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A case of panfacial cellulitis with contralateral orbital cellulitis and blindness after extraction of a tooth has been reported. Contralateral orbital involvement, with sparing of the ipsilateral eye, constituted the unusual feature. This was considered to be a result of hematogenous spread rather than of direct extension.
Computed tomography (CT) was used in the management of four patients with periorbital inflammation. These patients were selected for CT scanning because of the difficulty, on clinical examination alone, in determining the degree of orbital disease. The CT scans confirmed the presence and defined the location of an orbital abscess in three patients and eliminated the presence of an abscess in the fourth. On the basis of this experience, CT scanning is recommended in the evaluation of children with periorbital inflammation in whom proptosis, ophthalmoplegia, or loss of visual acuity develops, or in whom severe eyelid edema prevents adequate eye examination.
We report two cases of cellulitis of the legs occurring in adults where Escherichia coli (E. coli) was, or probably was, the causative bacterial agent. E. coli and other gram-negative bacilli cellulitis are rarely reported. However, in cellulitis, the causative microorganism is rarely identified, and some cases of E. coli cellulitis could be unrecognized. Furthermore, classical risk factors for gram-negative sepsis are characterized by a state of leucocyte dysfunction which could explain the possibility of a severe, even lethal, course of gram-negative cellulitis. Therefore, the occurrence of cellulitis in patients with risk factors should prompt attempts at isolating the pathogenic microorganism, and a broad spectrum of antibiotic therapy should be initiated.
The techniques of serum countercurrent immunoelectrophoresis, hemagglutinating (HA), and bactericidal (BC) antibody determinations were applied to seven patients with Haemophilus influenzae type B cellulitis. Capsular antigen was detected (greater than or equal to 10 ng/ml) in two patients at the time of admission and was found in two additional patients two days following hospitalization. Antibody responses in the patients with cellulitis were deficient, similar to those in children under 2 years of age with H influenzae type B meningitis. One of the patients with cellulitis had HA and BC antibody present in convalescent serum, and two additional patients demonstrated BC activity. The clinical presentations of our patients were typical except that violaceous discoloration of overlying skin was noted in only one of the seven. Two additional patients had atypical facial swelling that closely resembled angioneurotic edema and initially led to incorrect diagnosis. Countercurrent immunoelectrophoresis may be helpful in the diagnosis of patients with Haemophilus cellulitis, particularly if serial serum determinations are performed. Bacterial cultures obtained from blood and aspirates of the lesion appear to be more sensitive in determining the cause of H influenzae type B cellulitis.
Described herein are three patients over the age of 50 years who had cellulitis of the neck and the upper portion of the chest, associated with Hemophilus influenzae type B bacteremia and respiratory tract infection--particularly that of the upper airway. Only one of the patients with cellulitis had the classic bluish-purple hue commonly seen in children affected with this syndrome. In the other two, the H. influenzae type B cellulitis could not be distinguished clinically from the more common group A streptococcal or staphylococcal cellulitis. Since the antibiotics employed in treating patients with infection due to the latter two organisms differ significantly from those used to treat patients with H. influenzae type B infection, the possibility of disease due to H. influenzae type B must be considered in any adult or child in whom cellulitis of the neck, chest and possibly face is associated with a respiratory tract infection, especially of the upper airway.
Three immunocompromised patients presented with cellulitis as the primary manifestation of cryptococcal disease. Two were recipients of cadaveric renal transplants who were receiving immunosuppressive drug therapy. The other patient had profound lymphopenia and severe hypoalbuminemia due to intestinal lymphangiectasia. All had failed to respond to empiric therapy for presumed bacterial cellulitis before results of skin biopsy or aspiration were available for the correct diagnosis to be made. With administration of systemic antifungal therapy, two patients survived. Although other forms of cryptococcal involvement of the skin are not rare, cellulitis is seldom considered to be a cutaneous manifestation of the disease. Our cases and a review of the English-language literature indicate that Cryptococcus neoformans must be included in the differential diagnosis of cellulitis in immunocompromised patients and that the presence of cryptococcal cellulitis suggests disseminated cryptococcal disease. Prompt diagnosis and treatment may dramatically reduce mortality.
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.
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.
Serratia marcescens is an infrequent cause of cellulitis with only 5 reported cases. Four of the 5 patients were immunocompromised. Additionally, the cellulitis usually occurred at a site contiguous with a wound. We report a case of S. marcescens cellulitis in a patient with end-stage renal disease on chronic hemodialysis. The initial presentation was a soft tissue infection that progressed to septic shock. Ultimately, the patient responded to antibiotics and surgical debridement of infected tissue. This case serves as a reminder to consider infections due to gram-negative bacilli as a cause of cellulitis in immuno-compromised patients regardless of the presentation.
The clinical and laboratory data on 87 cases of orbital and periorbital cellulitis were reviewed. Two distinct clinical presentations were encountered. One group of 45 patients had no history of trauma or apparent focus of infection. Blood cultures on these patients were positive in 34%. Haemophilus influenzae accounted for 82% of the positive blood cultures. This group of patients shares common features with children who have facial cellulitis due to H. influenzae type b. The second group consisted of 42 patients with adjacent soft tissue focus of infection. There was only one positive blood culture in this group. Staphylococcus aureus and/or group A beta-hemolytic Streptococcus were isolated from conjunctival or wound exudate in the majority of these patients. Thirteen patients with orbital cellulitis were encountered among the 87 cases. These patients were older and had a higher incidence of demonstrable sinus disease when compared with the overall group. The pathophysiology of orbital and periorbital cellulitis is reviewed and an approach to the management of these disorders is formulated.
Three children, 8 months to 2 years of age, demonstrated unusual manifestations in association with Haemophilus influenzae septicemia and meningitis. After one child had been diagnosed as having orbital cellulitis in conjunction with H influenzae meningitis, a second child, with orbital cellulitis and no clinical evidence of meningitis, had a lumbar tap indicative of a meningitis. A third child developed a hypopyon in association with H influenzae meningitis and septic arthritis of several joints. We report the problem of diagnosis and treatment of orbital cellulitis in the context of our cases and those previously reported.
During orthodontic treatment to promote eruption of maxillary and mandibular second bicuspids, a young male patient had a severe endodontic cellulitis of a mandibular bicuspid. Apexogenesis and resolution of the periapical lesion was achieved by infection control with nonspecific intracanal medication without calcium hydroxide, as stated by Das. A mild periodontal cellulitis occurred shortly thereafter and rapidly resolved. A second endodontic cellulitis, after apexogenesis without an endodontic seal, occurred shortly after completion of orthodontic treatment. This also quickly resolved, and the canal was effectively sealed. This case indicates the importance of an effective endodontic seal shortly after apexogenesis is induced by infection control. This report and others on the subject indicate that apexogenesis of nonvital permanent immature teeth by infection control is a predictable endodontic treatment procedure.
Eikenella corrodens is a gram-negative, facultative anaerobic bacillus with specific culture and growth requirements and unusual antibacterial susceptibilities. It has only recently been recognized as a human pathogen. Ocular and adnexal infections with this organism are rare especially in children. We treated two children with orbital cellulitis caused by E. corrodens. One was an 8-year-old boy; the other was an 11-year-old girl. Orbital cellulitis in both patients occurred after an upper respiratory tract infection. Sinusitis and a subperiosteal abscess were present in both patients. Eikenella corrodens and Streptococcus viridans were isolated from the boy; E. corrodens was the sole isolate in the girl. Intravenous ampicillin, prolonged hospitalization, and surgical drainage of the orbit were required to control the infection in both patients. Eikenella corrodens must be considered in the differential diagnosis of orbital cellulitis in children, and ophthalmologists must become familiar with the characteristics of this peculiar organism.
Although Streptococcus pneumoniae remains the most common cause of community-acquired bacterial pneumonia, its involvement in skin infection is notably infrequent. A review of the literature uncovered only 13 cases of pneumococcal cellulitis in adults. Distinguishing features of skin infection by S. pneumoniae included the presence of bullae, brawny erythema, and a violaceous hue in the affected skin area. Most patients with pneumococcal cellulitis had chronic illnesses or were immunocompromised because of drug or alcohol abuse. Even with appropriate antimicrobial therapy, many patients required prolonged hospitalizations and surgery for cure. We report a case of primary pneumococcal cellulitis with secondary bacteremia in an alcoholic patient who required extensive surgical therapy and whose course was additionally complicated by acute glomerulonephritis.
A diffusing and lingering cellulitis is followed two months later by a right coxitis. Recovery of the coxitis and of the cellulitis is obtained by the antituberculous treatment. Authors demonstrate the possibility of the tuberculous etiology of the cellulitis.
Cellulitis of extremities due to Haemophilus influenzae is rare in children. Only 60 cases of Haemophilus influenzae cellulitis of the extremities have been reported. It usually affects young children between the ages of six and 24 months. The lesion often presents with a red-to-bluish-purple discoloration overlying the involved area. High fever and leukocytosis are commonly found. Culture of needle aspirate and blood with appropriate media is necessary for diagnosis. Early diagnosis is especially important because of associated bacteremia and the subsequent possibility of life-threatening complications such as meningitis. We reported a 8-month-old female infant with Haemophilus influenzae type b cellulitis over the right hand. She was admitted due to high fever and painful swelling of the right hand. Edematous right hand with dusky erythematous skin over the dorsum and swelling of the palm with limitation of range of motion were noted on admission. Smear of needle aspirate revealed gram negative bacilli and beta-lactamase(-) Haemophilus influenzae type b was cultivated in the blood culture. She was successfully treated with ampicillin and discharged with stable condition.
Orbital cellulitis as a complication of ophthalmic surgery is uncommon. We treated a patient who had orbital cellulitis and cavernous sinus thrombosis three weeks after uncomplicated cataract extraction and lens implantation. Sinus x-rays showed sphenoid sinus opacification. Computed tomographic scan confirmed the sphenoid sinus disease, and no abscess was found. The patient recovered completely after treatment with intravenous antibiotics. Most orbital cellulitis is secondary to sinus disease. The trauma of surgery and the retrobulbar block must be considered possible causative factors in this patient, but sinus disease is still the most likely cause. Intraocular inflammation did not increase during the illness although the intraocular pressure rose from 14 to 23mmHg.
Orbital cellulitis is a rarely reported, but potentially vision- and life-threatening complication after strabismus surgery. To date, only seven cases of orbital cellulitis complicating strabismus surgery have been reported in the world literature, and only two cases were reported in adult patients, both occurring more than 100 years ago. We describe a case of unilateral orbital cellulitis after bilateral strabismus surgery in an adult. Early diagnosis (aided by computed tomography) and aggressive intravenous antibiotic therapy resulted in a favorable visual outcome. Diagnosis and management are discussed, and this case is compared with previous cases in the literature.