Sunday, May 27, 2007

Preseptal and orbital cellulitis in a developing country

Preseptal and orbital cellulitis in a developing country
Orbit. 2007 Jan-Mar
Uy HS,
Tuano PM.
Sentro Oftalmologico Jose Rizal, Department of Ophthalmology, University of the Philippines - Philippine General Hospital. Manila. Philippines.

Purpose: To report the clinical features, etiology, management practices, and outcomes of preseptal (PC) and orbital cellulitis (OC) in a developing country.

Methods: The charts of all patients with PC and OC at the Philippine General Hospital from 1990 to 1995 were reviewed and the following data retrieved: age, gender, manner of presentation, causative agent, treatment, and outcomes.

Results: Of 91 patients, 56 (62%) were diagnosed with PC and 35 (38%) with OC. The mean age at presentation was 12.6 +/- 17.0 years and 17.1 +/- 18.6 years, respectively. No sex predilection was observed. Ophthalmoplegia, chemosis, pain, proptosis, and blurred vision were associated with OC. Eyelid infection was the most common antecedent factor and was present in 15 (27%) PC patients and 13 (37%) OC patients. Staphylococcus was the most frequent causative organism. Intravenous antibiotics were administered to 35 (62%) PC patients and all patients with OC. Surgical intervention was performed in 15 (27%) PC patients and 22 (63%) OC patients. None of the PC patients developed permanent sequelae. Seventeen (49%) OC patients developed serious complications such as: visual loss (29%), neurological deficits (17%), and mortality (3%).

Conclusions: In developing countries, eyelid infection may be the most important predisposing factor for periocular infection. Staphylococcus is the predominant causative agent. OC can be associated with serious complications. Aggressive management of OC may improve patient outcomes.

Keywords: Eyelid infection; orbital cellulitis; bacterial infections; microbiology; nasolacrimal duct obstruction; preseptal cellulitis; ophthalmoplegia; Staphylococcus; antibiotic therapy; underdeveloped countries; Philippines



Saturday, May 19, 2007

Cellulitis and treatment: a qualitative study of experiences

Cellulitis and treatment: a qualitative study of experiences

Br J Nurs. 2007 Mar

Carter K,
Kilburn S,
Featherstone P.
Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth.

Although cellulitis is usually a relatively mild condition, it is potentially life-threatening, often necessitating emergency treatment in either the acute or community care settings. The treatment of cellulitis with antibiotics is well established, with effectiveness generally measured against purely biochemical and clinical outcomes (Cox, 2002).

Although important, these outcomes are centred purely on the disease process from the medical perspective and little is known about patients' experiences of cellulitis. This qualitative study explores patients' views on the management of community-acquired cellulitis in the secondary healthcare setting. Data were collected through semi-structured groups and individual telephone interviews. Participants were selected through purposive sampling and the Framework Analysis Technique was used to analyse the data.

Three superordinate themes emerged: initial presentation/motivation for seeking help; confidence and satisfaction; anxiety and dissatisfaction.

Severe pain was almost universally a cause of distress and flu-like symptoms delayed recognition. Health information and communication was generally poor. Participants largely welcomed a move from inpatient to day-patient or outpatient care provided there was adequate information and support.

To meet the diverse needs of cellulitis patients, services must be more flexible and tailored to the needs of the individual. Patients are often not told what they can do to prevent recurrence.

PMID: 17505397 [PubMed - in process]

Labels: , , ,

Friday, May 11, 2007

Spontaneous Escherichia coli cellulitis in a child with nephrotic syndrome.

Spontaneous Escherichia coli cellulitis in a child with nephrotic syndrome.

Pediatr Infect Dis J. 2007 Mar

Sleiman JN,
D'Angelo A,
Hammerschlag MR.
Department of Pediatrics, Division of Infectious Diseases, Box 49, State University of New York Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA.

Spontaneous bacterial peritonitis is the most common infectious complication of childhood nephrotic syndrome, and Streptococcus pneumoniae is the preponderant bacterial pathogen. Spontaneous bacterial cellulitis, especially of the lower extremities, is another common infection encountered in the same patient group given that chronic edema acts as a potential culture medium. Gram-positive bacteria, including streptococci and staphylococci, are the most common causes of bacterial cellulitis. We report a case of spontaneous Escherichia coli cellulitis in a patient with steroid-dependent nephrotic syndrome.

PMID: 17484229 [PubMed - in process]

Labels: , , ,

Saturday, May 05, 2007

Disseminated cutaneous nocardiosis mimicking cellulitis and erythema nodosum.

Disseminated cutaneous nocardiosis mimicking cellulitis and erythema nodosum.
Dermatol Online J. 2006 Dec 10

George SJ,
Rivera AM,
Hsu S.
Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.

Infection with Nocardia asteroides is a rare, life-threatening infection, which is most commonly encountered in immunocompromised patients. Cutaneous involvement is usually seen with disseminated infection but may also occur as primary cutaneous nocardiosis. We present a case of an immunocompromised patient who presented with cellulitis of the right hand and disseminated subcutaneous nodules of the lower extremities resembling erythema nodosum. Cultures from both a skin biopsy of a subcutaneous nodule on the leg as well as a surgical specimen from the debridement of her hand grew Nocardia asteroides. The patient was treated successfully with trimethoprim-sulfamethoxazole.

This case likely represents primary cutaneous nocardiosis with secondary dissemination, which has been rarely reported. It also emphasizes that nocardial infection should be considered in the differential diagnosis of lesions suggestive of cellulitis or erythema


Cutaneous nocardiosis as an opportunistic infection

Ned Tijdschr Geneeskd. 2004 Mar

Comment in:
Ned Tijdschr Geneeskd. 2004 Jun 26;148(26):1311; author reply 1311.

Bogaard HJ,
Erkelens GW,
Faber WR,
de Vries PJ.

Afd. Longziekten, Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, 1100 DD Amsterdam.

A 46-year-old man who had been treated with azathioprine and budesonide for Crohn's disease for the past eight years developed a purulent skin condition on the right ring finger. Despite surgical drainage and treatment with amoxicillin and flucloxacillin, the condition spread itself over the hand and lower arm, partly per continuum and partly in jumps. The patient did not feel ill and there were no systemic symptoms. Ultimately, Nocardia asteroides was cultured from the wound and complete cure was achieved after 8 months' treatment with co-trimoxazole. Infections with Nocardia spp. are rare but may occur more often and run a more fulminant course in patients under treatment with immunosuppressants. Cutaneous nocardiosis generally has a characteristic lymphogenous spreading pattern, but an atypical picture with pustules, pyoderma, cellulitis or abscess formation is also possible. In non-cutaneous nocardiosis there is usually pneumonia or lung abscess, possibly with secondary haematogenous spread to the central nervous system or skin. Culturing Nocardia requires more time than usual but can be promoted by special culture media. Treatment of the infection with co-trimoxazole is the method of choice and is almost always successful in cases of cutaneous nocardiosis.

PMID: 15054953 [PubMed - indexed for MEDLINE]

Labels: , , ,