Monday, August 20, 2007

Microbiology of Pediatric Orbital Cellulitis.

Microbiology of Pediatric Orbital Cellulitis.
Am J Ophthalmol. 2007 Aug

McKinley SH, Yen MT, Miller AM, Yen KG.
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.

PURPOSE: To evaluate the microbiology of pediatric orbital cellulitis associated with sinusitis.

DESIGN: Retrospective review of medical records of pediatric patients treated for orbital cellulitis.

METHODS: All pediatric patients treated for orbital cellulitis associated with sinusitis at Texas Children's Hospital between December 1, 2001 and September 30, 2005 were reviewed. Data collected included patient age, history, microbiology results, and surgical intervention.

RESULTS: Thirty-eight cases were identified. Fifteen cases required medical management, whereas 23 patients received a combination of medical and surgical intervention. Three patients had multiple surgical procedures performed. Of the procedures performed, four were sinus irrigation, 12 were sinusotomy and drainage, nine were orbitotomy with drainage of abscess, and one was craniotomy with drainage of abscess. Surgical aspirate specimens yielded a higher positive culture result rate with 9/9 of orbital abscesses and 13/16 of sinus aspirates demonstrating a positive yield. Two of the 27 blood cultures had a positive yield. Staphylococcus species was the most common organism isolated. Methicillin-resistant S. aureus (MRSA) represented 73% of S. aureus isolates. Streptococcus species was the next most common pathogen. Three cultures yielded Haemophilus species with one being positive for H. influenzae.

CONCLUSIONS: Organisms responsible for causing pediatric orbital cellulitis are evolving, with Staphylococcus followed by Streptococcus species being the most common pathogens. The occurrence of MRSA in pediatric orbital cellulitis is increasing, and empiric antimicrobial therapy should be directed against these organisms if they are prevalent in the community. Sinus and orbital abscess aspirates yielded the greatest number of positive cultures, though these invasive surgical procedures should be performed only when clinically indicated.

Microbiology of Pediatric Orbital Cellulitis.

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Friday, August 03, 2007

Cellulitis and Bacteremia Caused by Bergeyella zoohelcum

Cellulitis and Bacteremia Caused by Bergeyella zoohelcum

J Formos Med Assoc. 2007 Jul

Lin WR, Chen YS, Liu YC.
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

Keywords: Bergeyella zoohelcum, cellulitis, dog bite, liver cirrhosis

Bergeyella zoohelcum is a rod-shaped, aerobic, Gram-negative, non-motile and non-saccharolytic bacterium. It is frequently isolated from the upper respiratory tract of dogs, cats and other mammals. Clinically, B. zoohelcum has been known to cause cellulitis, leg abscess, tenosynovitis, septicemia, pneumonia and meningitis, and is associated with animal bites. In addition, food-borne transmission was considered in a recent case report. We report a 73-year-old man with liver cirrhosis who had no history of dog bite but had dog exposure, who developed cellulitis of the left lower leg and B. zoohelcum was isolated from blood culture. This patient, without evidence of polymicrobial infection, was treated with cefazolin and gentamicin with a good outcome. B. zoohelcum is a zoonotic pathogen that may cause bacteremia in patients with underlying disease such as liver cirrhosis; it can be treated with a beta-lactam or quinolone.


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