Facial Cellulitis in Children

Pneumococcal Facial Cellulitis in Children

Received Mar 23, 2000; accepted Jun 8, 2000. Laurence B. Givner*, Edward O. Mason Jr., William J. Barson§, Tina Q. Tan, Ellen R. Wald¶, Gordon E. Schutze#, Kwang Sik Kim**, John S. Bradley, Ram Yogev, and Sheldon L. Kaplan

From the * Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Department of Pediatrics, Baylor College of Medicine, Houston, Texas; § Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois; ¶ Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; # Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; ** Department of Pediatrics, University of Southern California School of Medicine, Los Angeles, California; and Department of Pediatrics, Children's Hospital-San Diego, San Diego, California.

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 src="http://pediatrics.aappublications.org/math/12pt/normal/ge.gif" align="baseline">100.5°F) and leukocytosis (white blood cell count: >15 000/mm3) 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>

Key words: Streptococcus pneumoniae, cellulitis, antibiotic resistance.

Pediatrics