were Staphylococcus aureus, Streptococcus pneumoniae and S. pyogenes. Computed tomography identified retroseptal damage in 36 patients with 23 super osteal abscesses, 3 orbital abscesses and 3 intracranial complications. Sixty nine percent of the patients were treated with a single antibiotic (cefotaxime, cefuroxime or amoxicillin clavulanic acid) while 31% underwent multiple antibiotic therapy. Only 8.4% required surgery. CONCLUSIONS: Orbital cellulitis is a relatively common and potentially serious disease in children. The early use of CT to assess the extent of damage is important in establishing prognosis and in assessing the need for surgical therapy.

Adolescent↗
PubMed2001

Phenotypic and genotypic characterization of virulence factors of Escherichia coli isolated from broiler chickens with simultaneous occurrence of cellulitis and other colibacillosis lesions.

The objective of this study was to characterize virulence factors of Escherichia coli isolates from broilers with simultaneous occurrence of cellulitis and other colibacillosis lesions. Thirty flocks were sampled and 237 birds with cellulitis were examined. Eighty-two (34.6%) of 237 birds condemned for cellulitis had gross lesions in the heart, air sacs, joints, or liver. In 58 chickens, E. coli was isolated from both the cellulitis and other lesions of colibacillosis, and 18.9% of the E. coli isolates from the 2 types of lesions belonged to the same O group. Escherichia coli of serogroups O78, O1, and O2 predominated. Isolates of the same serogroup that were derived from different lesions in the same birds had similar patterns of biotype, aerobactin production, serum sensitivity profile, antibiotic sensitivity, and K1 capsule production. Escherichia coli derived from cellulitis lesions produced virulence factors similar to those found in E. coli isolated from other colibacillosis lesions in poultry.

Animals↗
PubMed2004

[Orbital cellulitis in children: a retrospective study of 33].

Orbital cellulitis is rare. However the high risk of severe ocular and neurological complications make early diagnosis and adequate therapy essential. The purpose of this retrospective study is to describe 33 cases observed in the pediatric infectious disease department of the Casablanca Children's Hospital in Morocco from 1994 to 2000. Orbital cellulitis was preseptal in 24 patients and retroseptal in 9. Infection occurred in relation with sinusitis in 10 cases, polydermitis in 8, wound infection in 6, ocular infection in 2, and dental abscess in 2. Ages ranged from 40 days to 15 years with a mean age of 5 years. Infants accounted for 25% of cases and always presented preseptal cellulitis. Fever and local edema were noted in all patients. Exophthalmia occurred in six patients and seizures in 2. The 9 cases of retroseptal cellulitis were complicated by empyema in 2 cases, meningitis in 1 case and thrombophlebitis of cavernous sinus with cerebromalacia in 1 case. Bacteriological testing identified micro-organisms in 10 cases, i.e., Staphylococcus aureus in 6 cases, Streptococcus B in 1, Streptococcus pyogenes in 1, Enterobacter Cloacae in land Acinitobacter jejuni in 1 case. Therapy was based on broad-spectrum antibiotics in association with surgery in the patient presenting in intracranial abscess. Ophthalmoplegia-like sequels including blindness, aphasia, and motor deficit occurred in 2 patients. Orbital cellulitis in children are usually preseptal and have a favorable prognosis. However prompt and adequate antibiotherapy is essential due to the risk of retroseptal involvement with inflammatory palpberal edema and possible cerebral extension.

Cellulitis↗
PubMed1989

[Acute infectious cellulitis. Apropos of 28 cases].

Acute infectious cellulitis is a common condition in pediatric patients. We retrospectively studied 28 cases seen over the last four years. Average age of patients was four years. Fever and a decline in general health were often found. Streptococcus pyogenes and Staphylococcus aureus were the most common organisms in our series. Outcome was favorable under early antimicrobial therapy selected according to age and clinical features. Before three months of age, cellulitis suggests a streptococcus B infection and should be treated by ampicillin or parenteral penicillin, combined with an aminoglycoside if called for. Between 4 months and 2 years of age, Haemophilus influenzae b or a pneumococcus are the most likely organisms; Haemophilus cellulitis should be treated by a third generation cephalosporin for ten days or longer, followed by ampicillin or ampicillin-clavulanic acid per os for ten or 15 days. Beyond 2-3 years of age, all organisms may be the cause of cellulitis, but the most likely are Streptococcus pyogenes and Staphylococcus aureus, treatment consists in administration of either a penicillin M or a macrolide, the route being selected according to the general condition and site of the cellulitis.

Acute Disease↗
PubMed1978

Clinical implications of preseptal (periorbital) cellulitis in childhood.

The available hospital records of all pediatric patients diagnosed as having periorbital, preseptal or orbital cellulitis over a five-year period were reviewed and compared to previously reported series. Only two of 39 patients had orbital cellulitis. The 37 patients with preseptal cellulitis had two characteristic clinical presentations. Twenty-two children had local trauma, abscesses, insect bites, or impetigo as the inciting event for their cellulitis. Infection was usually caused by staphylococci or streptococci. In contrast, 15 children, 12 of whom were under 36 months, had associated upper respiratory tract infections and otitis. Haemophilus influenzae was the most commonly implicated pathogen and the children were at risk of bacteremia and metastastic infection. Determination of the location of the infection in the orbit and consideration of the clinical presentation of the patient with infection in and about the orbit are of assistance in choosing appropriate therapy. Young children who have upper respiratory tract symptoms in association with preseptal cellulitis should receive antibiotic coverage for Haemophilus.

Abscess↗
PubMed1981

Cellulitis: treatment with cefoxitin compared with multiple antibiotic therapy.

Cefoxitin, a parenteral cephamycin beta-lactam antibiotic was prospectively evaluated as a single drug alternative in 31 children with cellulitis and the results of therapy were compared retrospectively with those from prevailing multiple antibiotic therapy for cellulitis in 56 children. Periorbital and lower extremity cellulitis accounted for more than 60% of the cases in both study groups. The most common bacterial agents included Haemophilus influenzae, Staphylococcus aureus, and group A beta-hemolytic Streptococcus. In as many as 50% of the cases, no etiologic agent could be found. In addition to blood cultures, cellulitis leading edge aspirate cultures were helpful in establishing the etiologic diagnosis. Of 52 patients sampled in the combined studies, 21% had positive aspirate cultures in the presence of negative blood cultures. The outcome and mean duration of hospital stay were similar in both groups. No severe adverse reactions were encountered. The mean number of antibiotics used in the retrospective study was three (range 1 to 7) whereas cefoxitin alone was used in the prospective study. All organisms isolated in the prospective study were susceptible to cefoxitin. Single antibiotic therapy with cefoxitin appears to be as safe and as effective in the treatment of cellulitis in children as multiple antibiotic therapy.

Anti-Bacterial Agents↗
PubMed1995

[Periorbital and orbital cellulitis in children].

During a six-year period 28 febrile children with acute periorbital swelling were identified. Median age was 1.8 years (range, two weeks-nine years). When possible, the children were classified as having preseptal cellulitis (infectious focus in the subcutaneous tissue in front of the orbital septum) or postseptal cellulitis (focus in the paranasal sinuses). In six children a diagnosis of preseptal subcutaneous cellulitis was based upon the clinical presentation and positive culture results. Five children were additionally classified as having preseptal cellulitis due to severe conjunctivitis. Fifteen children were classified as having postseptal cellulitis due to infection in the paranasal sinuses (ethmoiditis). In seven of the latter cases the diagnosis was based upon the results of CT/MR-scans or operation. Two children could not be classified. All children were given antibiotic treatment and four had an operation. There were no recurrences or sequelae. In our study a presumed diagnosis could be made in retrospect in most cases, but at the time of presentation the clinical picture was often confusing. We found a CT- or MR-scan to be most helpful, especially in identifying the children requiring surgical treatment.

Cellulitis↗
PubMedDate not supplied

A prospective study of cellulitis in broiler chickens in southern Ontario.

This study investigated the associations among cellulitis and hatchery, farm, and abattoir factors. Forty-four broiler flocks from 24 farms located in southern Ontario were followed from hatching to processing. Poisson regression was used to analyze the data. Cellulitis as a count outcome (CELLCOUNT) was significantly associated (P < or = 0.05) with the hatchery of origin, strain of birds, farm size, type of litter, lighting system, total down time, prevalence of abdominal scratches, Escherichia coli-related conditions (SEROSITIS), ascites, and valgus varus deformity. However, only farm size, abdominal scratches, SEROSITIS, ascites, and valgus varus deformity were significant (P < or = 0.05) after adjusting for clustering. No significant associations were found between cellulitis and source of eggs, sex, average bird weight, feed company, growth promoter, or stocking density. Factors significantly associated with cellulitis in this study could be considered as potential risk factors for cellulitis in broiler chickens in southern Ontario.

Animal Husbandry↗
PubMed1996

Cellulitis--an unreported complication of long-term SCI patients.

Major problems for spinal cord injured patients are pressure ulcers, urinary tract infections, and pain management. However, an unreported complication is cellulitis. A retrospective chart review for the calendar year 1993 revealed 312 cases of cellulitis identified as either a primary or secondary diagnosis. Cellulitis was identified more than once for some of the patients in this sample. A review of the literature showed limited citations specific to the spinal cord injured population. This paper analyzes the reported cases for the period of January 1, 1993 through December 31, 1993. The cellulitis diagnosis is examined with the following variables: frequency of occurrence, skin integrity impairment, presence of infection, septicemia, thrombophlebitis, length of hospitalization, rate of recurrence, and area of contact. This data suggest that cellulitis is an important complication to the spinal cord injured patient. However, additional research is needed to provide predictive value. This analysis provides information to SCI nurses to enhance knowledge and understanding of risk factors and develop patient teaching methods for management and prevention.

Adult↗