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PubMed1993

Acute visual loss in association with sinusitis.

Acute visual loss may occur in association with sinusitis either as a complication of orbital cellulitis or, less frequently, as a part of the orbital apex syndrome. We describe two cases of temporary monocular visual loss caused by sinusitis. In one case the visual loss was due to orbital cellulitis; while in the other patient it was due to incompletely developed orbital apex syndrome. This later mode of presentation is called 'partial orbital apex syndrome' by some authors and 'posterior orbital cellulitis' by others. The relationship between sinusitis and blindness is discussed.

Acute Disease↗
PubMed1999

Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis.

Peritonsillar infections include cellulitis and abscess (quinsy). Clinical diagnosis is often supplemented by diagnostic drainage (aspiration or incision) in an effort to distinguish abscess from cellulitis. In a prospective study of 14 patients we have shown that clinical impression alone is unreliable (sensitivity 78 per cent, specificity 50 per cent). Computerized tomography (CT) (sensitivity 100 per cent, specificity 75 per cent) and intraoral ultrasound (sensitivity 89 per cent, specificity 100 per cent) are much more reliable. We propose that intraoral ultrasound could play a useful role in the clinical assessment of peritonsillar infections helping to improve accuracy in distinguishing abscesses from cellulitis.

Adolescent↗
PubMed2003

Wells' syndrome: a clinical and histopathologic review of seven cases.

Wells' syndrome, or eosinophilic cellulitis, is characterized clinically by an acute dermatitis resembling cellulitis, which evolves into violaceous plaques that resolve spontaneously without scarring. The histopathologic features are dynamic, starting with dermal edema and infiltration of eosinophils, the development of "flame figures," and finishing with the appearance of phagocytic histiocytes. We present the clinical and histopathologic features of seven cases of eosinophilic cellulitis.

Adult↗
PubMed2002

Pterional orbital decompression in diseases with acute increase of intraorbital pressure.

BACKGROUND: Orbital cellulitis as well as traumatic or spontaneous intraorbital hemorrhages can lead to an acute rise of intraorbital pressure, threatening the function of orbital vascular, muscular and neural structures. The treatment of this rare entity with extended pterional orbital decompression is described in comparison with other methods of orbital decompression. PATIENTS AND METHODS: Between 1991 and 2000 the authors treated 16 patients with sight-threatening acute elevations of intraorbital pressure due to orbital cellulitis (3 patients) and spontaneous (3 patients), postoperative (1 patient) or traumatic diffuse or localized intraorbital hemorrhage (9 patients) with extended pterional orbital decompression. Pre- and postoperative parameters, like visual acuity, exophthalmos, restrictions of extraocular motility and pupillary disturbances, were retrospectively analyzed. RESULTS: In all patients, a distinct improvement of preoperative symptoms, like complete reduction of proptosis in all cases, improvement of visual acuity in 12 patients, improvement of eye motility disturbances in 14 patients and of afferent pupillary disturbances in 6 patients, was achieved by decompressing the orbital contents within a mean of 30.5 hours after onset of symptoms. Severe, operation-related complications were not seen. CONCLUSION: Extended pterional orbital decompression represents an effective treatment alternative and supplement in cases of severe, ocular function-threatening cases of acute elevated orbital pressure, due, for example, to orbital cellulitis or diffuse or localized spontaneous and traumatic intraorbital hemorrhage, where immediate reduction of pressure on orbital neural, muscular and vascular structures is intended.

Adolescent↗
PubMed2002

Acute adduction deficit in a 7-week-old infant.

A 7-week-old infant with sudden onset adduction deficit and proptosis is reported. The main differential diagnoses included orbital myositis, orbital cellulitis, capillary haemangioma and rhabdomyosarcoma. A CT scan revealed a postseptal cellulitis-like picture with thickening of the medial rectus muscle. He was given a course of antibiotics, withholding steroids and biopsy. His condition resolved completely on high-dose antibiotics alone. To our knowledge this is the youngest patient with infectious orbital myositis and postseptal cellulitis described in the literature. The clinical course emphasizes the importance of administering sufficiently high doses of antibiotics.

Acute Disease↗
PubMed2001

Value of standard laboratory tests for the early recognition of group A beta-hemolytic streptococcal necrotizing fasciitis.

The laboratory data for 17 patients with group A beta-hemolytic streptococcal necrotizing fasciitis (GAS NF) were compared with data for 145 patients hospitalized for cellulitis during the same period. Admission values of C-reactive protein and creatine kinase were higher for patients in the group with GAS NF than for patients in the group with cellulitis (P<.001), suggesting that standard laboratory tests may be useful for the early differential diagnosis of GAS NF and cellulitis.

Adolescent↗
PubMed1975

Effect of previous infection on antibody response of children to vaccination with capsular polysaccharide of Haemophilus influenzae Type b.

Children who had recovered from meningitis, orbital cellulitis, or epiglottitis caused by Haemophilus influenzae type b were immunized with capsular polysaccharide vaccine derived from that bacterium; some healthy siblings and adults who had not had H. influenzae infections were also vaccinated. Of 10 children who had had H. influenzae meningitis previously, only one had an antibody response to the vaccine. One child with prior H. influenzae orbital cellulitis also failed to respond. None of the children had detectable H. influenzae polysaccharide antigen in their bloodstream at the time of immunization. Two children who had had H. influenzae epiglottitis and six of seven controls without histories of H. influenzae infections responded immunologically to the vaccine. One of eight vaccinees under two years of age showed a response, and eight of 12 over two years responded well (P = 0.02). All four nonresponders over the age of two years had had H; influenzae meningitis or cellulitis. Children who had had H. influenzae meningitis responded less well to the polysaccharide vaccine than did other recipients of the vaccine; this difference could not be explained solely on the basis of age;

Antibody Formation↗
PubMed2003

Type and location of injection drug use-related soft tissue infections predict hospitalization.

The prevalence of soft tissue infections (abscesses, cellulitides, infected ulcers) among injection drug users (IDUs) is estimated to be between 21% and 32%. Little is known regarding the health care utilization associated with these infections. This study describes IDUs seeking emergency department (ED) care for soft tissue infections, their inpatient health care utilization, including operating room procedures, and the types and locations of infections associated with increased inpatient health care utilization. This study used a medical record case series of all IDUs seeking initial care for soft tissue infections at an urban, public emergency department from November 1999 through April 2000. Initial care for IDU-related soft tissue infections was sought by 242 patients. Most were male (63.6%), Caucasian (69.4%) and without health insurance (52.0%), and most had abscesses (72.3%). All patients with only cellulitis had arm or leg infections, while most abscesses were arm, deltoid, or buttock infections (81.1%). Forty percent of the patients were hospitalized, and 44.3% of the hospitalizations were for 3 or more days. Patients with only cellulitis were more likely to be hospitalized compared to those with abscesses. Among those with abscesses, deltoid abscesses were 5.2 times more likely to receive an operating room procedure compared to other abscess locations. IDUs with cellulitis and deltoid abscesses commonly required inpatient care and operating room procedures. The morbidity associated with such infections and the intensive use of hospital services needed to treat these infections provide strong rationale for the development of preventive interventions and improved care for this neglected clinical problem.

Abscess↗
PubMed1998

Bacterial colonization and infection rate of continuous epidural catheters in children.

UNLABELLED: Continuous epidural infusions are widely used for postoperative analgesia in children. We prospectively studied the incidence of bacterial colonization of caudal and lumbar epidural catheters, as well as the incidence of serious systemic and local infection, in 210 children after short-term epidural analgesia. Using aseptic technique, epidural catheters were inserted into either the lumbar or the caudal epidural space based on the preferences of the anesthesia team and/or clinical indication. The integrity of the catheter and overlying transparent dressing site was evaluated by a member of the pediatric pain service at least once a day. The catheters were aseptically removed if the patient had a fever greater than 39 degrees C, if the dressing was compromised, or when epidural analgesia was no longer required. The subcutaneous portion of the catheter was semiquantitatively cultured. Cellulitis (erythema, swelling, purulent discharge, pustule formation, or tenderness) was diagnosed by examination of the epidural insertion site. The mean (+/- SD) age of patients in the caudal catheter group (n = 170) was 3 +/- 3 yr; their mean weight was 13 +/- 11 kg. The mean (+/- SD) age of patients in the epidural catheter group (n = 40) was 11 +/- 4 yr; their mean weight was 36 +/- 23 kg. All catheters remained in place for 3 +/- 1 days (range 1-5 days). There was no serious systemic infection (meningitis, epidural abscess, or systemic sepsis). Of all epidural catheters, 35% (73 of 210) were colonized. Gram-positive colonization was similar in caudal (25%; 43 of 170) and lumbar (23%; 9 of 40) catheters. Gram-negative organisms were cultured from 16% of the caudal catheters (27 of 170) and 3% of the lumbar catheters (1 of 40). In patients treated with caudal epidural catheters, children aged >3 yr were less likely to have colonized epidural catheters than younger children. Age did not affect the probability of developing cellulitis at the insertion site. Although patients aged <3 yr with caudal catheters had a slightly greater risk of cellulitis than children aged >3 yr (14% vs 9%), this association was very weak (P = 0.33). We observed that, despite bacterial colonization of caudal and lumbar epidural catheters, serious systemic and local infection after short-term epidural analgesia did not occur in our study. IMPLICATIONS: Continuous epidural infusions are widely used for postoperative analgesia in children. We found no serious systemic infections after short-term (3 days) continuous epidural analgesia in children.

Abscess↗
PubMed2002

Bolus arterial-venous transit in the lower extremity and venous contamination in bolus chase three-dimensional magnetic resonance angiography.

RATIONALE AND OBJECTIVES: To investigate the phenomena and causes for undesired venous signal in the distal station of bolus chase 3D MRA. METHODS: Consecutive patients (in 8 months) undergoing peripheral MRA consisting of 2D projection MRA of the tibial trifurcation and 3D bolus chase MRA were retrospectively evaluated. Venous contamination in mid-calf in bolus chase 3D MRA was correlated to the arterial phase duration, the time between the contrast bolus arrival and venous return measured on time resolved 2D images. Statistical analyses were performed to identify the clinical parameters indicative of venous contamination. RESULTS: The arterial phase durations at the mid-calf were 49 +/- 8 seconds on 101 legs without venous signal in the bolus chase 3D MRA, 35 +/- 9 seconds on 13 legs with moderate venous signal, and 20 +/- 4 seconds on 40 legs with substantial venous signal; the differences were significant among different venous signal levels (P < 0.001 for all pairs). Legs with cellulitis had shorter arterial phase and more venous contamination than legs without cellulitis (P < 0.05). Patients with myocardial infarction had longer arterial phase and less venous contamination than patients without myocardial infarction (P < 0.01). CONCLUSION: Venous signal in the distal calf station of bolus chase 3D peripheral MRA is caused by fast arterial-venous transit. It is worse in legs with cellulitis and less in patients with a history of myocardial infarction.

Aged↗
PubMedDate not supplied

Orbital complications of hydrogel scleral buckles.

PURPOSE: Hydrogel is a biocompatible osmotic expansile material used in contact lenses, scleral buckles, and orbital expanders. Three unique complications from hydrogel scleral buckle use are presented: orbital cellulitis mimicry, fornical shortening with orbital prosthetic intolerance, and orbital pseudotumor. METHODS: A retrospective chart review was conducted on three subjects with unknown hydrogel scleral buckle complications at a tertiary care oculoplastics practice. Demographics, imaging studies, and pathologic specimens were reviewed. RESULTS: All three patients had a history of encircling hydrogel scleral buckle placed for retinal detachment. The mean time from implantation to presentation was 10.7 years (range, 7 to 15 years). One patient had an onset of presumed orbital cellulitis caused by an enlarged buckle and no abscess. The second patient had inability to wear an evisceration prosthesis as the result of a shortened fornix from an enlarged hydrogel scleral buckle implant. The third patient presented with an orbital mass caused by the enlarged implant. In all cases, surgical removal of the expanded buckle relieved the patient's symptoms. CONCLUSIONS: Although the hydrogel scleral band is designed to expand in a controlled fashion, overexpansion can occur. Expansion can cause buckle extrusion, prosthetic intolerance, a pseudo-orbital cellulitis, or orbital pseudotumor and may be due to a chemical change in the hydrogel polymer. Patients with hydrogel scleral buckles should be followed long-term for possible complications. Patients with newer uses of hydrogel, such as orbital expanders, should also be observed for long-term complications.

Adult↗
PubMed2003

Sepsis in a renal transplant recipient due to Citrobacter braakii.

Cellulitis is usually caused by organisms such as beta-hemolytic streptococci and Staphylococcus aureus. Citrobacter are gram-negative bacilli that can cause opportunistic infections in immunocompromised hosts. They are rarely implicated in skin or soft tissue infections. The genus Citrobacter has been respeciated according to genetic relatedness. Citrobacter braakii refers to the genomospecies 6 of the Citrobacter freundii complex. There are no detailed studies of infections caused by the newly formed specific genetic species. We report a case of C. braakii infection in a renal transplant patient receiving immunosuppressive therapy. The patient's lower extremity cellulitis did not respond to conventional antibiotic therapy. Blood cultures grew C. braakii. Sensitivity studies and treatment with appropriate antibiotics resulted in prompt recovery. Immunosuppressive therapy in renal transplant recipients predisposes to infection by unusual pathogens, and this should be suspected when lack of a clinical response to conventional antibiotics is observed. We believe this is the first reported case of C. braakii cellulitis and bacteremia in a renal transplant recipient.

Anti-Bacterial Agents↗
PubMedDate not supplied

Ultrasound localization of subperiosteal abscesses in children with late-acute osteomyelitis.

Ultrasonography was undertaken in nine children with late presenting acute osteomyelitis, in four children with typical superficial cellulitis, and in four with a soft tissue abscess. Ultrasound distinguished between superficial cellulitis, soft tissue abscess, and subperiosteal abscess. The abscesses were confirmed at operation, and a subperiosteal abscess was also detected in the child with deep periosseous cellulitis. Ultrasonography was particularly useful in confirming the existence of a subperiosteal abscess and in localizing it precisely in children with diffuse swelling and tenderness of a limb owing to late-acute osteomyelitis. Surgical drainage of pus can be avoided in patients without ultrasound features of an abscess and can be better planned in those who require it.

Abscess↗
PubMed1989

Eyelid swelling and erythema as the only signs of subperiosteal abscess.

On clinical grounds it is usually easy to distinguish between preseptal cellulitis, a cutaneous infection not threatening to vision, and orbital cellulitis, a potentially vision threatening infection of the orbital tissues generally arising from paranasal sinusitis. We recently cared for two patients with a clinical diagnosis of preseptal cellulitis who had CT scan evidence of subperiosteal abscess. Antibiotic therapy alone resulted in clinical resolution in each case.

Abscess↗
PubMed1997

Treatment of canine pyoderma with co-amoxyclav: a comparison of two dose rates.

The efficacy of oral co-amoxyclav, administered twice daily for up to 12 weeks either at the manufacturer's dose rate of 12.5 mg/kg or at 25.0 mg/kg, in curing the lesions of canine folliculitis, furunculosis and cellulitis was compared in a blind study. A total of 97 dogs entered the trial and 67 completed it. There was no significant difference in the rate of cure or the duration of therapy. The lesions of folliculitis were cured in 91.5 per cent of cases, in a mean period of 25.3 days. Furunculosis and cellulitis were cured respectively in 87.5 per cent and 60.0 per cent of the dogs, in mean periods of 37.6 and 44.7 days. The standard dose rate was very effective in folliculitis and furunculosis and there was no benefit in doubling the dose. Too few cases of cellulitis were treated to provide a reliable dose comparison.

Amoxicillin↗
PubMed1984

Inflammatory lesions of the groin: ultrasonic evaluation.

Sonograms of 72 patients with pain and swelling in the groin due to intravenous drug abuse were reviewed, together with 2 cases which were due to trauma. There were 27 abscesses, 36 cases of cellulitis or thrombophlebitis, 7 cases of lymphadenopathy, 3 hematomas, and 1 pseudoaneurysm. Most abscesses presented as distinct masses, while cellulitis was seen most often as soft-tissue swelling. However, 5 abscesses were manifested sonographically as diffuse soft-tissue swelling without a distinct mass, while 8 cases of cellulitis appeared as a mass. In most cases, ultrasound was able to distinguish diseases requiring surgery or percutaneous drainage from those that should respond to medical therapy. In some cases, percutaneous aspiration and/or follow-up sonograms after antibiotic therapy will be necessary for a specific diagnosis.

Adult↗
PubMed2006

Does erysipelas-like rash after hip replacement exist?

BACKGROUND: Orthopaedic implants are known to rarely induce or exacerbate dermatitis in metal-allergic patients. In the late 1990s, hypersensitivity to prosthetic material has been suspected to induce recurrent aseptic localized cellulitis. Patients presented with recurrent eruption of the skin overlying the implant, associated with fever. An aseptic origin of this new syndrome was hypothesized as no evidence of microbial involvement could be found and because antibiotic treatment was apparently inefficient. OBSERVATIONS: We observed 4 similar cases. All patients recovered after suppression of factors predisposing to erysipelas (gluteal portal of entry, anti-inflammatory drugs) and appropriate antibiotic therapy. DISCUSSION: Our conviction is that these manifestations are authentic infectious cellulitis. Delayed thigh erysipelas after hip surgery is a distinctive form of cellulitis, characterized by its unusual topography, its rapid outcome and the possibility to be recurrent.

Aged↗
PubMed1997

Deep fascial hyperintensity in soft-tissue abnormalities as revealed by T2-weighted MR imaging.

OBJECTIVE: The purpose of this study was to determine whether recently described criteria, including hyperintense T2-weighted signal or other abnormalities revealed by MR imaging within deep fascial planes, are specific for necrotizing soft-tissue infections. MATERIALS AND METHODS: We reviewed 22 MR imaging examinations that revealed abnormally high signal intensity within deep fascial planes on T2-weighted images. Twenty-one of the patients had clinical diagnoses other than necrotizing soft-tissue infection, including nonnecrotizing cellulitis (n = 4), abscess without evidence of necrotizing fasciitis (n = 5), and cellulitis with accompanying vascular thrombosis (n = 2). MR imaging was performed using T1-weighted spin-echo (range of TRs/range of TEs, 300-800/9-30) and fat-saturated T2-weighted fast spin-echo (3000-5000/76-108) sequences. Gadolinium-enhanced T1-weighted spin-echo MR images with fat saturation were obtained for 14 patients. Two reviewers, unaware of clinical diagnoses, evaluated each study for abnormalities in superficial and deep soft tissues and submitted a consensus diagnosis. RESULTS: Using only the described MR imaging criteria, we interpreted all cases as necrotizing cellulitis, including the cases of 21 patients who had nonnecrotizing conditions. CONCLUSION: Hyperintense T2-weighted signal within deep fascial planes and muscle, with or without contrast enhancement, is not specific for necrotizing soft-tissue infection. A variety of conditions exhibited similar findings and were indistinguishable from necrotizing soft-tissue infection.

Adult↗