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PubMed1997

Cellulitis after hip surgery: long-term follow-up of seven cases.

Cellulitis of the buttock after hip surgery is rarely reported, but raises concern about possible infection of the implant. In view of this we have investigated the frequency of previous hip surgery in patients with cellulitis of the hip and/or buttock and assessed for any predisposing factors. A review was made of the case notes of all patients admitted to our department with infectious cellulitis of the hip and/or buttock between 1981 and 1995. Seven of nine patients previously had had implantation of a hip prosthesis. The interval between skin infection and surgery was 7-9 weeks in two patients and 55-520 weeks in five. No infection of the implant was evident. The assumed portals of entry were gluteal fold intertrigo, tinea pedis, psoriatic plaque and a carbuncle of the buttock. The infection was successfully treated by intravenous antibiotics and, after a follow-up of a mean 64 months, no recurrence of cellulitis has been observed and only one aseptic loosening has occurred. Infectious cellulitis of the hip or buttock following hip surgery can occur secondary to impaired lymphatic drainage, a few weeks up to several years after surgery, without there being any infection of the orthopaedic implant.

Aged↗
PubMedDate not supplied

Escherichia coli associated cellulitis in broilers: correlation with systemic infection and microscopic visceral lesions, and evaluation for skin trimming.

In Alberta, cellulitis condemnations average 0.5% and are among the highest in Canada. Presently, all cellulitis-affected birds are condemned for fear of systemic infections and public health implications. In a slaughterhouse sample of 102 birds condemned with cellulitis, Escherichia coli was isolated from 83.3% of the lesions. All hearts were cultured and from 11.2% E. coli was recovered. Gross lesions of perihepatitis, infected oviducts, and arthritis were found in 11.2%, 6.7%, and 2.9% of the birds, respectively. Serotyping suggested that visceral infection occurs independent of cellulitis in at least half of the cases. There was no correlation between microscopic visceral lesions and positive bacterial cultures. Two E. coli isolates of serogroup 0157 produced no toxin and neither isolate produced CS31A, F107, or F1845 fimbriae. Cellulitis lesions ranged from 0.55 to 218.9 cm2. All lesions under 16 cm2 and 64% of lesions up to 48 cm2 were considered suitable for trimming.

Alberta↗
PubMedDate not supplied

Orbital and periorbital cellulitis in children.

The proper management of patients with orbital and periorbital cellulitis represents a distinct challenge to the clinician. A retrospective study is presented of 165 patients with the diagnosis of orbital or periorbital cellulitis admitted to the Children's Hospital of Philadelphia (CHOP) from January 1975 through December 1980. Sinusitis, trauma, local skin inflammations, and otitis were the most common etiologies. Twenty-three of the patients had orbital cellulitis, all of which were secondary to sinusitis. There was one death in this series. No patients had permanent ocular sequelae related to orbital or periorbital cellulitis. A discussion of etiology and management is presented, with emphasis on the usefulness of computerized tomography (CT).

Adolescent↗
PubMed1988

Orbital cellulitis due to mucormycosis. A case report.

A case of orbital cellulitis caused by mucormycosis developed in a patient subsequent to cataract extraction and during systemic steroid treatment for postoperative complications. Fatal mucormycosis is a rare disease usually beginning with a subcutaneous inflammatory lesion. As the subsequent development of orbital cellulitis is very rare, little has been published on this subject. In cases of subcutaneous mucormycosis, the diagnosis can easily be made by means of histologic examination of the lesion. However, early diagnosis is difficult in cases with orbital involvement, because the most common cause of orbital cellulitis is bacterial. Thus, orbital cellulitis caused by mucormycosis is often wrongly treated with antibacterial agents only, as histologic examination is neither easy nor part of any routine investigation. Therefore, a combined treatment using antibiotics and antifungal agents in immunusuppressed patients with this disease is advocated.

Aged↗
PubMed2006

Perineal cellulitis and persistent vaginal erosion after transobturator tape (Obtape)--case report and review of the literature.

Transobturator sub-urethral tapes are emerging as one of the surgical options for the management of urodynamic stress incontinence. Though with relatively less risk of injury to the bladder, a different approach as well as the different characteristics of the tape material mean a variety of complications like obturator abscess, obturator haematoma, retro-pubic haematoma, and perineal cellulitis. In this paper, we describe a case of perineal cellulitis following the insertion of a transobturator tape (Obtape). Though cellulitis was managed conservatively with intravenous antibiotics, the patient was found to have vaginal extrusion of the tape. Vaginal erosion was initially managed with resuturing of the vaginal wall. Persistent erosion unfortunately necessitated complete tape removal. The patient later had another sub-urethral procedure after 3 months. Perineal cellulitis is rare after transobturator tape procedures. In the literature, only two cases have been described so far. Though vaginal erosion can be managed conservatively, we recommend the complete removal of the tape when an infection is proven or suspected.

Cellulitis↗
PubMed1992

Cellulitis after axillary lymph node dissection for carcinoma of the breast.

We present a series of patients who developed cellulitis following axillary lymph node dissection for carcinoma of the breast. Bacterial cultures were not helpful in making a diagnosis for the majority of the cases. The clinical scenario of upper extremity cellulitis after axillary dissection mimics the presentation of cellulitis in the lower extremity. Until diagnostic methods or treatment advances can eliminate the indications for axillary lymphadenectomy, many women treated for breast cancer will be at long-term risk for the development of cellulitis due to localized immune impairment. Patient and physician awareness of this syndrome is the best available tool to prevent secondary exacerbation of lymphedema. Prompt treatment with appropriate antibiotics appears universally successful. Antistreptococcal antibiotics should not be withheld pending results of blood or tissue cultures, since in only a few cases will a pathogen be isolated. Although there are no studies confirming the concept, it is likely that appropriate treatment for lymphedema may reduce the risk of infection.

Adult↗
PubMed1983

Hemophilus influenzae cellulitis.

To define the clinical features of cellulitis due to Hemophilus influenzae type B, we reviewed the records of 78 children admitted to the hospital with cellulitis during a one-year period. Fifty-two children were afebrile (T less than 38 degrees C) and none had infections due to H. influenzae. Twenty-six children were febrile, 19 with facial and seven with extremity lesions. H. influenzae type B was recovered from seven of the febrile children with facial cellulitis, and one with extremity involvement. The mean WBC count of children with disease due to this organism was 17,500/mm3. Both fever and a leukocytosis (WBC count greater than 15,000/mm3) occurred more often in children with H. influenzae type B cellulitis than among those with infections due to other organisms.

Adolescent↗
PubMed2004

Recurrent periorbital cellulitis in a child. A random event or an underlying anatomical abnormality?

We present a case of recurrent periorbital cellulitis in a child. From the age of 2 years the child was admitted with periorbital cellulitis a total of six times with the first five episodes responding to conservative management with intravenous antibiotics. On the sixth admission endoscopic surgical treatment was carried out. Two abnormalities were noted: an anatomically abnormal uncinate process and an isolated abscess in an ethmoidal cell. It is believed that the abnormal uncinate process caused obstruction of the osteomeatal area, predisposing to recurrent peri-orbital cellulitis. We discuss the importance of early imaging and surgery in recurrent periorbital cellulitis.

Cellulitis↗
PubMed2006

Lower limb cellulitis: features associated with length of hospital stay.

AIMS: This study aimed to identify features associated with length of hospital stay (LOHS), length of intravenous antibiotic therapy (LIVAT) and six-week outcomes for patients with lower limb cellulitis, and to test the Eron/Passos classification of cellulitis in the New Zealand system. METHODS: Eighty-five variables were collected prospectively from a cohort of 51 inpatients admitted to Christchurch hospital. The primary end-point for analysis was LOHS. LIVAT and six-week outcomes were secondary end-points. RESULTS: On univariate analysis use of diuretics, living alone, cellulitis acuity, a creatinine concentration of >0.1 mmol/l, poor mobility, pulse >90 bpm, age >70 years, oedema extent, chronic oedema, ulceration, neutrophil count >10x10(9)/l, erythema area >1000 cm2 and haemoglobin concentration less than normal were significantly (P= or <0.05) associated with LOHS. A stay of < or =3 days was associated with less oedema, absence of diuretic use and less acute cellulitis. A stay of >7 days was associated with use of diuretics, living alone, age >70 years, more oedema, erythema area >1000 cm2, haemoglobin less than normal, ulceration, creatinine >0.1 mmol/l and poor mobility. The presence of a discharge was associated with LIVAT. Multivariate analysis accounted for 48% of the variance in LOHS and 16% for LIVAT. Use of diuretics, neutrophil count >10x10(9)/l and oedema score were independently associated with LOHS, with oedema score associated with short stay and diuretic use with long stay. The Eron/Passos system was not helpful so a new scoring system was devised which successfully classified patients into length of stay groups. CONCLUSIONS: The clinical features analysed accounted for half of the variance in LOHS. An important reason may be physician discretion. If so, our scoring system based on these results could be used in a clinical pathway to improve patient care. This tool would need to be evaluated prospectively.

Adolescent↗
PubMed2000

Prevention of cellulitis after open lacrimal surgery: a prospective study of three methods.

OBJECTIVE: Soft-tissue cellulitis after open lacrimal surgery, almost exclusively caused by infection, is associated with a reduced surgical success rate, inconvenience for the patient, and may predispose to secondary hemorrhage. Although postoperative oral antibiotics have been shown to significantly reduce the infection rate, this investigation was designed to compare this regimen with two other methods for the prevention of postoperative infection. DESIGN: A prospective nonrandomized comparative trial of three methods for prevention of postoperative infection. PARTICIPANTS: Patients, recruited over a 16-month period from the Lacrimal Clinic at Moorfields Eye Hospital, who required primary open dacryocystorhinostomy. METHOD: Two hundred and sixty-five patients were assigned, on the basis of hospital number, to one of three groups: to receive either an intravenous broad-spectrum antibiotic immediately after induction of anesthesia (group 1), intraoperative lavage of the rhinostomy site just after suture of the anterior mucosal flaps (group 2), or a postoperative course of oral antibiotics (group 3). OUTCOME MEASURES: Cellulitis was considered to be present when there was marked tenderness along a swollen and erythematous incision line, evidence of frank pus from the suture line, or late postoperative hemorrhage occurred. Patients were reviewed within a week of surgery. RESULTS: Signs of infective cellulitis occurred in 1 of 127 (0.8%) cases in group 1, 7 of 41 (18%) cases in group 2, and 2 of 127 (1.5%) cases in group 3. Whereas the infection rate in group 2 was significantly greater than that in group 1 (P << 0.001) or group 3 (P<0.001), no significant difference was found between that in groups 1 and 3 (0.75>P>0.5; chi-square test with Yates' correction). CONCLUSION: Compared with intraoperative saline lavage, intraoperative or postoperative broad-spectrum antibiotics have comparable efficacy in the prevention of postoperative soft-tissue cellulitis after open lacrimal surgery. Intraoperative administration of antibiotics has the advantages of compliance and economics.

Adolescent↗
PubMed1986

Ethmoiditis-associated periorbital cellulitis.

Seventy-two children with periorbital cellulitis were followed prospectively during a 30-month study period. Twenty patients (28%) had mucopurulent rhinorrhea with obvious radiological ipsilateral opacity of the ethmoid sinuses. This group of patients, as opposed to patients with periorbital cellulitis and no associated ethmoiditis, is characterized by the following features: Higher incidence of temperature greater than 38.5 degrees C (16/20 vs 24/52. P less than 0.01) and elevated white blood count greater than 15,000 cells/mm3 on admission (10/20 vs 5/52. P less than 0.001). Delayed recovery (6.7 +/- 3.4 vs 3.4 +/- 1.6 days. P less than 0.001). Higher rate of recurrent periorbital cellulitis with associated ethmoiditis within 6 months of follow-up (5/20 vs 1/52. P less than 0.01). This ethmoiditis-associated serious form of periorbital cellulitis requires an aggressive treatment regimen and a prolonged follow-up.

Anti-Bacterial Agents↗
PubMed2000

Periorbital cellulitis secondary to ethmoiditis in a 5-week-old child.

Periorbital cellulitis is a condition primarily affecting young children. We present a 5-week-old boy who developed periorbital cellulitis and had a CT scan which identified acute ethmoiditis as the source of the sepsis. His clinical course is outlined, and the relevant literature is discussed. We believe this patient is the youngest case of periorbital cellulitis due to confirmed ethmoiditis reported. This emphasises the possibility of an underlying sinusitis in patients with periorbital cellulitis, even in this very young age group.

Anti-Bacterial Agents↗
PubMed1984

Eosinophilic cellulitis (Wells' syndrome): histologic and clinical features in arthropod bite reactions.

Five patients are described with the clinical and histopathologic picture, including flame figures, of eosinophilic cellulitis (Wells' syndrome). Two of them had documented tick bites in the center of these expanding annular lesions, and the histologic picture showed the diagnostic flame figures of Wells' syndrome (eosinophilic cellulitis). A third patient had a clinical picture suggestive of a tick bite reaction but stated she was stung by a small garden bee at the involved site. The fourth patient removed a spider from the site of a spider bite, and this nodule also histopathologically was identical to that of eosinophilic cellulitis. Our fifth patient presented with papular urticaria of flea bites. We suggest that the characteristic flame figures of eosinophilic cellulitis (Wells' syndrome) are not diagnostic of a specific disease entity but rather a striking and peculiar histopathologic response to multiple factors of which arthropod bites (ticks, bees, fleas, and spiders) represent one definite etiology.

Adult↗
PubMed1997

Biopsy specimen findings in patients with previous lower extremity cellulitis after saphenous venectomy for coronary artery bypass graft surgery.

BACKGROUND: No previous study has examined the immune and inflammatory mechanisms involved in the pathogenesis of lower extremity cellulitis after saphenous venectomy for coronary artery bypass graft surgery. OBJECTIVE: Our purpose was to determine the histopathologic, immunologic, and inflammatory findings in skin biopsy specimens from saphenous venectomy limbs of patients with previous bouts of cellulitis. METHODS: Biopsy specimens were obtained from five patients with previous episodes of cellulitis. Specimens of the contralateral lower extremity of each patient were obtained for controlled comparisons. RESULTS: Histopathologic findings did not provide evidence that could account for the tendency for cellulitis to develop. Moreover, the distribution of CD1a, HLA-DR, intercellular adhesion molecule-1, and lymphocyte function-associated antigen type 1 were similar in specimens from the postvenectomy and contralateral legs. No tumor necrosis factor-alpha expression was found in specimens from the lower extremities. CONCLUSION: The mechanisms responsible for the production of this disorder do not involve the mediators studied.

Cellulitis↗
PubMed1998

Plaque-like erythema with milia: a noninfectious dermal mucinosis mimicking cryptococcal cellulitis in a renal transplant recipient.

Cellulitis of the skin is most commonly a bacterial infection caused by either staphylococcal or streptococcal species. However, in immunocompromised patients, cellulitis may be a harbinger of more ominous disease. In these patients, rapid clinical diagnosis and treatment is necessary. We describe an immunosuppressed renal transplant recipient with the clinical diagnosis of cryptococcal cellulitis who was found to have a heretofore unreported dermal mucinosis of the upper chest associated with milia. We believe that cyclosporine was a significant pathogenic factor. This entity, which should be included in the clinical differential diagnosis of cryptococcal cellulitis, has a benign nature and does not require treatment.

Aged↗
PubMed1998

Familial eosinophilic cellulitis, dysmorphic habitus, and mental retardation.

BACKGROUND: Eosinophilic cellulitis is a polymorphous, chronic disease characterized by eosinophil infiltration and granulomatous inflammation. OBJECTIVE: Our purpose was to describe the clinical, histologic, and immunohistologic findings in three family members who have had eosinophilic cellulitis since childhood associated with mental retardation and abnormal body habitus. METHODS: Family members were evaluated. Multiple skin biopsy specimens were obtained and examined after hematoxylin-and-eosin staining, by immunofluorescence and by electron microscopy. Blood specimens were analyzed by immunoassays for eosinophil granule proteins and eosinophil active cytokines. RESULTS: Three short-statured, mentally retarded family members with abnormal body habitus in at least two generations had recurrent eosinophilic cellulitis. Peripheral blood and bone marrow eosinophilia was present. Plasma eosinophil granule major basic protein and eosinophil-derived neurotoxin levels were elevated with normal plasma eosinophil cationic protein levels. Eosinophil survival in culture was increased by patients' plasma and was blocked with monoclonal interleukin-5 antibody. The level of plasma interleukin-5 was elevated. Lesional skin biopsy specimens showed massive staining for three eosinophil granule proteins. Electron microscopy showed eosinophil disruption. CONCLUSION: Eosinophilic cellulitis, mental retardation, and abnormal body habitus were likely inherited as a dominant syndrome in this family in which eosinophil involvement was striking.

Abnormalities, Multiple↗
PubMed1980

Cellulitis: a prospective study.

We prospectively studied 20 children, ages 2 to 12 years, seen with cellulitis. Each child had a complete blood count, a blood culture, and a culture of an aspirate from the lesion. The age of the child, the fever, and the extent of cellulitis determined whether the child was hospitalized. Outpatient antibiotic therapy was penicillin or dicloxacillin. Four children (20%) had an infection on the upper extremity: 14 (70%), the leg; 1 (5%), the forehead; and one (5%), the periorbital area. Three children (15%) had a white blood cell (WBC) count greater than or equal to 15,000 cu mm. Two were febrile. One child with a WBC count less than or equal to 15,000 cu mm was febrile. Two blood cultures (10%) were positive, both for Haemophilus influenzae. Twelve organisms were isolated from the aspirates: 8 Staphylococcus aureus (all penicillinase producing), 2 H influenzae, 1 Streptococcus pyogenes, and 1 Pseudomonas aeruginosa. Both children with H influenzae were febrile with WBC counts greater than or equal to 15,000 cu mm. Of the 17 children (85%) treated as outpatients, all but one responded. We recommend admission and cultures of the blood and an aspirate of the lesion for all facial cellulitis and treatment with oxacillin and chloramphenicol. In a truncal or extremity cellulitis, initial therapy should be directed against S aureus. If the child is febrile or the WBC count greater than or equal to 15,000 cu mm, H influenzae is a likely pathogen and thus intravenous chloramphenicol must be used after cultures are obtained.

Blood Cell Count↗
PubMed1981

Cellulitis: initial management.

Although Staphylococcus aureus and Streptococcus pyogenes cause the majority of cellulitis, recent studies have shown a significant role for Hemophilus influenzae in facial, and less frequently, nonfacial infections. We devised an algorithm for the initial management of cellulitis based on our previous investigations showing a correlation of this organism with fever, leukocytosis, and facial involvement. Children were divided into four groups characterized as follows: Group I - extremity, temperature less than 38.5 C; Group II - extremity, temperature greater than 38.5 C, WBC less than 15,000/cu mm; Group III - extremity, temperature greater than 38.5 C, WBC greater than 15,000/cu mm; and Group IV - facial. Forty-five children were successfully followed. There were 34 in Group I, five in Group II, one in Group III, and five in Group IV. Two children in Group IV and the only child in Group III had H influenzae, recovered form the blood (3) or a direct aspirate (1). All three were febrile, with a range of 39.5 C to 40.1 C and has an elevated white blood cell count with a range of 19,200/cu mm to 26,000/cu mm. With one exception, children with cellulitis not due to H influenzae did not have both fever and leukocytosis. This algorithm allows the clinician to identify children with H influenzae cellulitis who are at risk for septic complications while minimizing unnecessary diagnostic or therapeutic interventions.

Adolescent↗