Cellulitis

Idiopathic orbital myositis mimicking orbital cellulitis.

2010-06-05T04:17:00.000-07:00

Idiopathic orbital myositis mimicking orbital cellulitis.

Kim DS, Lee JH, Oh DY, Seo JW, Ahn ST, Rhie JW.

Department of Plastic Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea.

J Craniofac Surg. 2010 May

Journal of Craniofacial Surgery:

May 2010 - Volume 21 - Issue 3 - pp 932-934

doi: 10.1097/SCS.0b013e3181d7f0df

Brief Clinical Studies

Abstract

Idiopathic orbital myositis (IOM) is a subtype of orbital inflammatory disease characterized by primarily involving the extraocular muscle. The signs and symptoms of IOM may also be seen in such processes as orbital cellulitis, primary or metastatic orbital neoplasm, carotid-cavernous fistulae, arteriovenous malformations, cavernous sinus thrombosis, and thyroid eye disease, and because there is no pathognomonic sign, symptoms, laboratory test, or radiologic findings, its diagnosis is often provisional.

In our case, diagnosis of IOM was more difficult because our patient presented with proptosis after alloplastic implant insertion in the blow-out fracture. After considering radiologic and physical findings, we concluded that cellulitis was more likely as initial diagnosis. To remove foreign body or pus, surgical exploration was done, but intraoperative findings did not show any pus or sign of infection but diffuse enlargement and swelling of inferior rectus muscle. The diagnosis was confirmed as IOM, and the patient was treated with systemic corticosteroid. Although proptosis after alloplastic insertion in blow-out fracture is usually a sign of cellulitis, this case illustrates that it may also occur in patients with IOM.

Journal of Craniofacial Surgery

Intracranial brain abscess preceded by orbital cellulitis and sinusitis.

2010-06-05T04:12:00.000-07:00

Intracranial brain abscess preceded by orbital cellulitis and sinusitis.

J Craniofac Surg. 2010 May

Journal of Craniofacial Surgery:

May 2010 - Volume 21 - Issue 3 - pp 934-936

doi: 10.1097/SCS.0b013e3181d84124

Brief Clinical Studies

Yeh CH, Chen WC, Lin MS, Huang HT, Chao SC, Lo YC.

Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan. shium8852@gmail.com

Abstract

A 17-year-old boy with pyrexia, headache, and frequent drop attacks reported an acute onset of periorbital pain and swelling 1 month previously. Coronal computed tomography (CT) identified an ethmoid sinusitis, which was treated with functional endoscopic sinus surgery and intravenous gentamicin, prostaphylline, and metronidazone. Because of persistent symptoms, the patient returned 1 month later.

The CT identified accumulation of debris in both frontal sinuses and a multilobulated lesion over the right frontal lobe. Bicoronal craniotomy was performed, and a mass located in the right frontal lobe was excised; the mass comprised chronic inflammatory tissues without evidence of malignancy. A postoperative brain CT confirmed the absence of a residual mass, and no recurrence or neurologic deficits were noted during the 3-month follow-up period. Intracranial complications cannot be prevented entirely even with the judicious use of antibiotics. Early application of the appropriate imaging modality and institution of aggressive therapy in any patient, not just pediatric patients, to prevent potential long-term disabilities and death are essential.

Journal of Craniofacial Surgery

Florid osseous dysplasia: report of a case presenting acute cellulitis.

2009-10-20T04:47:00.000-07:00

Florid osseous dysplasia: report of a case

presenting acute cellulitis

Med Oral Patol Oral Cir Bucal. 2009 Sep

Pitak-Arnnop P, Dhanuthai K, Chaine A, Bertrand JC, Bertolus C.

Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany. poramate.pitakarnnop@gmail.com

In this review, we examined a 45-year-old Asian man who had been diagnosed with florid osseous dysplasia (FOD) of the mandible and acute perimandibular cellulitis. This presentation occurred after a history of off-and-on swellings of the jaw and multiple treatments received at another hospital. An aggressive resection of the jaw was planned; however, the patient denied the treatment and came to our clinic to seek a second opinion. The patient was successfully treated by conservative surgery and antibiotic treatment with preservation of the jaw integrity and the mandibular neurovascular canal. Intraoperatively, a piece of a calcified mass was removed and submitted for histopathological examination. The specimen showed woven bone and densely sclerotic mass of calcified materials exhibiting reversal lines and inflammatory cell infiltration of the connective tissue. The definitive diagnosis was FOD with a secondary infection. Treatments for FOD were discussed.

Full Text: Med Oral Patol Oral

Campylobacter fetus cellulitis in an immunocompromised patient: case report and review of the literature.

2009-10-20T04:43:00.000-07:00

Campylobacter fetus cellulitis in an immunocompromised patient:

case report and review of the literature

Acta Clin Belg. 2009 Jul-Au

Ausselet N, Huang D, Vandercam B, Yombi JC.

Department of internal medicine, infectious and tropical diseases, Saint Luc University hospital, Bruxelles.

Campylobacter fetus is an opportunist Gram-negative bacillus. The most frequent clinical manifestation is bacteriemia but it can also be responsable for soft tissue infections, endovascular infections, meningitis, peritonitis and thrombophlebitis. Campylobacter fetus cellulitis has been described, but rarely identified in subcutaneous puncture samples. We report a case of an immunocompromised patient with Campylobacter fetus bacteriemia associated with a soft tissue infection whose subcutaneous puncture also revealed the bacteria.

PMID: 19810424 [PubMed - in process]

How Cracked heels can let killer bacteria invade your body

2009-10-11T06:43:00.000-07:00

How Cracked heels can let killer bacteria

invade your body

By ALICE GREBOT

Last updated at 10:20 AM on 06th October

One night as Chris Banting was undressing for bed, he was surprised

when his wife Helen pointed out to him that the back of his right calf was

a worrying scarlet colour.

'It was strange because I wasn't in any discomfort at all,' says Chris, 62.

'If you have an infection, you think you'd be in pain or running a temperature,

but I felt fine.'

It was November 2007 and the busiest time of the year in his job as a charity

fundraising manager, but he decided it was something he should get checked

out.

In fact, Chris was suffering from cellulitis - a serious bacterial infection of the

skin.

Left untreated, the bacteria can spread through the body and cause potentially

fatal blood poisoning or an infection of the muscle, bone or heart valve.

Around 70,000 people are hospitalised with it every year.

Cellulitis - not to be confused with cellulite - affects the deep layer of skin

known as the dermis, and sometimes the layer of fat and soft tissues beneath.

Initially, it causes the skin to become sore, red and swollen.

Though it commonly affects the lower legs, it can occur on any part of the body.

Dr Nick Lowe, consultant dermatologist and spokesperson for the

British Skin Foundation, explains that we all have bacteria living on our skin.

Usually this doesn't cause any harm, but if the skin is damaged by an ulcer, cut,

graze or insect bite, or even if it is simply cracked through conditions such as

eczema, the bacteria can get in, causing an infection.

Nail infections or ingrown toenails can also be a source.

'When this happens, the infected area becomes inflamed, tender, red and

often hot,' says Dr Lowe.

'It may also blister. The infection is usually accompanied by symptoms of feeling

generally unwell, including fever and nausea.'

Those with weakened immune systems are particularly vulnerable, as their bodies

lack the strength to fight off the infection.

Other risk factors include diabetes, as it often causes poor blood supply to the skin,

which may lead to ulcers that can serve as an entry point for bacteria.

Athlete's foot can also make you more prone to cellulitis, as this may cause the skin to

crack.

A severe case of cracked heels could make you more vulnerable, too. As can

lymphedema - a condition that causes swelling in a part of the body because of fluid

build-up under the skin.

However, cellulitis can occur without a wound, when bacteria enters through

the lymphatic system.

The speed at which the symptoms manifest themselves depends on the

health of the infected patient.

'In a very healthy person, symptoms may take up to a week to appear,' says Dr Lowe.

'But in the elderly or those with weakened immune systems, symptoms can come

on rapidly, in just a day or two.

'This is why prompt diagnosis-and treatment with antibiotics is vital, before the

infection spreads.'

When Chris Banting discovered the angry rash on his leg, he made an appointment

at an out- of-hours clinic near his home in Bristol.

The doctor diagnosed cellulitis and gave Chris a prescription for antibiotics.

'He told me the most likely point of entry for the bacteria that had caused

my cellulitis had been cracks on the soles of my feet,' says Chris.

'I'd had athlete's foot since I was a teenager, and on top of a recent attack, which I'd

been treating with an anti-fungal cream, had developed a secondary fungal

infection that had caused the cracks.

'I'd heard cellulitis can potentially kill you, but that didn't even enter my head

then. My wife had been through the same thing, and although she'd spent a week

in hospital, she'd been cured, so I thought I'd take the antibiotics and I'd be fine.'

Generally, a course of antibiotics is enough to clear up the infection, but despite

the prompt diagnosis, his symptoms got progressively worse.

Just two days later, he had developed a huge blister on his right calf, around

one-and-a-half inches deep and the diameter of a grapefruit.

'I'd never seen anything like it,' says Chris. 'It seemed to have come out of

nowhere.

'Worse still, the stuff leaking out of it looked like some kind of machine oil.

It was revolting!'

Chris went straight to his GP, who took one look at his leg and told him he

needed to go to hospital.

'She explained the infection had gone beyond the stage when oral

antibiotics would help, and that I'd need to be admitted for intravenous

antibiotics,' he says.

'It was all rather dramatic and happened very quickly.'

Chris was admitted to the Bristol Royal Infirmary.

'One of the first things the doctors did was to draw on my leg with a

marker pen around the outline of the infected skin, so they could keep

track of whether it was spreading or not,' says Chris.

'It would seem it can spread rapidly in some instances - but luckily mine

stayed roughly the same.'

Thankfully, within a couple of days, Chris's infection began to dwindle

(his athlete's foot was also effectively treated).

He remained in hospital for a week and was then released to the care

of his GP surgery, where he went daily for ten days to have his dressings

changed.

Now the only lasting sign he ever suffered from cellulitis is a patch of

discoloured skin extending from behind the knee to the ankle bone.

Though he's recovered, Chris could well suffer a recurrence. Around

one-third of people develop cellulitis again within three years.

'Once you've had cellulitis, you're more likely to get it again - and in

the same area,' says Dr Lowe.

'This is because the infection can damage the lymph channels in the

area, so they become less efficient at filtering out germs.

Therefore, you need to be scrupulous about skin cleansing and keeping

your skin moisturised, to prevent it drying out and cracking.'

Meanwhile, Chris is thankful for the first-class treatment he received -

and to his wife for spotting the symptoms in the first place.

'If she hadn't, goodness knows what could have happened,' he says.

Mail Online

For additional information:

Cellulitis

Complications of Cellulitis and Lymphangitis

Prevention of Cellulitis

What is Cellulitis?

2009-10-11T06:04:00.000-07:00

What is Cellulitis?

Written by Amanda Wattson, MD
Saturday, 10 October 2009

Cellulitis is an infection of the skin and the layer of tissue under the skin.

What is going on in the body?

Cellulitis most often develops on the legs but can be seen on the face and on any other skin

on the body. It tends to affect a fairly large area of skin. Cellulitis is usually due to an infection

of the skin with bacteria, but it may also be caused by a fungus.

What are the causes and risks of the infection?

Cellulitis is usually caused by a break in the skin that becomes infected with bacteria or

fungi. It can occur in wounds caused by injury and in surgical wounds. It can also occur when

there is no obvious break in the skin.

Risk factors for cellulitis include the following:

- recent surgery
- diabetes
- recent chickenpox infection

-immunodeficiency disorder, in which the body's infection-fighting mechanisms are impaired.

People with AIDS, for example, have a significant risk of cellulitis.

- impaired circulation, such as peripheral arterial disease, which limits blood flow to the legs

and arms.

- chronic use of steroids

What are the treatments for the infection?

For mild, superficial infections, oral antibiotics, such as cephalexin or dicloxacillin, are often

used. Over-the-counter pain medication, such as ibuprofen or acetaminophen, can be used

as needed to relieve discomfort. For more severe infections, individuals may need intravenous

(IV) antibiotics, such as oxacillin or nafcillin.

Cellulitis may get worse even with treatment, especially in people with diabetes. In these

cases, more aggressive treatment may be needed. This may include surgery to remove dead

skin or even bone.

What are the side effects of the treatments?

Antibiotics and over-the-counter pain medications may cause upset stomach, rash, or allergic

reactions. Surgery may cause bleeding, new infections, or allergic reaction to anesthesia.

What happens after treatment for the infection?

In most cases, cellulitis goes away after treatment. If treatment is successful, people can

usually return to normal activities.

How is the infection monitored?

The healthcare provider will examine the area of cellulitis regularly to assess healing. In

some cases, special X-ray tests may be used if a deeper infection is suspected. Any new

or worsening symptoms should be reported to the healthcare provider.

24 Medica

Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review

2009-10-11T05:58:00.000-07:00

Staphylococcus aureus is the most common

identified cause of cellulitis: a systematic review

Epidemiol Infect. 2009 Aug 3

Chira S, Miller LG.

Alpert Medical School at Brown University, Providence, RI, USA.

Correspondence:

^c1 Author for correspondence: L. G. Miller, M.D., M.P.H., Division of Infectious Diseases, Harbor–UCLA Medical Center, 1000 W Carson St, Bin 466, Torrance, CA 90509, USA. (Email: lgmiller@ucla.edu)

SUMMARY:

We utilized Medline to perform a systematic review of the literature to quantify the aetiology of cellulitis with intact skin. Of 808 patients with cellulitis, 127-129 (15.7-16.0%) patients had positive needle aspiration and/or punch biopsy cultures from intact skin. Of the patients with positive cultures, 65 (50.4-51.2%) had cultures positive for Staphylococcus aureus, 35 (27.1-27.6%) for group A streptococcus, and 35-37 (27.1-29.1%) for other pathogens. The most common aetiology of cellulitis with intact skin, when it can be determined, is S. aureus, outnumbering group A streptococcus by a ratio of nearly 2:1. Given the increasing incidence of community-associated methicillin-resistant S. aureus infections, our findings may have critical therapeutic implications.

Cambridge

Necrotizing fasciitis and myonecrosis "synergistic necrotizing cellulitis" caused by Bacillus cereus.

2009-09-29T03:22:00.000-07:00

Necrotizing fasciitis and myonecrosis

"synergistic necrotizing cellulitis"

caused by Bacillus cereus.

J Dermatol. 2009 Jul

Sada A, Misago N, Okawa T, Narisawa Y, Ide S, Nagata M, Mitsumizo S.

Division of Dermatology, Department of Internal Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga 849-8501, Japan. Email: sadaasu@cc.saga-u.ac.jp

Our patient was a 37-year-old man with diabetes mellitus and hepatopathy as underlying diseases. Swelling, erythema and pain appeared in the left upper limb on the day before the initial examination. On examination, diffuse purpura was noted on the left upper limb, and, as it rapidly extended to the left upper trunk, emergency surgery was performed. Intraoperatively, gas-producing necrosis was observed not only in subcutaneous tissues but also from the fascia to muscle tissues, and the condition resembled clostridial gas gangrene. However, as the culturing of samples from the lesion yielded Bacillus cereus, a diagnosis of necrotizing fasciitis and myonecrosis (synergistic necrotizing cellulitis) due to B. cereus was made. While the patient developed a serious condition due to sepsis and disseminated intravascular coagulation, he could be saved by early debridement and intensive treatment with an appropriate selection of antibiotics.

Wiley InterScience

Emergency department management of home intravenous antibiotic therapy for cellulitis

2009-09-24T04:09:00.000-07:00

Emergency department management of home intravenous antibiotic therapy for cellulitis

Emergency Medicine Journal 2005;22:715-717; doi:10.1136/emj.2004.018143
© 2005 BMJ Publishing Group Ltd and the College of Emergency Medicine.

M Donald1, N Marlow2, E Swinburn1, M Wu3
1 Royal North Shore Hospital, Sydney, Australia2 Northern Sydney Health, Sydney, Australia3 Mona Vale Hospital, Australia

Correspondence to:Correspondence to: Dr M J Donald Royal North Shore Hospital, St Leeward’s, Sydney, NSW, Australia; mikedonald25@hotmail.com

Objectives: To evaluate the safety and efficacy of using intravenous cephazolin as a first line antibiotic for the treatment of cellulitis in a supervised outpatient programme.

Methods: This study was a retrospective analysis and included all patients who attended the emergency department (ED) of a university affiliated hospital in Sydney over the period of 1 year and who satisfied the following inclusion criteria: (a) age >16 years, (b) presented with acute cellulitis, and (c) were suitable for home intravenous antibiotic therapy according to APAC guidelines.

Results: In total, 124 patients were included, of whom 53 (42.7%) presented directly to the ED and 71 (57.3%) were referred by their general practitioner. Of these 124 patients, 75 (60.5%) were men and 49 (39.5%) were women. Age range was 16–97 years. There were 82 (66.2%) presentations of cellulitis of the lower limb, 30 (24.2%) of the upper limb, 9 (7.2%) of the face and 3 (2.4%) of the torso. Cephazolin 2 g twice daily was given to 123 (99.2%) of the patients, and one patient (0.8%) received ceftriaxone 2 g once daily. In total, 105 patients (84.7%) were treated successfully and 19 (15.3%) were re-admitted. Four of the unsuccessful treatment group required incision and drainage of abscesses. The mean duration of intravenous therapy was 6.24 days. One patient developed diarrhoea. There were no other complications attributable to therapy.

Conclusion: Low re-admission rates verify the efficacy of cephazolin 2 g twice daily in treating cellulitis in the home environment. Benefits are multiple and include economic savings and reduced risk of nosocomial infection.

Abbreviations: APAC, Acute/Post Acute Care; ED, emergency department; HIH, hospital in the home

Keywords: Cellulitis; cephazolin; department; emergency

Ermergency Medicine Journal

Continuous-infusion oxacillin for the treatment of burn wound cellulitis.

2009-09-20T12:02:00.000-07:00

Continuous-infusion oxacillin for the treatment of burn wound cellulitis.
Surg Infect (Larchmt). 2009 Feb

Schuster KM, Wilson D, Schulman CI, Pizano LR, Ward CG, Namias N.
Section of Trauma, Surgical Critical Care and Surgical Emergencies, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA. kevin.schuster@yale.edu

BACKGROUND: Burn cellulitis is an infection of the unburned skin at the margin of a burn wound or graft donor site, typically caused by group A beta-hemolytic streptococci and Staphylococcus aureus. beta-Lactam antibiotics exhibit time-dependent killing and, because of their narrow spectrum, minimize bacterial resistance. We therefore use continuous-infusion oxacillin in the treatment of burn cellulitis.

METHODS: Patients at a regional burn center who were treated for burn cellulitis from January 2003 to December 2005 were included. Charts were reviewed for all pertinent data regarding the antibiotic treatment methods and outcomes. Successful treatment was defined as resolution of physical findings, fever, and leukocytosis and intravenous antibiotic cessation.

RESULTS: Thirty-seven patients were treated for burn cellulitis, 26 (70%) of whom were treated initially with continuous-infusion oxacillin. Other initial antibiotics were chosen because of concomitant infections, penicillin allergy, or development of cellulitis during treatment with a beta-lactam antibiotic. Oxacillin treatment was successful in 19 patients (73%). Success required an average of 5.16 days, with 1.53 days required for fever resolution and 0.89 days for resolution of leukocytosis. Seven patients who did not respond rapidly were switched to intravenous vancomycin an average of 2.4 days after starting oxacillin, leading to a 100% success rate. There were no deaths, and only one suspected case of allergic reaction to oxacillin. In eleven patients treated with other antibiotics, the success rate was 75%. Success with these drugs required a longer treatment course of 6.45 days. Leukocytosis resolved significantly more slowly at 4.45 days (p = 0.02), and fever resolution was also slower at 3.18 days.

CONCLUSIONS: Continuous-infusion oxacillin was successful in the treatment of 73% of patients, a success rate that might have been higher with clinical patience, and leukocytosis resolved faster than with other antibiotics. Failure of continuous-infusion oxacillin can be managed without clinical consequence by conversion to intravenous vancomycin.

MaryAnn Liebert Publications

Fungal foot infection, cellulitis and diabetes: a review.

2009-09-17T11:35:00.000-07:00

Fungal foot infection, cellulitis and diabetes: a review.
Diabet Med. 2009 May

Bristow IR, Spruce MC.
School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK. ib@soton.ac.uk

AIMS: To review the current evidence for the presence of fungal foot infection (tinea pedis and toenail onychomycosis) as a risk factor for the development of cellulitis within the lower limb, particularly for those individuals with diabetes.

METHODS: A structured review of medline, embase and cinahl databases was undertaken to identify publications investigating fungal foot infection as a risk factor for the development of cellulitis.

RESULTS: Sixteen studies were identified. Eight studies adopted a case-control methodology, with the remainder being cross-sectional surveys. The majority of studies established the presence of tinea infection by clinical rather than established microbiological methods. Although the majority of papers suggested a link, only two case-control studies employed microbiological diagnosis to demonstrate that fungal foot infection was a risk for the development of lower limb cellulitis, particularly when infection was located between the toes. There were insufficient data to suggest that fungal foot infection posed an increased risk to patients with diabetes.

CONCLUSION: There is some evidence to suggest that fungal infection of the foot is a factor in the development of lower limb cellulitis, but further robust research is needed to confirm these findings and quantify the risk that fungi pose, particularly to the diabetic foot. Meanwhile, improved surveillance and treatment of tinea infections on the foot by healthcare professionals should be encouraged to reduce potential complications.

Wiley InterScience

Florid osseous dysplasia: report of a case presenting acute cellulitis.

2009-09-17T10:54:00.000-07:00

Florid osseous dysplasia: report of a case presenting acute cellulitis.

Med Oral Patol Oral Cir Bucal. 2009 Sept

Pitak-Arnnop P, Dhanuthai K, Chaine A, Bertrand JC, Bertolus C.
Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany. poramate.pitakarnnop@gmail.com

In this review, we examined a 45-year-old Asian man who had been diagnosed with florid osseous dysplasia (FOD) of the mandible and acute perimandibular cellulitis. This presentation occurred after a history of off-and-on swellings of the jaw and multiple treatments received at another hospital. An aggressive resection of the jaw was planned; however, the patient denied the treatment and came to our clinic to seek a second opinion. The patient was successfully treated by conservative surgery and antibiotic treatment with preservation of the jaw integrity and the mandibular neurovascular canal. Intraoperatively, a piece of a calcified mass was removed and submitted for histopathological examination. The specimen showed woven bone and densely sclerotic mass of calcified materials exhibiting reversal lines and inflammatory cell infiltration of the connective tissue. The definitive diagnosis was FOD with a secondary infection. Treatments for FOD were discussed.

Med Oral

Oral tacrolimus treatment for refractory eosinophilic cellulitis.

2009-06-08T06:41:00.000-07:00

Oral tacrolimus treatment for refractory eosinophilic cellulitis.
Clin Exp Dermatol. 2009 Jun
Ohtsuka T.
Department of Dermatology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.

A 72-year-old man presented with a 1-month history of a rash. The eruption had previously been successfully treated with oral corticosteroids (prednisolone 30 mg/day) and antihistamines on two previous occasions, but recurred several days after stopping treatment. On examination, multiple, indurated, round to annular erythematous plaques were found on the trunk and limbs. Histological examination revealed interstitial oedema, a dense infiltrate of eosinophils in the dermis, and flame figure formation. These results led us to the diagnosis of eosinophilic cellulitis. Treatment with oral corticosteroids (prednisolone 15 mg/day) was unsuccessful. Four weeks after the start of oral tacrolimus 1 mg/day, the eruption completely resolved.

WileyInterScience

Recurrent Cellulitis in a Case of Aagenaes Syndrome.

2009-06-08T06:38:00.000-07:00

Recurrent Cellulitis in a Case of Aagenaes Syndrome.
Clin Pediatr (Phila). 2009 Jun
Dang S, Sigal Y, Davies D.

Aagenaes syndrome, also called Lymphedema Cholestasis Syndrome (LSC 1), is a form of idiopathic familial intrahepatic cholestasis associated with lymphedema of the lower extremities. It is named after the Norwegian pediatrician Oyestein Aagenaes, who described the syndrome in 1968. The presence of lymphedema is likely the predisposing factor for development of recurrent infections in such patients.1 Recurrent cellulitis as such has never been described in the literature with Aagenaes syndrome. This case highlights recurrent cellulitis as one of the potential complications of Aagenaes syndrome.

Sage Journals

Acute renal failure in a young male with cellulitis in the lower leg

2009-05-19T06:24:00.000-07:00

Acute renal failure in a young male with cellulitis in the lower leg

An Med Interna. 2008 Jun

Rodríguez Lorenzo A, Martelo Villar F.
Servicio de Cirugía Plástica y Quemados, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, España.

Necrotizing fascitiis due to Streptococcus Pyogenes has a high mortality rate. Detection of the infection before it developes to the streptococcal toxic shock syndrome is quite challenging and its one of the main goals of its management because at this final stage the treatment is in most of the cases ineffective. In a secuence of events of the progression of the infection to shock, renal failure occurs before hipotension very often. We report the case of a 38-year-old patient affected by a fulminant necrotizing fascitiis by Streptococcus Pyogenes which presented at admission with lower leg cellulitis and acute renal failure.

Full Text Article SciELO - Spain

Streptococcal cellulitis following preparation of fresh raw seafood.

2009-05-19T06:19:00.000-07:00

Streptococcal cellulitis following preparation of fresh raw seafood.
Zoonoses Public Health. 2009 May

Koh TH, Sng LH, Yuen SM, Thomas CK, Tan PL, Tan SH, Wong NS.
Department of Pathology, Singapore General Hospital, Singapore.

We describe three zoonotic streptococcal soft tissue infections resulting from fresh seafood contact. One was a localized thumb infection with Streptococcus iniae in an immunocompetent healthy young male resulting from a puncture wound from a crab pincer. The other two were cases of ascending upper limb cellulitis associated with bacteraemia in mastectomy patients. One of these infections was caused by S. iniae while the other was caused by Streptococcus dysgalactiae subsp. dysgalactiae, a species that has not been previously described as a cause of zoonotic infection. Hence when cleaning raw seafood, protective equipment should be used to minimize the risk of percutaneous injuries.

Wiley InterScience

Langerhans cell histiocytosis mimicking preseptal cellulitis.

2009-05-19T06:15:00.000-07:00

Langerhans cell histiocytosis mimicking preseptal cellulitis.
J Pediatr Ophthalmol Strabismus. 2009 Mar-Apr

Kempster R, Ang GS, Galloway G, Beigi B.
Adnexal Service, Department of Ophthalmology Norfolk & Norwich University Hospital, Norwich, United Kingdom.

A 7-year-old girl presented with signs of preseptal cellulitis that initially responded to antibiotics but then relapsed. Computed tomography scan revealed a cystic lesion in the preseptal tissues with associated soft tissue swelling and lacrimal gland inflammation. Anterior orbitotomy revealed a hemorrhagic-appearing lesion extending from the preseptal tissues subperiosteally along the roof of the orbit. The lesion was excised and histopathology and immunohistochemical staining confirmed a diagnosis of Langerhans histiocytosis. Management of this condition depends on the extent of systemic involvement, with single bony lesions usually pursuing a benign course and often spontaneously regressing or resolving following biopsy. This case serves to highlight that an underlying cause for preseptal cellulitis should be sought and if there are relapses or inadequately resolving signs of preseptal cellulitis, then prompt investigation to rule out other causes is required.

PMID: 19343973 [PubMed - indexed for MEDLINE]

Febrile cellulitis surrounding a scar revealing a large immunoblastic B-cell lymphoma

2008-12-30T07:13:00.000-08:00

Febrile cellulitis surrounding a scar revealing a large immunoblastic B-cell lymphoma
Ann Dermatol Venereol. 2008 Dec

Charavin-Cocuzza M, Templier I, Simon A, Salameire D, Cuchet E, Reymond JL, Beani JC, Leccia MT.
Pôle pluridisciplinaire de médecine, service de dermatologie, CHU Albert-Michallon, BP 217, 38043 Grenoble cedex 09, France.

BACKGROUND: Secondary skin sites of lymphoma appear in the advanced stages of the disease. We report the first case of a pericicatricial skin infiltration, mimicking febrile dermohypodermitis, revealing diffuse immunoblastic large B-cell non-Hodgkin's lymphoma.

PATIENTS AND METHODS: Four months after decompressive cervical laminectomy, a 56-year-old man presented an inflammatory pericicatricial patch evoking cellulitis in a setting of hyperthermia and lymphadenopathy. Blood cultures and bacteriological analysis of skin biopsy samples were negative. The images showed infiltration of the soft subcutaneous areas and polyadenopathy. Two weeks later, several subcutaneous nodules appeared on the trunk. Histological analysis and immunolabelling pointed to immunoblastic large B-cell non-Hodgkin's lymphoma. A clone of B lymphocytes CD45+, CD20+, CD79a+, Bcl2+, CD5+, MUM1+, CD3-, CD10-, CD23- and Bcl6- was seen. The remainder of the extension examination was negative. CHOP-rituximab polychemotherapy resulted in complete regression of all lesions, notably the inflammatory cervical plaque.

DISCUSSION: Secondary skin manifestations of lymphoma are generally non-specific (pruritus, ichthyosis, purpura, etc.) rather than specific in terms of lymphoid infiltration. As in our patient, certain cutaneous sites of lymphoma may have a misleading clinical presentation, histological analysis alone was able to provide a conclusive diagnosis. In our patient, the highly specific infiltration seen around the entire scar could either suggest a Koebner phenomenon or point to a role of the cutaneous aggression within the development of an inflammatory process contributing to pericicatricial infiltration by lymphoid cells. Locoregional invasion from the osseous part of the cervical spine and not macroscopically diagnosed during neurosurgery could also be responsible.

EM Consulte

A Case of Helicobacter cinaedi Bacteraemia in a Previously Healthy Person with Cellulitis.

2008-12-30T05:53:00.000-08:00

A Case of Helicobacter cinaedi Bacteraemia in a Previously Healthy Person with Cellulitis.

Open Microbiol J. 2008

Holst H, Andresen K, Blom J, Højlyng N, Kemp M, Krogfelt KA, Christensen JJ.
Department of Bacteriology, Mycology and Parasitology.

Helicobacter cinaedi is an infrequent, but well recognized cause of gastroenteritis in immunosuppressed patients. Here we report a case of an extra-intestinal infection in a previous healthy 61-year old heterosexual male. Focus for the infection was most likely cellulitis on the lower right leg. The bacterium was cultured from blood twice within one week. Electron microscopy of the isolate visualized bipolar flagella. Partial DNA sequencing of the 16S rRNA gene and phenotypic characterization of the isolate established the species diagnosis. The patient was treated with rifampicin. After end of treatment blood cultures were negative and the cellulitis had disappeared.

Introduction

Helicobacter cinaedi belongs to the enterohepatic helicobacters. They inhabit the lower gastrointestinal tract of mammals and birds and have been implicated as cause of human gastroenteritis, particularly in immunocompromised individuals. In contrast to Helicobacter pylori which very rarely invade the bloodstream, the enterohepatic helicobacters may do so. Of these, H. cinaedi is the most frequently reported bloodstream invading organism, especially in immunocompromised hosts and particularly in men infected with HIV. Only few cases of bacteraemia with H. cinaedi have been observed in heterosexual immunocompetent men. In the case presented here, the patient suffered from bacteraemia with H. cinaedi and had a large area with erysipelas-like infection on his lower right leg – a characteristic clinical picture seen previously in relation to blood-stream infection with H. cinaedi. The initial identification of H. cinaedi was established by a culture independent method; i.e. PCR using 16S rDNA universal bacterial primers and subsequent DNA sequence analysis of the PCR product. Also given the problems associated with conventional phenotypic identification of organisms like H. cinaedi, sequence analysis of rRNA genes (in particular 16S) is increasingly used as an alternative approach for identification of unspecified isolates. In our case supplementary electron microscopy was carried out. Due to the slow growth and fastidious requirements of this organism, H. cinaedi bacteraemia may currently be under-recognized.

Case Presentation

Case Story

A 61-year old heterosexual male was admitted to hospital with an infection on his lower right leg. Before admission he was treated empirically with oral beta-lactam antibiotics for a few days and then changed to dicloxacillin for three days by his general practitioner. On admission he had fever, chills and a leukocyte count of 15,9x109 /l. and a C-reactive protein concentration of 77mg/l. The condition was at first considered to be erysipelas and treated with intravenous penicillin 2mill. IU x 4. The patient was discharged after three days of intravenous treatment and continued with oral penicillin treatment for another week. He was readmitted, however, two days later because the cellulitis had progressed. Blood cultures were taken at both admissions and gave by both episodes growth of motile spiral-shaped Gram-negative rods after 5 days incubation. At readmission PCR/sequencing on the first blood-culture sample indicated presence of H. cinaedi and treatment was then changed to peroral rifampicin 300 mg once daily for 2 weeks. At the end of treatment no helicobacters were detected in blood cultures and the skin alterations had disappeared. Fecal specimens were not available. Antibodies reacting against H. pylori were detectable in serum. No recurrences were noted at 5 months follow-up. Source of infection is unknown; no contact to domestic animals was reported. Exposure to mice excrements was reported, while cleaning the attic of his house. Focus for the bacteraemia was most likely cellulitis on the lower right leg.

Microbiology

Bacterial isolates were recovered from blood samples using the Bactec 9240 system (Becton Dickinson).One set of blood cultures consist of two Bactec Plus aerobic/F bottles and one Bactec Plus anaerobic/Bottle. In both sets of blood cultures aerobic blood cultures (2 bottles out of 4) became positive after 5 days of incubation. Light microscopy of the blood culture fluid identified a spiral-shaped, motile, and Gram-negative rod.The organism failed to grow on 5% horse blood agar, but grew successfully at microaerophilic conditions at 37°C on horse blood agar enriched with 5% yeast. Electron microcopy visualized bipolar sheathed flagella (Fig. 1). Electron microscopy was carried out using a FEI Morgani D268 electron microscope at 80 kW. Bacteria grown for two days were harvested from blood agar plates and gently resuspended in distillated water. Bacterial ultra structure was examined by the negative staining technique using 1.5% phosphotungstic acid.

Demonstration of bacterial DNA and partial DNA sequencing of the 16S rRNA was performed on blood-culture fluid and on the isolate. DNA was released using the Qiagen extraction kit or heating isolated bacteria at 95o C for five minutes. For demonstrating presence of bacterial DNA the universal primers BSF-8/BSR-534 and BSF-8/BSR-1409 were used as previously described [4]. The data obtained were compared to deposited sequences in the NCBI database using the BLAST search engine. Blast files were evaluated with respect to %/ number of identities, score (bits) and E-values for the best and the next best matches. When using the primers BSF-8/BSR-534, BLAST examination of the obtained sequence showed a high degree of base similarity with H. cinaedi (Identities 487/487, 100%, Maxscore of 965 bits) and Flexispira rappini (Identities 486/487, 99%, Maxscore of 957 bits). A subsequent BLAST examination was performed whereby 87% of the 16S rRNA genome was sequenced (primers BSF-8/BSR-1409) confirming H. cinaedi (Identities 1255/1256, 99%, Maxscore of 2314 bits) to be prior to F. rappini (Identities 1245/1256, 99%, Maxscore of 2259 bits). Further, H. cinaedi appeared 18 times as best taxon match before F. rappini appeared in the BLAST search. The 16SrRNA gene sequence has been deposited in the Gen Bank Database under accession number EU589201.

To unambiguously confirm the identification of the isolate based on phenotypic distinctions between H. cinaedi and Flexispira species, differentiating growth capabilities and biochemical features were set up for 4 species including the patient isolate; the following culture collection strains from Culture Collection of University of Gothenburg, Sweden (CCUG) were used: H cinaedi (CCUG 18818), H. fennelie (CCUG 18820) and Flexispira 8 (CCUG 23435).

Characteristics used to differentiate, as recommended by Fox and Megraud gave the following results for the blood isolate and H. cinaedi (CCUG 18818): Catalase-positive, nitrate reductase-positive, but alkaline phosphatise, urease, indoxyl acetatehydrolysis, and gamma-glutamyltransferase negative. The isolate did not grow in air at 37˚C, and grew slowly at 37˚C at microaerophilic conditions, but not at 42˚C and 25˚C. The isolate was susceptible to nalidixic acid and resistant to cephalotin using disk diffusion technique. For treatment guidance the isolate was tested and found sensitive to rifampicin (E-test of 0.064mg/L). Flexispira 8 and H. fennelliae could be separated on the basis of different reactions for, respectively, catalase, urease- plus gamma-glutamyl transferase production and susceptibility to cephalotin.

Comments

Helicobacter species have been isolated from the gastrointestinal and hepatobiliary tracts of mammals and birds. H. cinaedi, has been isolated from humans, hamsters, macaques, foxes, rats, and dogs. In relation to that no known animal exposition was noted for this patient. In humans, H. cinaedi is most commonly isolated from homosexual men (“cinaedi” is latin for “homosexuals”) infected with HIV, but can also occur in other immunocompromised patients or, occasionally, in healthy hosts. This patient is an example of the latter as the patient did not belong to any of the mentioned risk groups. Enterohepatic helicobacters can cause diarrhea and disseminated infection with positive blood cultures. Nearly all patients have fever and a relatively mild , subacute course. Leukocytosis and thrombocytopenia occur variably. Interestingly, colitis is typically not seen in patients with H. cinaedi bacteremia. However, a chronic focal (may be multifocal) cellulitis, usually of the lower extremities, is very common. A presentation identical to the one seen in this case.

Antimicrobial agents that have been found active against H. cinaedi includes doxycycline, rifampicin, ceftriaxone and imipenem. Strains may be resistant to erythromycin and ciprofloxacin as in vitro results have been mixed. Antimicrobial therapy should be continued for a minimum of 2 weeks and perhaps longer for patients with bacteremia. In view of several reports of recurrent infection, additional blood cultures after completion of therapy should be considered.

Molecular methods have proven beneficial in cases of fastidious isolates with special growth needs and where antibiotic treatment has preceded specimen sampling. In our case microscopy revealed Gram-negative rods, which however did not grow by standard procedures. It has recently been reported that use of enriched blood culture media as the Bactec Peds Plus (Becton Dickinson) provides better growth with fastidious organisms as Helicobacter canis.The use of 16S rRNA gene sequencing of extracted DNA from the blood culture fluid pointed on H. cinaedi as the etiology and optimizing growth conditions according to this information resulted in bacterial growth. This gave the opportunity to compare molecular and phenotypic results and obtain a definite diagnosis as both methods supplemented each other. Solely based on molecular results (16S rRNA gene sequencing) it would not be possible to reach a secure species designation, which has been observed previously within this group of bacteria as species by this method are very closely related. Likewise, a relatively biochemically inert bacteria as H. cinaedi may be extremely difficult to identify on only phenotypic reactions.

Thus, the combination of molecular results with phenotypic characteristics, including a demonstration of the bipolar sheathed flagella, confirmed the species designation. A valuable hint was given by the molecular results thereby making it possible to grow the isolate for further characterization.

PubMed Central

Breaking the mold of orbital cellulitis

2008-11-28T08:15:00.000-08:00

Breaking the mold of orbital cellulitis

Surv Ophthalmol. 2008 Nov

Peden MC, Neelakantan A, Orlando C, Khan SA, Lessner A, Bhatti MT.
Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA.

A 52-year-old, immune-suppressed man presented with painful proptosis. Orbital imaging revealed enhancement of his right inferior rectus muscle and mild ethmoidal sinus disease. Sinus washings and turbinectomy demonstrated Curvularia. Despite aggressive intravenous antimicrobials, the patient remained febrile. Repeat imaging demonstrated a well-defined intramuscular abscess without contiguous orbital or paranasal involvement. Following surgical drainage, the patient improved. Cultures of the material expressed from the abscess confirmed a co-infection with Fusarium. Although rare, fungal abscess of the extraocular muscle should be considered in patients (particularly if immunosuppressed) with extraocular muscle enlargement resistant to conventional antimicrobial therapy. Prompt diagnosis and treatment could potentially prevent further serious morbidity or mortality.

Elsevier

Efficacy of oral beta-lactam versus non-beta-lactam treatment of uncomplicated cellulitis.

2008-11-22T03:18:00.000-08:00

Efficacy of oral beta-lactam versus non-beta-lactam treatment of uncomplicated cellulitis.

Am J Med. 2008

Madaras-Kelly KJ, Remington RE, Oliphant CM, Sloan KL, Bearden DT.College of Pharmacy, Idaho State University, Boise, Idaho, USA. KMK@otc.isu.edu

BACKGROUND: Preferred therapy for purulent skin and soft tissue infections is incision and drainage, but many infections cannot be drained. Empiric therapies for these infections are ill-defined in the era of community-acquired methicillin-resistant Staphylococcus aureus.

METHODS: A multicenter retrospective cohort study of outpatients treated for cellulitis was conducted to compare clinical failure rates of oral beta-lactam and non-beta-lactam treatments. Exclusion criteria included purulent infection requiring incision and drainage, complicated skin and soft tissue infection, chronic ulceration, and intravenous antibiotics. Failure rates were compared using logistic regression to adjust for both covariates associated with failure and a propensity score for beta-lactam treatment.

RESULTS: Of 2977 patients, 861 met inclusion criteria and were classified by treatment: beta-lactam (n = 631) or non-beta-lactam therapy (n = 230). Failure rates were 14.7% versus 17.0% (odds ratio [OR] 0.85, 95% confidence interval [CI], 0.56-1.31) for beta-lactam and non-beta-lactam therapy, respectively. Failure was associated with: age (P = .02), acute symptom severity (P = .03), animal bites (P = .03), Charlson score > 3 (P = .02), and histamine-2 receptor antagonist use (P = .09). Relative efficacy of beta-lactam therapy was greater after adjustment for factors associated with failure but remained statistically insignificant (adjusted OR 0.81, 95% CI, 0.53-1.24); adjusted including propensity score covariate (OR 0.71, 95% CI, 0.45-1.13). Discontinuation due to adverse effects differed between beta-lactam (0.5%) and non-beta-lactam (2.2%) therapies (P = .04).

CONCLUSION: There was no significant difference in clinical failure between beta-lactam and non-beta-lactam antibiotics for the treatment of uncomplicated cellulitis. Increased discontinuation due to adverse events with non-beta-lactam therapy was observed.

ScienceDirect

Dissecting cellulitis of the scalp treated with rifampicin and isotretinoin: case reports

2008-11-12T06:09:00.000-08:00

Dissecting cellulitis of the scalp treated with rifampicin and isotretinoin: case reports

Cutis. 2008 Sep

Georgala S, Korfitis C, Ioannidou D, Alestas T, Kylafis G, Georgala C.
Department of Dermatology, University of Athens, Andreas Sygros Hospital, Greece.

Dissecting cellulitis of the scalp, or perifolliculitis capitis abscedens et suffodiens, is an uncommon chronic suppurative disease of the scalp manifested by follicular and perifollicular inflammatory nodules that suppurate and undermine, forming intercommunicating sinuses, and leading to scarring alopecia. Treatment generally fails to obtain a permanently successful result; thus, many therapeutic options have been proposed. We report 4 cases of dissecting cellulitis of the scalp successfully treated with oral rifampicin and oral isotretinoin. To our knowledge, this is the first report of oral rifampicin used concomitantly with oral isotretinoin in this disease entity. We also present a brief review of the literature on the topic.

PubMed

MR Imaging of Orbital Inflammatory Syndrome, Orbital Cellulitis, and Orbital Lymphoid Lesions: The Role of Diffusion-Weighted Imaging.

2008-11-04T04:34:00.000-08:00

MR Imaging of Orbital Inflammatory Syndrome, Orbital Cellulitis, and Orbital Lymphoid Lesions: The Role of Diffusion-Weighted Imaging.

AJNR Am J Neuroradiol. 2008 Oct 8

Kapur R, Sepahdari AR, Mafee MF, Putterman AM, Aakalu V, Wendel LJ, Setabutr P.
Departments of Ophthalmology and Visual Sciences and Radiology, University of Illinois at Chicago, Chicago, Ill; Department of Radiology, University of California, San Diego, Calif; and Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa.

BACKGROUND AND PURPOSE: Orbital inflammatory syndrome (OIS) has clinical features that overlap with orbital lymphoid lesions and orbital cellulitis. Prompt diagnosis is needed in all 3 conditions because the management of each one differs greatly. CT and MR imaging, though useful, do not always distinguish among these conditions. The aim of this study was to identify the role of diffusion-weighted imaging (DWI) in differentiating these 3 diagnoses.

MATERIALS AND METHODS: A retrospective analysis of orbital MR imaging was conducted. T1- and T2-weighted and postcontrast images were analyzed. Region-of-interest analysis was performed by using measurements in areas of abnormality seen on conventional MR imaging sequences and measurements of the ipsilateral thalamus for each patient. The DWI signal intensity of the lesion was expressed as a percentage of average thalamic intensity in each patient. Similarly, lesion apparent diffusion coefficients (ADCs) and lesion-thalamus ADC ratios were calculated. Statistical significance was determined by the Kruskal-Wallis test, and post hoc pairwise comparisons, by the Mann-Whitney U test for DWI-intensity ratio, ADC, and ADC ratio.

RESULTS: A significant difference was noted in DWI intensities, ADC, and ADC ratio between OIS, orbital lymphoid lesions, and orbital cellulitis (P < .05). Lymphoid lesions were significantly brighter than OIS, and OIS lesions were significantly brighter than cellulitis. Lymphoid lesions showed lower ADC than OIS and cellulitis. A trend was seen toward lower ADC in OIS than in cellulitis (P = .17).

CONCLUSIONS: DWI may help differentiate OIS from lymphoid lesions and cellulitis and may allow more rapid management.

American Journal of Radiology (Full text article)

Acute neck cellulitis and mediastinitis complicating a continuous interscalene block.

2008-10-26T07:36:00.000-07:00

Acute neck cellulitis and mediastinitis complicating a continuous interscalene block.
Anesth Analg. 2008 Oct
Capdevila X, Jaber S, Pesonen P, Borgeat A, Eledjam JJ.
Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Avenue du Doyen G Giraud, Montpellier, France. x-capdevila@chu-montpellier.fr

We report a case of acute neck cellulitis and mediastinitis complicating a continuous interscalene brachial plexus block. A 61-yr-old man was scheduled for an elective arthroscopic right shoulder rotator cuff repair. A continuous interscalene block was done preoperatively and 20 mL of 0.5% bupivacaine and 20 mL of 2% mepivacaine were injected through the catheter. Postoperative analgesia was provided by a continuous infusion of bupivacaine, 0.25% at 5 mL/h for 39 h using a 240-mL elastomeric disposable pump. The day after surgery, the patient complained of neck pain. The analgesic block was not fully effective. He was discharged home. Three days later, the patient was readmitted with neck edema and erythema, fever and fatigue. Neck ultrasonography and computed tomographic scan revealed an abscess of the interscalene and sternocleidomastiod muscles and cellulitis, as well as acute mediastinitis. Two blood cultures and surgical samples were positive for Staphylococcus aureus. The infection was treated with surgery, the site was surgically debrided, and a 2-mo course of vancomycin, imipenem, and oxacilline. The technique of drawing local anesthetic from the bottle and filling the elastomeric pump was the most likely cause of infection. This case emphasizes the importance of strict aseptic conditions during puncture, catheter insertion, and management of the local anesthetic infusate.

PubMed

Posttraumatic cellulitis and ulcerative conjunctivitis caused by Yersinia enterocolitica

2008-10-26T07:33:00.000-07:00

Posttraumatic cellulitis and ulcerative conjunctivitis caused by Yersinia enterocolitica

Ophthal Plast Reconstr Surg. 2008 Sep-Oct

Mills DM, Meyer DR.
Ophthalmic Plastic Surgery, Albany Medical Center, Lions Eye Institute, Albany, New York 12159, USA. davidmills4186@msn.com

A 55-year-old white man presented with orbital cellulitis and suspicion of an intraorbital foreign body after ocular trauma. He underwent orbital exploration, but no intraorbital foreign bodies were identified. Intraoperative orbital and conjunctival cultures grew Yersinia enterocolitica O:8. The patient's signs and symptoms resolved with intravenous antibiotic treatment after this exploratory orbitotomy. This is the first case, to our knowledge, of human orbital cellulitis caused by Y. enterocolitica O:8. The single visible interpalpebral conjunctival ulceration was suspected to be an entry wound by the patient's primary physician, the emergency room physician, and the orbital surgeon prior to surgical investigation, at which time all the other ulcerations were identified. Therefore, the physical manifestations of this rare but important infection are presented because they may mislead clinicians in suspecting an intraorbital foreign body.

PubMed

Undiagnosed type 2 diabetes mellitus presenting with orbital cellulitis.

2008-10-26T07:29:00.000-07:00

Undiagnosed type 2 diabetes mellitus presenting with orbital cellulitis.

Orbit. 2008

Authors: Patricio Colapinto a; Sher A. Aslam b; Ourania Frangouli b; Naresh Joshi c
Affiliations:
a Department of Ophthalmology, Central Middlesex Hospital, Park Royal, London, UK
b Moorfields Eye Hospital, London, UK
c Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK

Abstract

The authors describe the case of a 48 years old woman who presented with a one week history of a painful, swollen left eye with proptosis and diplopia. A computed tomography (CT) scan showed features of left orbital cellulitis, and blood tests and urinalysis confirmed the diagnosis of diabetes mellitus. The infection resolved following a course of intravenous antibiotics and with glycaemic control. To our knowledge, undiagnosed diabetes mellitus presenting with orbital cellulitis has not previously been reported.

Keywords: Orbital; cellulitis; bacterial; diabetes

Informaworld

In-Patient Preseptal Cellulitis: Experience from a Tertiary Eye Care Center.

2008-08-15T04:17:00.000-07:00

In-Patient Preseptal Cellulitis: Experience from a Tertiary Eye Care Center.

Br J Ophthalmol. 2008 Aug

Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Arat YO.
King Khaled Eye Specialist Hospital, Saudi Arabia.

OBJECTIVE: To describe causes of preseptal cellulitis (PSC) and outcome of treatment in patients admitted to a tertiary eye-care center.

METHODS: A 15-year (January 1991 - December 2005) review of in-patients with clinical signs and symptoms or radiologic evidence suggestive of PSC was conducted. Patients with infection anterior to the orbital septum which is characterized by acute onset of eyelid edema, tenderness, erythema, warmth and chemosis were included in the study.

RESULTS: Among the 104 patients (Male:female 64:40) fulfilling the diagnostic criteria for PSC, acute dacryocystitis (ADC) was the most common predisposing cause in 32.6% patients, followed by sinusitis/upper respiratory infection (URI) in 28.8% and trauma/recent surgery in 27.8% patients. Fifty-percent required surgical intervention including dacryocystorhinostomy/probing/stenting in 74% and abscess/chalazian drainage in 28.8%. In 38.5% of the patients who had surgical intervention, microbiological investigations were carried out, cultures were positive in 90%. Most common microorganisms recovered included Staphylococcus and Streptococcus species followed by Haemophilus influenzae and Klebsiella pneumonia. Blood cultures were positive in 2 of the 34 patients in whom blood was drawn. Most patients responded to systemic antibiotics with resolution of PSC. Seven patients developed late complications which included subacute lid abscesses, eyelid necrosis and cicatricial ectropion.

CONCLUSIONS: Sinusitis/URI, ADC and recent history of trauma/ surgery were the most common cause of PSC in admitted patients. Although most patients responded to systemic antibiotics, surgical intervention was necessary in some patients to prevent associated complications.

PMID: 18697809 [PubMed - as supplied by publisher]

Escherichia coli Extensive Cellulitis After Laparoscopic Radical Prostatectomy.

2008-08-12T07:31:00.000-07:00

Escherichia coli Extensive Cellulitis After Laparoscopic Radical Prostatectomy.
July 2008

El Karoui K, Lanternier F, Taieb F, Poirée S, Zahar JR, Mechaï F, Lortholary O, Peyromaure M.

Center of Infectiology Necker-Pasteur, Hôpital Necker Enfants-Malades, Paris, France; Departments of Infectious Diseases, Hôpital Necker Enfants-Malades, Paris, France.

A 59-year-old patient underwent laparoscopic radical prostatectomy (LRP) in our department. After surgery, he had an extensive cellulitis of the right flank develop. Urine, drainage effluent, and blood cultures were all positive for Escherichia coli. Prolonged broad spectrum antibiotherapy allowed progressive resolution of the cellulitis. This case shows that severe cellulitis can occur after LRP. Urinary tract infection and vesicourethral anastomotic leakage may contribute to this complication.

Elsevier

Histoplasmosis presenting as cellulitis 18 years after renal transplantation.

2008-08-04T00:54:00.000-07:00

Histoplasmosis presenting as cellulitis 18 years after renal transplantation.
Med Mycol. 2008 Aug

Marques SA, Hozumi S, Camargo RM, Carvalho MF, Marques ME.
Department of Dermatology and Radiotherapy.

A 49-year-old renal transplant patient, under an 18-year course of immunosuppressive therapy with prednisone and azathioprine and, more recently, prednisone plus mycophenolate sodium, developed a cutaneous-subcutaneous infection caused by Histoplasma capsulatum. The clinical presentation consisted of a slowly enlarging, erythematous and infiltrative 25 cm plaque in the major axis on the arm. There was no involvement of the lungs or any other organ. Cure was obtained with itraconazole treatment after 12 months. Histoplasmosis is an uncommon opportunistic infection among solid organ transplanted patients with incidence of 0% to 2.1% observed in a large number of cases. This report describes an atypical cutaneous clinical presentation of a potentially fatal disease in immunosuppressed patients.

Informaworld

Subcutaneous Sarcoidosis Masquerading as Cellulitis.

2008-07-13T03:04:00.000-07:00

Subcutaneous Sarcoidosis Masquerading as Cellulitis.

Dermatology. 2008 Jul 8

Papadavid E, Dalamaga M, Stavrianeas N, Papiris SA.
2nd Dermatology Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Sarcoidosis is a multisystem disease encountered by general physicians as well as medical specialists. Subcutaneous sarcoidosis is not an uncommon clinical presentation of sarcoidosis and is challenging for physicians because it can mimic cellulitis or several chronic infections. Our patient presented with a swollen forearm and hand which were initially treated as acute cellulitis with antibiotics by general physicians but without any improvement. A skin biopsy showed granulomatous panniculitis but confirmation of the diagnosis of systemic sarcoidosis was based on the characteristic chest roentgenogram, the high CD4/CD8 ratio of T lymphocytes in bronchoalveolar lavage, and the typical 'panda' and 'lambda' signs on the (67)Ga scan. Such cases with atypical clinical presentation cause some difficulty in reaching the diagnosis but a skin biopsy as well as typical imaging and laboratory signs are usually important to establish the diagnosis of sarcoidosis, when invasive procedures cannot be performed to get confirmation from a second target organ.

Karger

Two Cases of Cellulitis in the Course of African Tick Bite Fever: A Fortuitous Association?

2008-06-29T04:08:00.000-07:00

Two Cases of Cellulitis in the Course of African Tick Bite Fever: A Fortuitous Association?
Dermatology. 2008 May
Bouvresse S, Del Giudice P, Franck N, Buffet M, Avril MF, Mondain V, Rolain JM, Raoult D, Dupin N.
Department of Dermatology, Tarnier-Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris V, Université René Descartes, Paris, France.

In African tick bite fever (ATBF), inoculation eschar - resulting from disruption of the cutaneous barrier - may be a risk factor for cellulitis. We report 2 cases of ATBF associated with cellulitis. A 77-year-old woman was referred for severe leg cellulitis upon returning from sub-Saharan Africa. She developed erythematous macules. Rickettsia africae was detected by PCR assay from a skin biopsy specimen, and ATBF diagnosis was confirmed. A 75-year-old man was hospitalized after his return from Zimbabwe for a maculopapular exanthema and erysipelas-like rash of the leg. The diagnosis of cellulitis associated with ATBF was confirmed by PCR and serological methods. Both patients were treated for ATBF and cellulitis by a combination of doxycycline and beta-lactam antibiotics, and both had a good recovery. Inoculation eschar may be a risk factor for cellulitis; thus, we hypothesize a non-fortuitous association between ATBF and cellulitis.

Karger

Clindamycin-resistant Clostridium perfringens cellulitis

2008-06-27T03:25:00.000-07:00

Clindamycin-resistant Clostridium perfringens cellulitis

J Tissue Viability. 2008 Jun 14.

Khanna N.
Department of Microbiology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, United Kingdom.

Clostridium perfringens is responsible for a number of clinical conditions ranging from relatively mild food poisoning to the potentially life-threatening gas gangrene. Fortunately, C. perfringens has remained relatively susceptible to first line antibiotics in the treatment of soft tissue infection, however, the prevalence of antibiotic resistance is increasing amongst other anaerobic organisms. A case of anaerobic cellulitis caused by a clindamycin-resistant C. perfringens is described here, emphasising the emerging problem of antimicrobial resistance.

Elsevier ScienceDirect

Spontaneous Onset of Bacterial Cellulitis in Lower Limbs with Chronic Obstructive Venous Disease.

2008-06-10T06:54:00.000-07:00

Spontaneous Onset of Bacterial Cellulitis in Lower Limbs with Chronic Obstructive Venous Disease.

Eur J Vasc Endovasc Surg. 2008 Jun

Raju S, Tackett P Jr, Neglen P.
University of Mississippi Medical Center and River Oaks Hospital, Flowood, MS 39232, USA.

BACKGROUND: Cellulitis, often recurrent is a common complication of severe chronic venous disease (CVD) when dermatitis or ulcer is present. The skin breakdown obviously provides easy entry for bacteria but other factors such as edema and lymphatic dysfunction likely play a role in pathogenesis as well. An iliac obstructive lesion is commonly present and correction with stent(s) often heals dermatitis/ulcer and relieves cellulitis. The current manuscript focuses on a relatively infrequent "spontaneous" variety of cellulitis which also occurs in obstructive venous disease in the absence of overt skin breakdown. Stenting results are of particular interest in this subset because its therapeutic efficacy can be related to factors other than healing of dermatitis/ulceration (portal of entry).

MATERIAL AND METHODS: One thousand and nine limbs underwent iliac vein stenting for symptomatic CVD over a 7 year period; 29 limbs that were stented to treat spontaneous recurrent cellulitis of two or more prior attacks and 16 additional limbs with only one prior episode (stented for other indications) are analysed. Eighty two percent of the limbs had obvious swelling and the remainder had none at the time of stenting when cellulitis was inactive. Iliac vein outflow obstruction was found by intravascular ultrasound (IVUS) and all limbs were stented.

RESULTS: Median age was 54 and male to female ratio 1:2. Aetiology of iliac obstruction was post-thrombotic in 33% and non-thrombotic in 67%. Preoperatively, lymphatic abnormalities were present in 17 (38%) of the limbs: no activity in 7, delayed flow in 8 and pooling of isotope in the lower leg in 2 limbs. Swelling and pain improved significantly after stent placement. Cumulative freedom from recurrent attacks of cellulitis was 76% at 3 years.

CONCLUSION: Iliac vein outflow obstruction may underlie CVD limbs afflicted with cellulitis. IVUS examination is recommended if cellulitis is recurrent and conventional therapy had failed. Correction of outflow obstruction by venous stent placement appears to yield moderate freedom from repeat infections in the near term.

Elsevier Science Direct

Efficacy of oral beta-lactam versus non-beta-lactam treatment of uncomplicated cellulitis

2008-05-14T03:34:00.000-07:00

Efficacy of oral beta-lactam versus non-beta-lactam treatment of uncomplicated cellulitis
Am J Med. 2008 May

Madaras-Kelly KJ, Remington RE, Oliphant CM, Sloan KL, Bearden DT.
College of Pharmacy, Idaho State University, Boise, Idaho, USA. KMK@otc.isu.edu

BACKGROUND: Preferred therapy for purulent skin and soft tissue infections is incision and drainage, but many infections cannot be drained. Empiric therapies for these infections are ill-defined in the era of community-acquired methicillin-resistant Staphylococcus aureus.

METHODS: A multicenter retrospective cohort study of outpatients treated for cellulitis was conducted to compare clinical failure rates of oral beta-lactam and non-beta-lactam treatments. Exclusion criteria included purulent infection requiring incision and drainage, complicated skin and soft tissue infection, chronic ulceration, and intravenous antibiotics. Failure rates were compared using logistic regression to adjust for both covariates associated with failure and a propensity score for beta-lactam treatment.

RESULTS: Of 2977 patients, 861 met inclusion criteria and were classified by treatment: beta-lactam (n = 631) or non-beta-lactam therapy (n = 230). Failure rates were 14.7% versus 17.0% (odds ratio [OR] 0.85, 95% confidence interval [CI], 0.56-1.31) for beta-lactam and non-beta-lactam therapy, respectively. Failure was associated with: age (P = .02), acute symptom severity (P = .03), animal bites (P = .03), Charlson score > 3 (P = .02), and histamine-2 receptor antagonist use (P = .09). Relative efficacy of beta-lactam therapy was greater after adjustment for factors associated with failure but remained statistically insignificant (adjusted OR 0.81, 95% CI, 0.53-1.24); adjusted including propensity score covariate (OR 0.71, 95% CI, 0.45-1.13). Discontinuation due to adverse effects differed between beta-lactam (0.5%) and non-beta-lactam (2.2%) therapies (P = .04).

CONCLUSION: There was no significant difference in clinical failure between beta-lactam and non-beta-lactam antibiotics for the treatment of uncomplicated cellulitis. Increased discontinuation due to adverse events with non-beta-lactam therapy was observed.

Keywords: Antibiotics, Cellulitis, Epidemiology, Outcomes, Skin and soft tissue infections

Elsevier

Temporal cellulitis of odontogenic origin complicated by temporomandibular osteoarthritis

2008-04-22T06:27:00.000-07:00

Temporal cellulitis of odontogenic origin complicated by temporomandibular osteoarthritis

Rev Stomatol Chir Maxillofac. 2008 Apr

Persac S, Péron JM.
Service de chirurgie maxillofaciale et stomatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.

INTRODUCTION: Temporal cellulitis complicated by temporomandibular osteoarthritis and mandibular osteomyelitis is rare with the availability of antibiotics and the prevention of dental infections.

CASE REPORT: A 56 year-old woman developed a jaw abscess during hospitalization in an intensive care unit following medical drug overdose. Repeatedly surgical drainage was performed guided by CT scans and multiple antibiotherapies. CT scan follow-up revealed temporomandibular arthritis with decrease of the joint space, synovitis, and subchondral cysts. Slow improvement was noted but limited mouth opening was persistent.

DISCUSSION: This case illustrates the insidious evolution of an uncommon infection. It requires both expert clinical evaluation and an early MRI or CT scan investigation to determine the extension of the infection. Treatment is urgent because of the prognosis and is achieved by surgical drainage and adequate long-term antibiotherapy.

Masson.fr

Natural Killer/T-cell Lymphoma Masquerading as Orbital Cellulitis.

2008-03-27T09:24:00.000-07:00

Natural Killer/T-cell Lymphoma Masquerading as Orbital Cellulitis.

Mar 2008 Ophthal Plast Reconstr Surg.

Charton J, Witherspoon SR, Itani K, Jones FR, Marple B, Morse B.
Departments of *Ophthalmology, †Otolaryngology, Head and Neck Surgery, and ‡Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.

We describe 3 cases of natural killer/T-cell lymphoma that presented by masquerading as orbital cellulitis. All of the patients were examined for pain, fever, proptosis, and motility restriction. Computed tomography of the orbits and sinuses revealed orbital soft-tissue swelling without focal abscess in all 3 cases. Bacterial and fungal cultures were negative in each case and all of the patients had initial improvement on systemic antibiotics, only to relapse several days later. Diagnosis of natural killer/T-cell lymphoma was then made based on biopsy of the orbit or sinus. Natural killer/T-cell lymphoma should be considered in cases of orbital cellulitis or sinusitis that fail to respond to traditional management. Biopsy of the affected region should be performed expeditiously to diagnose this condition. Repeat biopsy may be needed.

Lippincott, Wilkins & Williams

Orbital cellulitis or lymphoma? A diagnostic challenge.

J Laryngol Otol. 2005 Sep

Salam A, Saldana M, Zaman N.
Southampton Eye Unit, Southampton General Hospital, UK. aysha_salam@yahoo.com

We present a case report of an aggressive natural killer T cell lymphoma in a police officer who presented with combined features of orbital cellulitis and mid-facial destruction. However, his initial diagnosis was confused with other disease conditions that had overlapping features. This emphasizes the significance of clinical alertness and adequate tissue sampling; this can have a great impact on early diagnosis and treatment.

PMID: 16156921 [PubMed - indexed for MEDLINE]

Moxifloxacin-Associated Neutropenia in a Cirrhotic Elderly Woman with Lower Extremity Cellulitis

2008-03-20T17:29:00.000-07:00

Moxifloxacin-Associated Neutropenia in a Cirrhotic Elderly Woman with Lower Extremity Cellulitis

Ann Pharmacother. 2008 Mar

Chang CM, Lee NY, Lee HC, Lee IW, Wu CJ, Lin YS, Ko WC.
Divisions of Infectious Diseases, Geriatrics, and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.

OBJECTIVE: To report a case of moxifloxacin-associated neutropenia in a cirrhotic patient with cellulitis.

CASE SUMMARY: A 77-year-old cirrhotic woman developed cellulitis of the right leg, with a nadir white blood cell (WBC) count of 1.5 x 103/microL and absolute neutrophil count (ANC) of 0.345 x 103/microL, which occurred after 5 days of moxifloxacin therapy. Moxifloxacin was switched to cefixime and neutropenia resolved 2 days after the withdrawal of moxifloxacin.

DISCUSSION: Cases of neutropenia related to fluoroquinolones have rarely been reported in the literature, and neutropenia associated with moxifloxacin has not been described before. Because of the temporal relationship between moxifloxacin administration and the development of neutropenia in our patient, as well as the relationship between drug withdrawal and improvement in WBC count and ANC, moxifloxacin-associated neutropenia was suspected. This reaction was categorized as probable according to the Naranjo probability scale.

CONCLUSIONS: We report the first case of moxifloxacin-associated neutropenia. Although such an adverse reaction is rare, clinicians should be aware of this potential complication of moxifloxacin therapy.

Annals of Pharmacotherapy

Retrospective study of the clinical features of limb cellulitis in 63 horses

2008-03-14T05:50:00.000-07:00

Retrospective study of the clinical features of limb cellulitis in 63 horses

Vet Rec. 2008 Feb 23

Fjordbakk CT, Arroyo LG, Hewson J.
Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario n1g 2w1, Canada.

A retrospective study of 63 horses diagnosed with limb cellulitis between 1994 and 2005 was conducted. They all had an acute onset of painful, generalised limb swelling, and a clinical diagnosis of limb cellulitis was made by the attending clinician. None of the horses had more than one limb affected. Hindlimbs were significantly more often affected than the forelimbs (P less then 0.05).

Veterinary Record

Cervical cellulitis and mediastinitis following esophageal perforation: A case report.

2008-03-08T18:18:00.000-08:00

Cervical cellulitis and mediastinitis following esophageal perforation: A case report.

World J Gastroenterol. 2008 Mar

Righini CA, Tea BZ, Reyt E, Chahine KA.
Department of ENT-HNS, University Medical Center of Grenoble, 38043 Grenoble Cedex 09, France. crighini@chu-grenoble.fr.

Chicken bone is one of the most frequent foreign bodies (FB) associated with upper esophageal perforation. Upper digestive tract penetrating FB may lead to life threatening complications and requires prompt management. We present the case of a 52-year-old man who sustained an upper esophageal perforation associated with cervical cellulitis and mediastinitis. Following CT-scan evidence of FB penetrating the esophagus, the impacted FB was successfully extracted under rigid esophagoscopy. Direct suture was required to close the esophageal perforation.

Cervical and mediastinal drainage were made immediately. Naso-gastric tube decompression, broad-spectrum intravenous antibiotics, and parenteral hyperalimentation were administered for 10 d postoperatively. An esophagogram at d 10 revealed no leak at the repair site, and oral alimentation was successfully reinstituted.

Conclusion: Rigid endoscope management of FB esophageal penetration is a simple, safe and effective procedure. Primary esophageal repair with drainage of all affected compartments are necessary to avoid life-threatening complications.

Key words: Esophagus; Perforation; Foreign body; Mediastinitis; Surgery

Peer reviewer: Michael F Vaezi, Department of Gastroenterology and Hepatology, Vanderbilt University Medical Center, 1501 TVC, Nashville, TN 37232-5280, United States

Righini CA, Tea BZ, Reyt E, Chahine KA. Cervical cellulitis and mediastinitis following esophageal perforation: A case report. World J Gastroenterol 2008; 14(9): 1450-1452 Available from: URL: - DOI:

INTRODUCTION

Management of ingested foreign bodies (FB) is a common clinical encounter. Complications of this pathology are dependent on patient age, nature and localization of the FB, presence of a perforation, and initial management procedures[1]. Beside the lingual tonsils, the base of tongue and the upper esophagus are the most common sites of FB impaction[2]. The most frequent ingested FBs in the upper digestive tract are chicken and fish bones, and they are the most commonly associated with pharyngo-esophageal perforation[1], cervical abscess and potentially life threatening complications[3].

CASE REPORT

A 52-year-old man, with no relevant past medical history, presented to the ENT clinic complaining of severe dysphagia, substernal pain, and fever for 3 d. Five days prior to presentation, the patients started having symptoms of mild dysphagia after chewing on a piece of chicken. One day later on, exacerbation of dysphagia prompted the patient to seek otolaryngology consultation in town. Following seemingly normal head and neck examination, the patient was reassured and discharged. On admission at the University Medical center of Grenoble, the patient had a fever of 40℃ and mild shortness of breath. No abnormalities were noted on examination of the oropharynx, but the hypopharynx and larynx were swollen and there was abundant saliva in hypopharynx. The neck exam revealed bilateral anterior and lateral tenderness, inflammation and edema of the skin, and crepitation. On pulmonary auscultation, sparse rales were heard over the lower part of each hemi-thorax. Cardiac auscultation revealed a regular rhythm and normal heart sounds.

The patient had a white blood cell count of 20 × 109/L with 80% neutrophils and a C reactive protein level to 120 mg/L

A cervical and thoracic CT-scan revealed a fragment of bone in the upper part of esophagus, air in the retropharyngeal space and the upper part of the posterior mediastinum, and deep subcutaneous collection suggestive of cervical posterior mediastinal collection (Figure 1).

The patient was taken immediately to the operating room for surgical treatment under general anesthesia. Endoscopic examination was performed using a rigid endoscope (Storz f 16 mm - L 50 cm, Tuttlingen, Germany) which revealed meat fragments and a piece of chicken bone impacted in the upper esophageal wall, 19 cm from incisors. Meat fragments were aspirated using a 4 mm rigid aspiration; forceful pulling of the FB using forceps caused the edges of the FB to bend, enabling extraction through the rigid esophagoscope. After bone removal, a 4 mm perforation was visible at the site of impaction with pus draining through it. Gastric decompression via a naso-gastric tube was performed.

A large neck incision was required to drain the pus from cervical spaces (Figure 2), and the collection in the upper posterior mediastinum was evacuated through the same incision following retropharyngeal space dissection. The drainage of the neck abscess revealed a small bone fragment within the purulent discharge, and cultures were taken. The edges of the perforation were carefully derided and the entire surgical field was well irrigated. The defect was then closed in two layers using fine interrupted absorbable monofilament suture. Drainage of the neck and the upper mediastinum was done by placement of multi-tubular silicone drains through cervical incision. A temporary tracheotomy was performed to bypass the edematous larynx. Broad-spectrum intravenous antibiotics (imipeneme 2 g/d+ amikacine 1 g/d+ metronidazole 1 g/d), and parenteral hyperalimentation were started. The patient was admitted to the intensive care unit for 5 d. The patient medical status improved rapidly, and biological laboratory exams were normalized during the first post operative week. Tracheotomy and drains were removed at postoperative d 6 and d 8 respectively. An esophagogram performed at d 10 revealed no leak at the repair site, and oral alimentation was successfully reinstituted. Streptococcus b C hemolytic was isolated from the cultured pus, allowing for switching to amoxicillin and clavulanic acid 4 g/d at postoperative d 3, and continued for 7 d. The patient was discharged from the hospital in good condition on postoperative d 15.

DISCUSSION

The majority of ingested FBs pass through the gastrointestinal tract uneventfully[1]. Severe complications are rare, but upper digestive tract perforation is the most frequent. Among the esophageal perforation etiologies, FB represent the second most common etiology after iatrogenic manipulation (esophagoscopy, esophageal dilatation, para-esophageal surgery, external trauma)[4]. The diagnosis of esophageal perforation is usually suspected on clinical basis, and suggestive history of sharp bodies ingestion (chicken and fish bones)[5]. Symptoms include pain, dysphagia, and rarely hematemetis; pain is the most frequent symptom (> 90%)[5]. In case of upper esophagus perforation, tenderness and subcutaneous emphysema of the neck are the two main signs. Substernal pain and polypnea are signs associated with mediastinal extension[5]. In these cases, mediastinal crunch (Hamman sign) and crepitations are heard on chest auscultation[6]. Fever and leukocytosis with increase in the number of immature polymorphonuclear cells are present in more than 90% of patients[5].

Standard neck and chest radiograms are ordered if an esophageal perforation is suspected. But these exams reveal esophageal perforation in only a small proportion of cases[7]. Moreover, even if FB is radiopaque, it can be unrecognized because a lot of bone structures are superposed. The perforation diagnosis is confirmed in almost all cases by contrast esophagograms, which can delineate both the level of perforation and the communication of the injury into cervical and mediastinal spaces[6,7]. CT-scan allows the visualization of FB and the identification of findings suggestive of esophageal perforation (esophageal wall thickening and laceration, peri-esophageal air and fluid). Intravenous administration of contrast material helps CT-scan localization of the exact extension of peri-esophageal infection in the neck, mediastinal, and pleuro-parenchymal spaces[8]. Its sensitivity can be increased with gastrografin ingestion. Thus, an appropriate CT examination enables an accurate and timely diagnosis which significantly affects prognosis and provides valuable indications for treatment.

Extraction of FBs located in the first few centimeters under the upper esophageal sphincter, is difficult with a flexible esophagoscope, especially if they have sharp edges, such as bone fragments[9]. Rigid endoscopy may be a more appropriate procedure in these instances. The rigid endoscope is placed just above the proximal tip of the FB; it dilates the esophageal lumen to the extent that the impacted FB is movable. The use of a rigid endoscope during removal of an impacted FB has several advantages: it causes expansion of the upper esophagus, which can release totally or in part the impacted FB, and prevents aspiration and esophageal or pharyngeal injury. It must be practiced under general anesthesia by a trained operator.

Non-operative management is excluded in case of cervical and/or mediastinal abscesses[4]. Different surgical approaches are available for esophageal perforation, including primary repair with drainage, generally chosen for patients without evidence of a severe esophageal injury and without other esophageal disease[10]. A simple suture is recommended in case of small perforation in the cervical esophagus[5]. It is not necessary to use mucosal flaps to reinforce the esophageal sutures, contrarily to the recommendations for injuries of the middle and lower parts of esophagus[11]. In case of cervical abscess and/or mediastinitis, drainage of the different affected spaces must be done[12]. The choice of surgical approach for mediastinal drainage is dependent on abscess localization. In case of posterior and superior mediastinitis, drainage from cervical incision with retropharyngeal space dissection is adopted. Prognosis in case of upper esophageal perforation is relatively good with mortality inferior to 10%[5].

In conclusion, perforation of the upper esophagus caused by a FB is rare, but can cause potentially life threatening mediastinal complications. CT-scan enables accurate and timely diagnosis and provides valuable indications for treatment. Extraction of esophageal FB with a rigid endoscope is a good and safe treatment alternative. Non-operative management of esophageal perforation is not an option in the presence of neck and mediastinum abscesses and necessitates a surgical suture and drainage.

REFERENCES

1 Selivanov V, Sheldon GF, Cello JP, Crass RA. Management of foreign body ingestion. Ann Surg 1984; 199: 187-191 PubMed
2 Chee LW, Sethi DS. Diagnostic and therapeutic approach to migrating foreign bodies. Ann Otol Rhinol Laryngol 1999; 108: 177-180 PubMed
3 Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004; 77: 1475-1483 PubMed
4 Altorjay A, Kiss J, Voros A, Bohak A. Nonoperative management of esophageal perforations. Is it justified? Ann Surg 1997; 225: 415-421 PubMed
5 Michel L, Grillo HC, Malt RA. Operative and nonoperative management of esophageal perforations. Ann Surg 1981; 194: 57-63 PubMed
6 Scheinin SA, Wells PR. Esophageal perforation in a sword swallower. Tex Heart Inst J 2001; 28: 65-68 PubMed
7 De Lutio di Castelguidone E, Pinto A, Merola S, Stavolo C, Romano L. Role of Spiral and Multislice Computed Tomography in the evaluation of traumatic and spontaneous oesophageal perforation. Our experience. Radiol Med (Torino) 2005; 109: 252-259 PubMed
8 Exarhos DN, Malagari K, Tsatalou EG, Benakis SV, Peppas C, Kotanidou A, Chondros D, Roussos C. Acute mediastinitis: spectrum of computed tomography findings. Eur Radiol 2005; 15: 1569-1574 PubMed
9 Seo YS, Park JJ, Kim JH, Kim JY, Yeon JE, Kim JS, Byun KS, Bak YT. Removal of press-through-packs impacted in the upper esophagus using an overtube. World J Gastroenterol 2006; 12: 5909-5912 PubMed
10 Cheynel N, Arnal E, Peschaud F, Rat P, Bernard A, Favre JP. Perforation and rupture of the oesophagus: treatment and prognosis. Ann Chir 2003; 128: 163-166 PubMed
11 Fell SC. Esophageal perforation. In: Pearson EG, Deslauriers J, Ginsberg RJ, Hiebert CA, Mc Kneally MF, Urschel HC Jr, editors. Esophageal surgery. New York: Churchill Livingstone, 1995: 495-515
12 Righini CA, Motto E, Ferretti G, Boubagra K, Soriano E, Reyt E. Diffuse cervical cellulites and descending necrotizing mediastinitis. Ann Otolaryngol Chir Cervicofac 2007; 124: 292-300 PubMed

World Journal of Gastroenterology

Our experience using primary oral antibiotics in the management of orbital cellulitis in a tertiary referral centre

2008-03-01T19:45:00.000-08:00

Our experience using primary oral antibiotics in the management of orbital cellulitis in a tertiary referral centre

Eye. 2008 Feb 29

Cannon PS, Keag DM, Radford R, Ataullah S, Leatherbarrow B.
1Oculoplastic and Orbit Department, Manchester Royal Eye Hospital, Oxford Road, Manchester, UK.

Correspondence: PS Cannon, Oculoplastic and Orbit Department, Manchester Royal Eye Hospital, Oxford Road, Manchester M13 WH, UK. Tel: +0044 161 276 5565; Fax: +0044 161 272 6618; E-mail: pscan05@yahoo.co.uk

Aims/PurposeOrbital cellulitis is conventionally managed by intravenous (i.v.) antibiotic therapy, followed by oral antibiotics once the infection shows signs of significant improvement. We report 4 years of experience using primary oral ciprofloxacin and clindamycin in cases of orbital cellulitis. Oral ciprofloxacin and clindamycin have a similar bioavailability to the i.v. preparations and provide an appropriate spectrum of antibiotic cover for the pathogens responsible for orbital cellulitis.MethodsA retrospective review was performed that identified all patients with orbital cellulitis and treated with primary oral antibiotic therapy admitted to the Manchester Royal Eye Hospital between March 2003 and March 2007. Age, stage of disease, surgical intervention, hospital duration, and complications were obtained. A comparison was made with patients admitted to our unit with orbital cellulitis and treated with primary i.v. antibiotics between March 2000 and March 2003.ResultsNineteen patients were included in the review for the period March 2003 to March 2007, which comprised of 7 children and 12 adults. Five patients required surgical intervention. All patients responded to the oral regimen, 18 patients had no change to their oral antibiotic therapy. Mean hospital stay was 4.4 days. There were no complications.DiscussionEmpirical oral ciprofloxacin and clindamycin combination may be as safe and effective as i.v. therapy in the management of orbital cellulitis. Oral treatment can offer the advantages of rapid delivery of the first antibiotic dose, fewer interruptions in treatment, and simplified delivery of medication particularly in children.

Eye advance online publication, 29 February 2008; doi:10.1038/eye.2008.44.

Nature

Orbital cellulitis after faden operation on the medial rectus

2008-02-26T19:39:00.000-08:00

Orbital cellulitis after faden operation on the medial rectus

Strabismus. 2007 Oct-Dec

Armesto A, Ugrin MC.
Ophthalmology Department, Hospital Alemán, Buenos Aires, Argentina. larmesto@intramed.net

Keywords: Orbital cellulitis; strabismus surgery; ethmoid sinusitis; Faden operation; intravenous antibiotics

BACKGROUND: Orbital cellulitis after strabismus surgery is uncommon, may cause blindness and may lead to death. Very few cases have been described in detail due to the low incidence of this complication.

METHODS: We report the first case of orbital cellulitis following Faden operation on the medial rectus muscle. We believe that the infection was due to asymptomatic ethmoid sinusitis. Our case is compared with other cases previously reported.

RESULTS: A two-year-old boy was surgically treated for residual esotropia after two botulinum toxin A injections. Two days after surgery, signs of orbital cellulitis developed in his right orbit. CT-scan disclosed right ethmoid sinusitis that spread to the orbit after surgery. After intravenous antibiotic treatment, the infection resolved with full restoration of visual acuity and ocular motility.

CONCLUSION: Despite adequate measures to prevent infection, orbital cellulitis may complicate strabismus surgery. Patients must be instructed to recognize early symptoms of this severe infection and call the surgeon immediately. Diagnosis may be confirmed by CT-scanning of the orbits. Prompt treatment with intravenous antibiotics usually leads to full recovery.

InformaWorld

A case of herpes zoster presenting as orbital cellulitis

2008-02-23T04:19:00.000-08:00

A case of herpes zoster presenting as orbital cellulitis
2007

Al-Rikabi A, Trotter MI, Khan H, Raut VV.

Head and Neck Department, Russells Hall Hospital, Dudley Group of Hospitals, Dudley, UK. alikamil30@yahoo.com.

We presented an unusual case of ophthalmic herpes zoster masquerading as orbital cellulitis, resulting in delay in appropriate treatment. A 65-year-old woman presented with left periorbital pain and swelling of a week duration. Examination revealed periorbital edema and inflammation but no proptosis. The erythema extended onto the brow. There was no change in visual acuity and cranial nerve function was normal. She was apyrexial and all other parameters were within normal limits. The patient was admitted with an initial diagnosis of sinusitis with orbital cellulitis/dacryocystitis and intravenous co-amoxiclav and a non-steroidal anti-inflammatory drug were administered. The following day, there was little change in her condition with the ocular movements being normal and vision remaining unaffected. She was apyrexial but the periorbital swelling persisted. Computed tomography of the sinuses did not show sinusitis or a periorbital collection. The third day after admission and 10 days after the initial appearance of pain, vesicles appeared on the left forehead, which enabled a diagnosis of herpes zoster of the ophthalmic branch of the trigeminal nerve. She was then treated with acyclovir with a good result.

PMID: 18187989 [PubMed - in process]

Case Cluster of Necrotizing Fasciitis and Cellulitis Associated with Vein Sclerotherapy

2008-02-22T06:40:00.000-08:00

Case Cluster of Necrotizing Fasciitis and Cellulitis Associated with Vein Sclerotherapy

Infectious Diseases
Volume 14, Number 1–January 2008

Hiu-Tat Chan,* Jillian Low,† Lorraine Wilson,† Owen C Harris,* Allen C Cheng,† and Eugene Athan† *St. John of God Pathology, Geelong, Victoria, Australia, and †Barwon Health, Geelong, Victoria, Australia

To the Editor: Varicose vein sclerotherapy is a commonly performed cosmetic surgical procedure in which a sclerosing agent is injected into small varicose veins of the leg by using small gauge needles. It is regarded as a minor, safe procedure, usually performed in an office clinic (1). We describe a cluster of infections with group A Streptococcus that was associated with throat carriage in a cosmetic surgeon.

In early December 2006, 3 patients were seen over a 10-day period at Geelong Hospital with infections following varicose vein sclerotherapy. All patients had undergone varicose vein sclerotherapy with polidocanol (Laurath-9; Aethoxysklerol, BSN Medical, Mount Waverley, Australia) at a clinic of a single cosmetic surgeon. The index patient (patient A) had toxic shock syndrome and necrotizing fasciitis of the treated legs. The 2 other patients (patients C and D) had multifocal cellulitis directly correlating to the injection sites. The time between sclerotherapy and disease onset was 1–2 days.

A case-patient was defined as a patient who had undergone sclerotherapy at the clinic and subsequently had infection directly related to the site of sclerosant injection. Events were dated from the day on which the index patient had her surgical procedure. We reviewed clinic notes and infection control procedures in conjunction with the Department of Human Services of the State Government of Victoria, Australia. Specimens, where available, were collected for culture from patients by the treating clinicians. A throat swab was taken from the cosmetic surgeon. Specimens were transported and cultured by using standard methods.

Figure. Days of procedures for infected and noninfected patients and their first manifestations of infection...

During the outbreak period, 44 patients had vein sclerotherapy with 3% polidocanol at the cosmetic surgeon's clinic. In addition to the 3 patients identified on admission to hospital, a fourth patient (patient B) sought treatment from her general practitioner for medical care for a postprocedure infection. All patients had procedures on day 1 or day 7 (Figure); patients A and B were seen consecutively on day 1, and 2 patients were treated between patients C and D on day 7.

Patient A required surgical debridement, intravenous antimicrobial drugs, intensive care, and hyperbaric oxygen therapy. Intraoperative specimens taken from her during debridement cultured group A Streptococcus. Patients B, C, and D had cellulitis, but no specimens suitable for microbiologic diagnosis of cellulitis were taken for culture. Patient B was treated with oral antimicrobial agents as an outpatient. Patient C was admitted to hospital for intravenous antimicrobial therapy, and patient D showed no improvement on oral antimicrobial therapy as an outpatient and was subsequently admitted to hospital for intravenous antimicrobial agents.

Group A Streptococcus was isolated from a throat swab taken on day 16 from the cosmetic surgeon. He reported no upper respiratory tract infection symptoms before the outbreak. He also reported that antiseptic skin preparation was not routinely used during the procedures; nor were gloves used. However, alcohol hand rubs were used between patients. The surgeon had not changed his infection control procedures recently and had not been aware of any infective complications previously. Environmental surface swabs taken on day 14 from 3 different areas (procedural trolley, surgical spotlight, and examination couch) in the clinic during the assessment yielded no pathogenic organisms. The infection control assessment team noted overall cleaning, disinfection, and hand hygiene to be inadequate.

Decolonization of the surgeon was performed by using rifampicin 600 mg daily and amoxicillin 500 mg every 6 hours for 10 days, during which time the surgeon suspended surgical procedures. Recommendations were made regarding infection prevention practices; these were undertaken by the surgeon.

Although soft tissue infection following sclerotherapy may be underreported, large case series have not noted this complication in the past (2,3); this finding suggests that any soft tissue infection following sclerotherapy should be investigated. These cases highlight the need for vigilance when considering infection control for minor procedures that take place outside of the support of hospital-based infection control services.

Soft tissue infections as complications following varicose vein sclerotherapy appear to be rare (1–3). The Australian Aethoxysklerol study reported no cellulitis in 16,804 legs injected with the sclerosing agent, and superficial thrombophlebitis occurred at a rate of 0.08% at 2-year review (2). Likewise a multicenter registry with 22 European phlebology clinics reported no cellulitis or necrotizing fasciitis in 12,173 sessions (3).

Similarly, surgical site infections with Group A Streptococcus are uncommon. A multicenter survey of 72 centers worldwide reported all β-hemolytic Streptococcus (including Group A and Group G) accounted for less then 5% more then 4.5%. A Canadian study reported invasive Group A Streptococcus infections following surgery in 1.1 cases per 100,000 admissions (6). Outbreaks have been infrequently described (5,7–10), and sources of colonization range from throat to anus and vagina.

Acknowledgments

We thank Rosemary Lester and Michelle Cullen for their input.

CDC.Gov

References

Puissegur Lupo ML. Sclerotherapy: review of results and complications in 200 patients. J Dermatol Surg Oncol. 1989;15:214–9.
Conrad P, Malouf GM, Stacey MC. The Australian polidocanol (aethoxysklerol) study: results at 2 years. Dermatol Surg. 1995;21:334–6.
Guex JJ, Allaert FA, Gillet JL, Chleir F. Immediate and midterm complications of sclerotherapy: report of a prospective multicenter registry of 12,173 sclerotherapy sessions. Dermatol Surg. 2005;31:123–8.
Koontz FP. Trends in post-operative infections by Gram-positive bacteria. Int J Antimicrob Agents. 2000;16(Suppl 1):S35–7.
Mastro TD, Farley TA, Elliott JA, Facklam RR, Perks JR, Hadler JL, et al. An outbreak of surgical-wound infections due to group A Streptococcus carried on the scalp. N Engl J Med. 1990;323:968–72.
Daneman N, McGeer A, Low DE, Tyrrell G, Simor AE, McArthur M, et al. Hospital-acquired invasive group A streptococcal infections in Ontario, Canada, 1992–2000. Clin Infect Dis. 2005;41:334–42.
Kolmos HJ, Svendsen RN, Nielsen SV. The surgical team as a source of postoperative wound infections caused by Streptococcus pyogenes. J Hosp Infect. 1997;35:207–14.
Viglionese A, Nottebart VF, Bodman HA, Platt R. Recurrent group A streptococcal carriage in a health care worker associated with widely separated nosocomial outbreaks. Am J Med. 1991;91:329S–33S.
Paul SM, Genese C, Spitalny K. Postoperative group A beta-hemolytic Streptococcus outbreak with the pathogen traced to a member of a healthcare worker's household. Infect Control Hosp Epidemiol. 1990;11:643–6.
Schaffner W, Lefkowitz LB Jr, Goodman JS, Koenig MG. Hospital outbreak of infections with group A streptococci traced to an asymptomatic anal carrier. N Engl J Med. 1969;280:1224–5.

Lymphatic abnormalities demonstrated by lymphoscintigraphy after lower limb cellulitis.

2008-02-18T17:01:00.000-08:00

Lymphatic abnormalities demonstrated by lymphoscintigraphy after lower limb cellulitis.

Br J Dermatol. 2008 Jan 30

Soo JK, Bicanic TA, Heenan S, Mortimer PS.

Department of Dermatology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.

Background

Cellulitis is a common cause for admission to hospital, and repeated episodes are thought to damage the lymphatic system. Lymphoedema is recognized as a condition predisposing to cellulitis but there are no data to suggest its prevalence among a population presenting to hospital with acute cellulitis. Objectives To ascertain whether lymphatic abnormalities represent a common problem in patients with lower limb cellulitis.

Methods

Patients admitted with cellulitis of the lower limb were invited to undergo clinical examination and lymphoscintigraphy. Results Thirty patients agreed to participate in the study. Fifteen underwent lymphoscintigraphy. Thirteen had abnormal scans indicating impaired lymph drainage (seven patients had clinical lymphoedema).

Conclusions

Lymphatic abnormalities represent an important but unrecognized problem in patients with leg cellulitis.

Blackwell Synergy

Acute Bacterial, Nonnecrotizing Cellulitis in Finland: Microbiological Findings

2008-02-16T05:27:00.000-08:00

Acute Bacterial, Nonnecrotizing Cellulitis in Finland: Microbiological Findings
Clin Infect Dis. 2008 Feb 8

Siljander T, Karppelin M, Vähäkuopus S, Syrjänen J, Toropainen M, Kere J, Vuento R, Jussila T, Vuopio-Varkila J.
Departments of 1Bacterial and Inflammatory Diseases and 2Vaccines, National Public Health Institute, and 3Department of Medical Genetics, University of Helsinki, Helsinki, and 4Department of Internal Medicine and 5Centre for Laboratory Medicine, Tampere University Hospital, and 6Hatanpää City Hospital, Tampere, Finland; and 7Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.

Background.

Bacterial, nonnecrotizing cellulitis is a localized and often recurrent infection of the skin. The aim of this study was to identify the beta-hemolytic streptococci that cause acute nonnecrotizing cellulitis infection in Finland.

Methods.

A case-control study of 90 patients hospitalized for acute cellulitis and 90 control subjects was conducted during the period of April 2004-March 2005. Bacterial swab samples were obtained from skin lesions or any abrasion or fissured toe web. Blood culture samples were taken for detection of bacteremia.

The patients, their household members, and control subjects were assessed for pharyngeal carrier status. beta-Hemolytic streptococci and Staphylococcus aureus were isolated and identified, and group A and G streptococcal isolates were further analyzed by T serotyping and emm and pulsed-field gel electrophoresis typing.

Results.

Beta-Hemolytic streptococci were isolated from 26 (29%) of 90 patients, 2 isolates of which were blood-culture positive for group G streptococci, and 24 patients had culture-positive skin lesions. Group G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis) was found most often and was isolated from 22% of patient samples of either skin lesions or blood, followed by group A Streptococcus, which was found in 7% of patients. Group G streptococci were also carried in the pharynx of 7% of patients and 13% of household members but was missing from control subjects. Several emm and pulsed-field gel electrophoresis types were present among the isolates. Six patients (7%) had recurrent infections during the study. In 2 patients, the group G streptococcal isolates recovered from skin lesions during 2 consecutive episodes had identical emm and pulsed-field gel electrophoresis types.

Conclusions.

Group G streptococci, instead of group A streptococci, predominated in bacterial cellulitis. No clear predominance of a specific emm type was seen. The recurrent nature of cellulitis became evident during this study.

PMID: 18260753 [PubMed - as supplied by publisher]

Odontogenic orbital cellulitis

2008-02-03T05:54:00.000-08:00

Odontogenic orbital cellulitis

Ophthal Plast Reconstr Surg. 2008 Jan-Feb

Youssef OH, Stefanyszyn MA, Bilyk JR.
Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.

PURPOSE:

To describe a small series of patients with odontogenic orbital cellulitis and review the visual outcomes of such patients reported in the scientific literature.

METHODS: Review of medical records and the scientific literature. Measured parameters included gender, age, days to presentation and surgery, the need for surgical intervention(s), sinus and orbital involvement on CT imaging, and pathogens involved.

RESULTS: Current cases and review of the scientific literature resulted in 24 patients with odontogenic orbital cellulitis and adequate examinations for statistical analysis. Twelve of 24 patients had preserved vision (final vision better than 20/70), whereas 11 of 24 patients had vision loss (final vision of light perception or no light perception). Analysis of data showed no statistical correlation between visual loss and age (p = 0.81), days to clinical presentation (p = 0.45), days to surgical exploration (p = 0.96), sinus radiographic involvement (p = 0.50), orbital radiographic findings (p = 0.19), or type of bacterial infection (Gram-positive aerobic vs. anaerobic organisms), (p = 0.31 and p = 0.50 respectively). Male gender, the need for surgical drainage, and multiple surgical procedures performed correlated statistically with loss of vision (p = 0.05, p = 0.03, and p = 0.02, respectively).

CONCLUSIONS: Multiple case reports have demonstrated that orbital cellulitis from an odontogenic source can result in devastating visual loss. Male gender, the need for surgical drainage, and multiple surgical procedures correlated statistically with severity of visual loss.

Lippincott, Williams & Wilkins

Cellulitis with Compartment Syndrome as a Complication of Varicella Zoster Infection.

2008-01-19T06:37:00.000-08:00

Cellulitis with Compartment Syndrome as a Complication of Varicella Zoster Infection.

Klin Padiatr. 2007 Dec 21

Schwerk N, Rokahr C, Hansen G.
1Medizinische Hochschule Hannover, Zentrum für Kinder- und Jugendmedizin, Pädiatrische Pneumologie und Neonatologie, Hannover.

BACKGROUND: Varicella zoster infection (chickenpox) is a common and usually benign self limiting disease of childhood in non-vaccinated populations. Although varicella usually goes along with mild to moderate illness in immunocompetent patients, serious complications can arise. Varicella is highly infectious, with attack rates in susceptible individuals ranging from 61% to 100%.

PATIENT: This case describes a rare but life threa-tening complication of varicella zoster infection in a child.

CONCLUSIONS: High morbidity in non-vaccinated populations that led to rare cases of severe complications became a significant health burden all over the world. This aspect must be considered in the discussion about the importance and benefit of a population wide varicella vaccination programme as it was added to the childhood immunization schedule in Germany in 2004. The case described here might have been avoided by vaccination.

Thieme Connect

Clinical analysis of computed tomography-staged orbital cellulitis in children

2007-12-24T03:55:00.000-08:00

Clinical analysis of computed tomography-staged orbital cellulitis in children
J Microbiol Immunol Infect. 2007 Dec

Ho CF, Huang YC, Wang CJ, Chiu CH, Lin TY.
Division of Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.

BACKGROUND AND PURPOSE: Bacterial infection of the orbital structures can affect all age groups, but is more frequent in pediatric populations. Prompt recognition, correct diagnosis, and adequate management are important if serious complications are to be avoided. This study sought to delineate the clinical, bacteriological and radiological findings, management and outcome of orbital cellulitis.

METHODS: This retrospective study reviewed 80 children admitted to Chang Gung Children's Hospital with a diagnosis of orbital cellulitis who were staged by computed tomography (CT), between January 1999 and August 2005. The staging classification was as follows: stage I, inflammatory edema (preseptal); stage II, subperiosteal phlegmon and abscess; stage III, orbital cellulitis; stage IV, orbital abscess; and stage V, ophthalmic vein and cavernous sinus thrombosis. The patients were categorized into 2 groups: preseptal (stage I) and postseptal (stage II-V).

RESULTS: Of the 80 children, 50 were male and the mean age was 6.8 years. Sinusitis and upper respiratory tract infection were the most common predisposing factors. Forty one percent of patients in stage I presented with symptoms that indicated postseptal involvement. The patients with postseptal involvement had a significantly higher rate of proptosis and limitation of extraocular motility. Bacterial pathogens were identified in 31 patients (39%), the 2 most common pathogens being Staphylococcus and Streptococcus. Ten patients (13%) had polymicrobial infection. Twenty three patients underwent sinus and/or orbital and/or intracranial surgery, including all 5 patients (100%) in stage IV, 3 of 6 patients (50%) in stage III, 13 of 35 patients (37%) in stage II, and 2 of 34 patients (6%) in stage I. Complete resolution without complication was achieved in 72 children. Eight patients had complications, including intracranial infection in 3, recollection of abscess in 2, ophthalmoplegia in 2, and corneal scar in 1.

CONCLUSIONS: Proptosis and limitation of extraocular motility may be considered the most important signs on CT examination in children with suspicious orbital cellulitis. Given that polymicrobial infection is common, broad-spectrum antibiotics are indicated initially. Surgery should be considered not only when an abscess is demonstrated by CT scan but also if clinical deterioration occurs within 24 to 36 h of adequate intravenous antibiotic treatment.

Journal of Microbiology, Immunology and Infection

Submandibular cellulitis (Ludwig's angina) associated to a complex odontoma erupted into the oral cavity. Case report and literature review.

2007-12-21T01:30:00.000-08:00

Submandibular cellulitis (Ludwig's angina) associated to a complex odontoma erupted into the oral cavity. Case report and literature review.
Minerva Stomatol. 2007 Nov-Dec

Bertolai R, Acocella A, Sacco R, Agostini T.
Division of Maxillofacial Surgery, Department of Odontostomatology, Faculty of Medicine, University of Florence, Florence, Italy tommytt23it@yahoo.it.

The clinical presentation of Ludwig's angina consists in a severe expanding cellulitis causing swelling of the floor of the mouth, tongue and submandibular region, thus resulting in a possible obstruction of the airway and in a rapid progress in deep neck soft tissue infection and mediastinitis with potentially fatal consequences. Frequently, submandibular cellulitis develops from an acute infection spreading from the lower molar teeth. Mandibular fractures, traumatic laceration of the floor of the mouth, and peritonsillar abscesses are other concomitant clinical features. A case of Ludwig's angina associated with a large erupted odontoma and with a deeply impacted third molar displaced to the border of the mandible is described. The patient was affected by enlargement of submandibular space, marked face swelling causing an evident face deformity, tenderness and redness of the neck and limited movement of the neck and mouth. In the past, Ludwig's angina was frequently fatal, however aggressive surgical and medical therapy have significantly reduced the mortality rate. The reported case can be considered as important, not only because of the rarity of the odontoma eruption in the oral cavity, but mainly for the extent of the clinical manifestation of a lesion usually described in literature as asymptomatic.

PMID: 18091716 [PubMed - in process]

Ludwig's angina: a clinical review.

Srirompotong S, Art-Smart T.

Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, 40002 Khon Kaen, Thailand. srirompotong@yahoo.com

Ludwig's angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by a brawny induration of the floor and suprahyoid region (bilaterally), with an elevation of the tongue potentially obstructing the airway. In the pre-antibiotic era, Ludwig's angina was frequently fatal; however, antibiotics and aggressive surgical intervention have significantly reduced mortality. We reviewed nine patients with Ludwig's angina between July 1996 and June 2002, all of whom presented with fever, neck swelling, bilateral submandibular swelling and elevation of the tongue. In eight patients (89%) a dental infection appeared to be the underlying cause. High-dosage intravenous antibiotics directed towards the suspected causative microorganisms were given to all of the patients: two were treated successfully with conservative medical management, while seven underwent surgical drainage (a tracheotomy was necessary in one patient). Routine aerobic cultures were done on samples of drained material and the predominant microorganisms were Streptococcus species in two patients; there were none in the other five. Two patients had post-operative complications, but all recovered.

PMID: 12937916 [PubMed - indexed for MEDLINE]

Approach to the patient with presumed cellulitis.

2007-12-15T03:24:00.000-08:00

Approach to the patient with presumed cellulitis.

Semin Cutan Med Surg. 2007

Kroshinsky D, Grossman ME, Fox LP.
Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY.

Dermatologists frequently are consulted in the evaluation and management of the patient with cellulitic-appearing skin. For routine cellulitis, the clinical presentation and patient symptoms are usually sufficient for an accurate diagnosis. However, when the clinical presentation is somewhat atypical, or if the patient fails to respond to appropriate therapy for cellulitis because of routine bacterial pathogens, the differential diagnosis should be rapidly expanded. We discuss the approach to the patient with presumed cellulitis, with an emphasis on the differential diagnosis of cellulitis in both the immunocompetent and immunucompromised patient.

PMID: 18070684 [PubMed - in process]