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PubMed1986

Pathogen identification of abscesses and cellulitis.

The goal of culturing abscesses and/or cellulitis is to identify the offending pathogen in order to understand and treat the infection. Abscesses respond to incision and drainage. Antibiotics are not indicated in the patient with normal host defense, and thus in these patients cultures and Gram stains are not indicated. In immunocompromised patients, in patients with abscesses of the central face, and in those with abscesses that contain gas or involve muscle or fascia, Gram stain, culture, and antibiotics are necessary. The Gram stain is a reliable indicator of sterile abscesses, abscesses in pure culture (especially Staphylococcus aureus), and those in mixed anaerobic culture. Location and odor of abscesses are clues to offending bacteria. Cultures of tissue or blood in patients with cellulitis usually are positive in less than 40% of cases, regardless of the technique used. Hemophilus influenzae cellulitis in pediatric patients is an exception; blood cultures are positive in more than two-thirds of cases. Although not specific, certain types of cellulitis show different clinical characteristics. Treatment with elevation, warm soaks, and antibiotics is still the mainstay of therapy. Gram stain and culture are limited to those patients who do not respond to initial therapy or who are immunocompromised.

Abscess↗
PubMed1996

Changing bacteriology of periorbital cellulitis.

STUDY OBJECTIVE: Bacteremic periorbital cellulitis has traditionally been associated with Haemophilus influenzae infection, and the recommended diagnostic evaluation in young children includes blood culture and cerebrospinal fluid (CSF) analysis. The objectives of this study were to examine in pediatric patients with periorbital cellulitis (1) the prevalence of H influenzae bacteremia in the era of vaccination for H influenzae type B (HIB) and (2) the yield of routine CSF analysis. METHODS: This was a retrospective case series of children aged 2 months to 17 years with a final discharge diagnosis of periorbital cellulitis who were treated from 1986 through 1994 at an urban university referral hospital. The prevalence of bacteremia and meningitis was obtained from chart review. RESULTS: Forty-nine children were enrolled, of whom 3 were treated as outpatients. The mean age was 36 months (median, 19 months). A blood culture was obtained for 92% of the patients. Five patients (10%; 95% confidence interval, 3% to 22%) had a positive blood culture (four streptococcal species, one H influenzae). The patient with H influenzae bacteremia was treated in 1987 and had not had the HIB vaccine. CSF was analyzed for 41% of the patients, and none had an abnormal cell count or a positive culture. Sinusitis was diagnosed radiographically in 19% of the subjects. CONCLUSION: Streptococcal organisms are the most common cause of bacteremia associated with periorbital cellulitis in the post-HIB vaccination era. H influenzae bacteremia is now a rare occurrence. Meningitis is uncommon, and lumbar puncture may not be mandatory in well-appearing children. Sinusitis is common and was probably underdiagnosed in our series because most children were not evaluated radiographically. Outpatient management may be indicated in selected children.

Adolescent↗
PubMed2000

Cellulitis syndromes: an update.

Cellulitis is a commonly seen clinical syndrome that is most often associated with beta-haemolytic streptococci and Staphylococcus aureus. Several medical conditions and a variety of procedures can predispose to the development of cellulitis by a common mechanism: venous and lymphatic compromise. The precise pathophysiologic and immunologic details involved in the predisposition to cellulitis remain poorly understood. Therapy is directed at resolution of acute infection and prevention of recurrent episodes of cellulitis.

Anti-Bacterial Agents↗
PubMed2005

Acinetobacter as a causative agent in preseptal cellulitis.

BACKGROUND: The bacterial genus Acinetobacter, once viewed as inconsequential, has been increasingly implicated as a significant pathogen. Acinetobacter is becoming progressively more resistant to older and newer-generation antibiotics. The primary species encountered in infections is Acinetobacter baumannii. CASE REPORT: A 39-year-old woman came in for treatment of a preseptal cellulitis and conjunctivitis. She was referred to W.W. Hastings Optometry Clinic eleven days after first being diagnosed with a hordeolum that developed into a preseptal cellulitis, despite the use of oral cephalexin anazithromycin. After being referred, the patient was placed on oral regimen of gatifloxacin and topical ciprofloxacin. The patient gradually improved over the next 10 days, with full resolution occurring 21 days after the first presentation. Culturing revealed the offending organism to be Acinetobacter. DISCUSSION: Most ocular infections are still caused by common organisms such as Staphylococcus. However, atypical bacteria such as Acinetobacter are responsible for a minority of infections. Careful consideration of patient history and clinical signs must be made to differentiate preseptal cellulitis and orbital cellulitis. CONCLUSION: This case emphasizes that clinicians need to be aware of emerging and resistant bacteria in ocular infections. Infections that do not respond to traditional therapy should be treated aggressively with the latest-generation antibiotics. Ocular infections that do not resolve in a timely manner should be cultured for the offending organism and these organisms should be tested for susceptibility to anti-microbial drugs.

Acinetobacter↗
PubMed2001

Selection bias in epidemiological studies of infectious disease using Escherichia coli and avian cellulitis as an example.

In epidemiological studies of infectious disease, researchers often rely on specific cues of the host, such as clinical signs, as surrogate indicators of pathogen presence. A selection bias would manifest if the specific visual cues used in sampling for the pathogen were not representative of the full range of signs caused by the strains of that pathogen. In our molecular epidemiological studies of Escherichia coli associated with avian cellulitis in broilers, we collect carcasses at the processing plant based on visual cues of lesion morphology. Therefore, the objectives of this study were to: (1) explore the potential impacts of selection bias in an application of infectious disease epidemiology, and (2) utilize a validation protocol to assess the potential for selection bias in our molecular epidemiological studies of E. coli and avian cellulitis. In two different trials, E. coli DNA fingerprints were compared between birds that our observers collected and the birds that the observers missed. Using Fisher's exact tests and simulation models, we determined that the isolates collected by the observers were not significantly different from the isolates missed by the observers (P > 0.60 in both trials). Our method of selecting birds suspected of having cellulitis did not significantly bias our inferences about the population of E. coli associated with cellulitis in the flock. We encourage more investigators to critically assess the relationship of the sample to the target population in epidemiological studies of infectious disease.

Animals↗
PubMed2001

Necrotising orbital cellulitis.

PURPOSE: To report 2 cases of severe necrotising orbital cellulitis which illustrate the need for aggressive surgical management to prevent blindness. METHODS: The case records of 2 patients with necrotising orbital cellulitis were reviewed. RESULTS: Both patients had orbital cellulitis associated with sinusitis. Each case was characterised by the rapid development of severe systemic toxicity, extensive soft tissue necrosis and abscess formation. One patient developed panophthalmitis and the eye had to be eviscerated. The other patient underwent repeated surgical drainage of multiple orbital abscesses. This led to resolution of the infection and preservation of vision. CONCLUSIONS: Atypical rapidly progressive necrotising orbital cellulitis may occasionally be encountered. In such cases, aggressive surgical drainage of orbital abscesses is crucial to prevent blindness and death.

Abscess↗
PubMed2001

Nodular presentation of eosinophilic cellulitis (Wells' syndrome).

Eosinophilic cellulitis is a rare condition of unknown aetiology. The classical presentation is of a tender or mildly pruritic cellulitis-like eruption, that has typical histology characterized by tissue eosinophilia, oedema and "flame" figures. Other reported clinical presentations include papular and nodular eruptions. It may be recurrent, and preceded at a variable time by a pruritic papular eruption. We describe a patient with the rare nodular variant of eosinophilic cellulitis affecting the palms of the hands, which occurred 2 years after a nonspecific pruritic papular eruption, without an obvious precipitant and in the absence of the more typical cellulitis-like plaques.

Adult↗
PubMed1998

Microbiology of perianal cellulitis in children: comparison of skin swabs and needle aspiration.

OBJECTIVE: To establish the aerobic and anaerobic microbiology of perianal cellulitis in children, comparing skin swab and needle aspirate methodology. METHOD: Swabs of involved skin and needle aspirates of cellulitis were studied for aerobic and anaerobic bacteria. RESULTS: Specimens obtained from 10 patients with perianal cellulitis showed bacterial growth. Polymicrobial aerobic-anaerobic flora was found in all skin surface cultures, where the predominate isolates were Peptostreptococcus spp., Escherichia coli, and alpha hemolytic streptococci. The number of isolates in needle aspirates varied between one and two. The predominant ones were E. coli (3), Peptostreptococcus spp. (3), Staphylococcus aureus (2), and Bacteroides fragilis group (2). Complete or partial concordance in microbiology between skin swabs and needle aspirates was present in six instances. In four instances, isolates recovered from needle aspirates were not isolated from the skin surface. CONCLUSIONS: This study demonstrates the diversity of aerobic and anaerobic organisms isolated from perianal cellulitis, and the superiority of needle aspirates in establishing the microbiology of the infection.

Anus Diseases↗
PubMed2002

Manifestation of cellulitis after saphenous venectomy for coronary bypass surgery.

A few cases of onset of cellulitis after saphenous venectomy for coronary by-pass surgery were first reported by Baddour and Bisno in 1982. We reviewed the dinical characteristics of 31 subjects followed up in our department following onset of manifestations of cellulitis after saphenous venectomy for coronary by-pass surgery. In all the subjects the cellulitis originated at the scar of the saphenous venectomy, and most presented ill-defined, mildly erythematous, slightly oedematous lesions. Mycologically confirmed tinea pedis was found in 25 subjects. All the patients responded well to penicillins or cephalosporins. In this report we comment on the pathogenesis of this complication of saphenous venectomy based on the clinical features of the cases reviewed. We suggest that saphenous venectomy may destroy the lymphatics in the lower leg, that are located adjacent to the great saphenous vein, and thus microorganisms penetrating into the skin may easily cause cellulitis in areas with impaired lymphatic drainage.

Aged↗
PubMed2000

High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco.

The prevalence of and risk factors for abscesses and cellulitis were investigated among a community sample of injection drug users (IDUs). Participants were interviewed, and those with symptoms were examined. Of 169 IDUs, 54 (32%) had abscesses (n=35), cellulitis (n=5), or both (n=14); 27% had lanced their own abscesses; and 16% had self-treated with antibiotics they purchased on the street. IDUs who skin-popped (injected subcutaneously or intramuscularly) were more likely to have an abscess or cellulitis than those who had injected only intravenously (odds ratio, 4.9; 95% confidence interval, 2.2-11). The likelihood of abscesses and cellulitis increased with frequency of skin-popping and decreased with increasing duration of injection drug use. Abscesses are extremely prevalent among IDUs in San Francisco. Skin-popping is a major risk factor, and self-treatment is common.

Abscess↗
PubMed2006

Risk factors for recurrent lower extremity cellulitis in a U.S. Veterans Medical Center population.

BACKGROUND: Despite the frequency of recurrent acute cellulitis of the lower extremities, factors associated with this infection have not been previously assessed in a case-control study among patients admitted to U.S. hospitals. METHODS: We compared the clinical characteristics of 47 patients with those of 94 age- and sex-matched control subjects admitted to the Miami Veterans Affairs Medical Center. RESULTS: In a multivariate analysis, two physical factors, lower extremity edema and body mass index, one behavioral factor, smoking, and one demographic factor, homelessness, were significantly and independently associated with recurrent cellulitis. The latter two factors have not previously been reported to be independently associated with cellulitis. CONCLUSIONS: Our results suggest that increased emphasis on weight loss, smoking cessation, and improved foot hygiene in the homeless might decrease recurrences of lower extremity cellulitis.

Body Mass Index↗
PubMed2001

Medical management of orbital cellulitis.

To determine the appropriate early management of orbital cellulitis and the current bacterial etiology and to evaluate the clinical usefulness of orbital computed tomographic imaging for this infection, a prospective study of orbital cellulitis was conducted during a 2-year period, 1999 to 2000, after the introduction of a conservative medical management plan designed by our pediatric infectious diseases, ophthalmology and otolaryngology services. Basically patients did not have surgical intervention unless progressive involvement of the optic nerve occurred after 24 to 36 h of intravenous antimicrobial therapy. Nine patients had orbital cellulitis and subperiosteal abscesses; only one required surgical drainage because of progressive disease, this case being culture-negative. One had a blood culture positive for Streptococcus pneumoniae; conjunctival cultures showed moderate to heavy growth for S. pneumoniae from this and two other patients, but otherwise bacterial etiology could not be defined. Haemophilus influenzae was not recovered from any of their blood or conjunctival cultures. This experience, during the computed tomography scan and Haemophilus vaccine era, supports an initial medical management approach for most patients with subperiosteal or retrobulbar abscesses resulting in orbital cellulitis.

Anti-Bacterial Agents↗
PubMed2005

Effect of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess.

PURPOSE: To determine the effect of intravenous corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess. METHODS: The inpatient records of all patients treated for orbital cellulitis with subperiosteal orbital abscess between January 2001 and August 2003 were reviewed. The use of corticosteroids, length of hospital stay, need for surgical drainage, treatment course, and clinical outcomes were reviewed. A t test and Fisher exact test analysis were calculated to evaluate statistical significance. RESULTS: Twelve patients received intravenous corticosteroids and 11 patients did not receive corticosteroids. All patients had complete resolution of their abscess without complications. Length of hospitalization between the patients treated with and without intravenous corticosteroids was not significantly different (p = 0.26). Four of 12 patients treated with intravenous corticosteroids underwent orbitotomy for drainage of the abscess, and 6 of 11 patients treated without intravenous corticosteroids underwent surgical drainage (p = 0.20). Two of 12 patients treated with corticosteroids received intravenous antibiotics after discharge, whereas 7 of 11 in the group not treated with corticosteroids received intravenous antibiotics after discharge (p = 0.03). CONCLUSIONS: The use of intravenous corticosteroids does not appear to adversely affect clinical outcomes and may be beneficial in the treatment of pediatric orbital cellulitis with subperiosteal abscess. Review of our data suggests that a prospective, randomized trial is warranted to further clarify the role of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess.

Abscess↗
PubMed2007

Bullous eosinophilic cellulitis succession with eosinophilic pustular folliculitis without eosinophilia.

Eosinophilic cellulitis is characterized clinically by an acute dermatitis resembling cellulitis with unknown etiology. Eosinophilic pustular folliculitis is also a rare inflammatory dermatosis characterized by recurrent crops of erythematous follicular papulopustules that coalesce to form annular plaques with unclear etiopathogenesis. We describe a 20-year-old white male who had vesiculobullous and plaque-like lesions on the hands and feet and was diagnosed with bullous eosinophilic cellulitis clinically and histologically without any etiological agents. Following therapy with oral corticosteroid and oral tetracycline capsules, the lesions disappeared. After a 2-month asymptomatic period, the patient developed pruritic follicular papules and pustules on the lower and upper extremities and upper back. Stool examination revealed Gierdia intestinalis eggs. The patient had complete clearance with treatment of ornidazol for 2 weeks and indomethacin for 2 months. This is the first report of bullous eosinophilic cellulitis coexisting with eosinophilic pustular folliculitis without eosinophilia in the English published work.

Adult↗
PubMed2005

Modern external beam radiation therapy for refractory dissecting cellulitis of the scalp.

BACKGROUND: Dissecting cellulitis of the scalp can be an extremely painful and disfiguring dermatological condition. The associated pain can be severe enough in some cases to require opioid analgesics, and this pain in conjunction with the disfigurement can induce significant emotional distress. Conservative treatments often fail to provide relief. Radiation therapy has been successfully used in the past but with outdated equipment and techniques. OBJECTIVES: To evaluate the efficacy and toxicity of modern external beam radiation therapy techniques for the treatment of dissecting cellulitis of the scalp. METHODS: Four patients with intractable dissecting cellulitis of the scalp were treated with electrons or a combination of electrons and photons to the entire scalp. Daily fraction sizes were 2.5 or 3 Gy and initially prescribed to 15-21 Gy. Patients were re-evaluated 3-4 weeks after completion of therapy. Any residual hair growth was treated with additional radiation treatments to ensure full epilation, up to a maximum dose of 35 Gy. RESULTS: Rapid resolution of pain was seen in all patients with pain. Regression of nodules and decreased discharge was seen in all patients following treatment and cosmesis was subjectively improved. No long-term toxicity has been observed. CONCLUSIONS: Using modern techniques and equipment, radiation therapy appears to be a reasonable option for patients with severe/refractory dissecting cellulitis of the scalp. Acute effects are mild and well tolerated. Aside from alopecia, which was present to some extent in all patients before treatment, no long-term complications have been observed.

Adult↗
PubMed2005

Tinea capitis mimicking dissecting cellulitis: a distinct variant.

BACKGROUND: Tinea capitis is a common scalp dermatosis with several clinical patterns. Only two patients with a presentation of tinea capitis mimicking dissecting cellulitis have been described in the English literature. OBSERVATION: We report a patient with tinea capitis mimicking dissecting cellulitis who did not respond to griseofulvin therapy at 16 mg/kg/day but eventually cleared after a protracted course of higher dose griseofulvin. CONCLUSION: recognition of a dissecting cellulitis-like pattern of tinea capitis will increase clinical suspicion and avoid inappropriate management of a recalcitrant "dissecting cellulitis" in favor of prompt antifungal therapy of appropriate dosage and duration for patients with this unusual variant of tinea capitis.

Antifungal Agents↗
PubMed2006

Genital lymphangioma with recurrent cellulitis in men.

BACKGROUND: Lymphangioma circumscriptum rarely occurs on the penis. This report describes a patient observed in private practice who presented with recurrent unexplained cellulitis of the penis for whom this diagnosis was not initially apparent. METHODS: Diagnosis of lymphangioma in this patient resulted in a retrospective records review of the Mayo Clinic experience with patients who had genital lymphangioma and cellulitis. RESULTS: Six other male patients with recurrent cellulitis complicating genital lymphangioma were identified. Five of these six patients were managed with antibiotic prophylaxis. CONCLUSIONS: Compromised lymphatic drainage should be suspected in male patients with otherwise unexplained penile swelling or cellulitis. These patients usually require long-term antibiotic prophylaxis for recurrent infection.

Adolescent↗
PubMed1996

Periorbital cellulitis: a comparison of different treatment regimens.

Periorbital cellulitis was retrospectively investigated in a cohort of 69 children, 1.5-16 years of age, who were admitted to Hacettepe University Children's Hospital. The aim of the study was to define the most important cause of the disease and to choose the most appropriate antimicrobial regimen. Sinusitis (43%) was found to be the most frequent disease associated with periorbital cellulitis. Trauma (25%) and odontogenic infections (6%) were the next most common predisposing causes. Staphylococcus aureus was isolated from 14 (74%) of 19 cultures. Two antibiotic combinations, penicillin plus chloramphenicol and sulbactam-ampicillin (SAM) with or without ornidazole was used in 30 (43%) and 39 (57%) of 69 cases, respectively. The duration of treatment with these two antibiotic combinations was generally between 7 and 10 days. No statistical difference was found between the two antibiotic combinations in the cure and recurrence rates but five (17%) of the 30 cases using penicillin plus chloramphenicol, and one (3%) of the 39 cases using SAM with or without ornidazole had recurrent periorbital cellulitis. It was concluded that SAM can be the first line of drug treatment for periorbital cellulitis as it is easily used in every age group and etiology (trauma, sinusitis, etc.). It provides total recovery and has less side effects and risk of recurrence. It also has a broad antimicrobial spectrum.

Ampicillin↗