Direct laryngoscopy should be procedure of choice in the airway management of patients with dental cellulitis.

Feb 2012

Boccheciampe N, Hell-Remy C, Le Manach Y, Andrieu G, Riou B, Bertolus C, Langeron O.

Source

From the Department of Anaesthesiology and Critical Care (NB, YLM CHR, GA, OL), Department of Emergency Medicine and Surgery (BR) and Department of Maxillofacial Surgery (CB), CHU Pitié-Salpêtrière, Paris, France.

Abstract

CONTEXT:

Airway management of patients with dental cellulitis can be difficult due to laryngeal deviation and oedema. Awake fibre-optic intubation has been recommended.

OBJECTIVE:

The aim of this study was to assess our routine procedure which is based mainly on direct laryngoscopy.

DESIGN:

This was a prospective observational study.

SETTING:

In a single centre between February 2008 and February 2009.

PATIENTS:

All patients suffering from dental cellulitis and requiring emergency surgery were included except pregnant women and patients under 18 years.

INTERVENTION:

Nasotracheal intubation by direct laryngoscopy under general anaesthesia was performed unless the supine position was not tolerated, or difficult mask ventilation or intubation was anticipated, when awake nasotracheal fibre-optic intubation was indicated. In the case of failure at the first attempt, orotracheal intubation by direct laryngoscopy was attempted. If failure persisted, tracheotomy was then performed.

MAIN OUTCOME MEASURES:

The principal endpoint was the incidence of difficult mask ventilation which was expected to be less than 5%. Secondary endpoints were the incidence of difficult tracheal intubation and tracheotomy.

RESULTS:

We included 127 consecutive patients (mouth opening 20 ± 10 mm). One did not tolerate the supine position and was successfully intubated using the fiberscope. Among the 126 remaining, difficult mask ventilation did not occur [0%, 95% confidence interval (CI) 0-3%], 124 (98%) patients were intubated by direct laryngoscopy and two (2%) required tracheotomy. Retrognathia (odds ratio 8.2, 95% CI 1.3-50.1) and extension to oral floor (odds ratio 15.1, 95% CI 1.8-129.5) were significantly associated with the prediction of intubation failure at the first attempt.

CONCLUSION:

Most patients with dental cellulitis can be safely intubated through direct laryngoscopy even if mouth opening is limited.

European Journal of Anesthesiology

Pemetrexed-induced cellulitis: A rare toxicity in non-small cell lung cancer treatment.

Feb 10, 2012

Katsenos S, Psara A, Panagou C.

Source

Department of Pneumonology, Army General Hospital of Athens, Athens, Greece.

Abstract

Pemetrexed is indicated for locally advanced or metastatic non-squamous non-small-cell lung cancer as an initial treatment in combination with cisplatin or after prior chemotherapy as a single agent. It is generally a well-tolerated drug.

The most common adverse reactions (incidence ≥20%) with single-agent use are fatigue, nausea, and anorexia. Additional common side effects when used in combination with cisplatin include vomiting, neutropenia, leukopenia, anemia, stomatitis/pharyngitis, thrombocytopenia, and constipation. Peripheral edema with associated erythema has rarely been described as an adverse effect. Herein, we report a patient with advanced non-small-cell lung cancer who experienced bilateral peripheral edema after pemetrexed administration.

Discontinuation of pemetrexed and corticosteroids use completely resolved peripheral edema.

PubMed

Ambulatory Intravenous Antibiotic Therapy for Children With Preseptal Cellulitis.

Feb 2012

Brugha RE, Abrahamson E.

Source

From the Paediatric Emergency Department, Chelsea and Westminster NHS Trust, London, United Kingdom.

Abstract

OBJECTIVE:

This study aimed to compare the use of outpatient ambulatory care versus admission for intravenous antibiotics in the management of preseptal cellulitis.

METHODS:

This is a retrospective consecutive cohort study of children younger than 16 years presenting to an Inner London Paediatric Emergency Department with signs and symptoms of preseptal cellulitis.

RESULTS: A total of 94 cases were identified during a 17-month period. Of them, 30 children were prescribed oral antibiotics. One child did not receive treatment. Of the 63 children prescribed with intravenous antibiotics, 42 were managed on an ambulatory basis and 21 were admitted. There was no significant difference in duration of treatment in days between those on ambulatory management and those admitted (2.79 ± 0.8 vs 2.76 ± 1.9, P = 0.94) or in the rate of complications. The net cost saving was $205,924 (£131,065; (euro)147,578) overall, equal to $4900 (£3120; (euro)3513) per patient.

CONCLUSIONS:

Ambulatory intravenous antibiotics with daily review are a safe and cost-effective alternative to inpatient admission in simple preseptal cellulitis for children in our population who require parenteral antibiotics.

PubMed

A systematic review of bacteremias in cellulitis and erysipelas.

Feb 2012

Gunderson CG, Martinello RA.

Source

Department of Internal Medicine and VA Connecticut Health Care System, Yale School of Medicine, 950 Campbell Avenue, West Haven CT 06516, USA; Veterans Health Administration, Public Health, 950 Campbell Avenue, West Haven CT 06516, USA.

Abstract

OBJECTIVES:

Because of the difficulty of obtaining bacterial cultures from patients with cellulitis and erysipelas, the microbiology of these common infections remains incompletely defined. Given the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) over the past decade the proportion of infections due to S. aureus has become particularly relevant.

METHODS:

OVID was used to search Medline using the focused subject headings "cellulitis", "erysipelas" and "soft tissue infections". All references that involved adult patients with cellulitis or erysipelas and reported associated bacteremias and specific pathogens were included in the review.

RESULTS:

For erysipelas, 4.6% of 607 patients had positive blood cultures, of which 46% were Streptococcus pyogenes, 29% were other β-hemolytic streptococci, 14% were Staphylococcus aureus, and 11% were Gram-negative organisms. Forcellulitis, 7.9% of 1578 patients had positive blood cultures of which 19% were Streptococcus pyogenes, 38% were other β-hemolytic streptococci, 14% were Staphylococcus aureus, and 28% were Gram-negative organisms.

CONCLUSIONS:

Although the strength of our conclusions are somewhat limited by the heterogeneity of included cases, our results support the traditional view that cellulitis and erysipelas are primarily due to streptococcal species, with a smaller proportion due to S. aureus. Our results also argue against the current distinction between cellulitis and erysipelas in terms of the relative proportion of infections due to S. aureus.

Elsevier-sciVerse

Periorbital mass with cellulitis caused by dirofilaria.

Oct-Dec 2011

Joseph K, Vinayakumar AR, Criton S, Vishnu MS, Pariyaram SE.

Source

Department of Microbiology, Amala Institute of Medical Sciences, Thrissur - 680 555, Kerala, India. katherinejc17@gmail.com

Abstract

Dirofilariasis is a zoonotic disease caused by Dirofilaria, a parasite of domestic and wild animals. The disease is transmitted by inoculation of mosquitoes infected with the microfilariae during their blood meal. Accidental infection of man results in lung nodule, subcutaneous mass anywhere in the body or ocular lesion that may be subconjunctival or periorbital. The incidence of ocular dirofilariasis is on the rise in several parts of India particularly in Kerala. Here we report a case of ocular dirofilariasis with cellulitis presenting as a periorbital mass.

Indian Journal of Medical Microbiology

Orbital cellulitis.

Jan 2012

[Article in French]

Mouriaux F, Rysanek B, Babin E, Cattoir V.

Source

Service d'ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.

Abstract

Orbital cellulitis is uncommon in ophthalmologic practice. The majority of cases arise from direct spread of sinus infection or eyelid infection. Clinically, orbital cellulitis is divided into two forms: the preseptal form, anterior to the orbital septum, and the retroseptal form, posterior to the orbital septum. Management and prognosis differ widely between the two types. The retroseptal form or "true" orbital cellulitis is a severe disease with potentially disastrous consequences for vision and survival. Clinical examination and urgent CT scanning are indispensable for correct diagnosis, evaluation of severity, surgical planning and antibiotic selection.

EM/Consulte

An analysis of risk factors for postoperative pelvic cellulitis after laparoscopic-assisted vaginal hysterectomy.

Dec 2011

Chang WC, Hsieh CH, Lin CC, Lin WC, Hung YC, Wu WC.

Source

Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.

Abstract

Keywords:

Pelvic cellulitis;

Postoperative infection;

Risk factors for postoperative infection

OBJECTIVE:

To assess risk factors for postoperative pelvic cellulitis in women undergoing laparoscopic-assisted vaginal hysterectomy (LAVH).

MATERIALS AND METHODS:

A total of 195 patients who underwent LAVH for benign gynecological diseases during the period 2007-2008 were enrolled. Among them, 11 patients developed pelvic cellulitis (group 1, cases) and 184 did not (group 2, controls).

RESULTS:

The proportion of patients in American Society of Anesthesiologists physical status scale (ASA) class II was significantly higher in group 1 (p=0.017). The grade of pelvic adhesion was significantly more severe in group 1 (p=0.044). The mean length of hospital stay in group 1 was significantly longer than in group 2. Logistic regression analysis revealed that patients in ASA class II were six times more likely to develop postoperative pelvic cellulitis than patients in ASA class I. In addition, the analysis showed that there was a twofold increase in risk for pelvic cellulitis with each single-grade increase in the degree of pelvic adhesion. Women with postoperative pelvic cellulitis also had a significantly increased length of hospital stay.

CONCLUSION:

Understanding the risk factors for postoperative pelvic infection, such as systemic disease, pelvic adhesion, and prolonged hospital stay, comprehensive care of patients, and correction of modifiable risk factors will help reduce the rate of postoperative pelvic cellulitis in women undergoing LAVH.

Elsevier