Cellulitis In Adults Research Articles

Odontogenic Peri-Mandibular Cellulitis in Adults : Clinical Profile and Treatment at Owendo University Hospital (CHUO)

Odontogenic Peri-Mandibular Cellulitis in Adults : Clinical Profile and Treatment at Owendo University Hospital (CHUO)

221 Distinguishing clinical features for pseudocellulitis in pediatric inpatients: A retrospective study

Cellulitis is a common skin infection presenting with expanding erythema, warmth, pain, and swelling of the affected area. While adult cellulitis is well-studied, there is a paucity of data on pediatric cellulitis and no objective tests to confirm a cellulitis diagnosis. There are also several diseases that clinically mimic cellulitis, known as pseudocellulitis. This study evaluates and compares the clinical presentation of inpatient pediatric pseudocellulitis to cellulitis to identify associated factors.

Cosmetological competence of nail patches in combating onychomycosis-An approach to improve the quality of life

Onychomycosis (Tinea unguium) is said to be the most common cosmetological nail fungal infection. Dermatophyte is a type of fungus that causes this condition. Discoloration and thickening of the nail are found to be the common symptoms of all nail diseases. In this scenario, Onychomycosis is considered as one of the cosmetic problems that leads to cellulitis in adults and diabetic patients. Anatomical structure of the nail and disease manifestations made nail disorders as a difficult endeavor. Onychomycosis is chronic and difficult to eradicate. Many oral antifungal agents are available for the treatment of nail infections. The oral and parenteral administration of antifungal agents can elevate the serum hepatic enzyme levels and causes typical hepatocellular injury within a few weeks of therapy. The goal of this review is to study the role of transungal delivery systems (nail patches) as a promising tool for onychomycosis to encounter the clinical conditions of the patient. Longer therapies and technical treatment methods may frustrate the patients. This novel antifungal therapy helps to avoid the surgical removal of nail for onychomycosis patients. Eradication of issues with Onychomycosis can be achieved by an excellent delivery system with deeper drug release and drug retention in the nail cuticle. Patients who are suffered from onychomycosis are facing embarrassment and disfigurement in the society. So, this newer treatment solution can improve the quality of life of patients.1-3

Pearls in the Evaluation and Treatment of Orbital Cellulitis in Adults

Pearls in the Evaluation and Treatment of Orbital Cellulitis in Adults

Differences in characteristics, aetiologies, isolated pathogens, and the efficacy of antibiotics in adult patients with preseptal cellulitis and orbital cellulitis between 2000–2009 and 2010–2019

Background/aimsTo understand whether the epidemiology, aetiologies, common pathogens and the antibiotic efficacy against the identified bacteria of periorbital cellulitis in adults have changed recently (2010–2019) compared with the past decade...

Efficacy of ultrasonography-guided sterile isotonic saline aspirate in the isolation of microorganism in the management of cellulitis

Background: Cellulitis is an acute spreading infection of the skin and subcutaneous tissues characterized by local findings of tenderness, erythema, increased warmth, swelling, and regional adenopathy. Attempts to establish a precise bacteriologic diagnosis in most cases of cellulitis in adults are usually unrewarding, and therapy tends to be empiric. The aim of the study was to determine the efficacy of Ultrasonography guided sterile isotonic saline aspirate (UGSISA) in the isolation of microorganisms in the management of cellulitis.Methods: A cross-sectional study with 100 patients suffering from lower limb cellulitis was performed. The most infected area was marked with ultrasonography, using the 21 G needle under sterile precaution; around 0.5 ml of sterile isotonic saline was injected into the most infected area and aspirated. The aspirate was sent for gram staining, cultured, and analyzed according to standard procedures.Results: Needle aspirations in 100 patients were performed, and 30% had positive aspirants. The most common organism grown was Streptococci, and the least common was coagulase-negative Enterococcus, 2 patients had mixed infections. Major risk factors associated with lower limb cellulitis in our study were diabetes (54%) and spontaneous (20%).Conclusions: In our study, as a routine diagnostic procedure, needle aspiration may not be justified for all cellulitis patients, though it may still be useful in patients where the most infected area was marked with ultrasonography before needle aspiration.

Route and duration of antibiotic therapy in acute cellulitis: A systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment

Compared with guideline recommendations, antibiotic overuse is common in treating cellulitis. We conducted a systematic review and meta-analyses on antibiotic route and duration of treatment for cellulitis in adults and children. We searched MEDLINE, EMBASE and trial registries from inception to Dec 11, 2019 for interventional and observational studies of antibiotic treatment for cellulitis. Exclusions included case series/reports, pre-septal/orbital cellulitis and non-English language articles. Random-effects meta-analyses were used to produce summary relative risk (RR) estimates for our primary outcome of clinical response. CRD42018100602. We included 47/8423 articles, incorporating data from eleven trials (1855 patients) in two meta-analyses. The overall risk of bias was moderate. Only two trials compared the same antibiotic agent in each group. We found no evidence of difference in clinical response rates for antibiotic route or duration (RR(oral:IV)=1.12, 95%CI 0.98-1.27, I2=32% and RR(shorter:longer)=0.99, 95%CI 0•96-1.03, I2 = 0%, respectively). Findings were consistent in observational studies. Follow-up data beyond 30 days were sparse. The evidence base for antibiotic treatment decisions in cellulitis is flawed by biased comparisons, short follow-up and lack of data around harms of antibiotic overuse. Future research should focus on developing patient-tailored antibiotic prescribing for cellulitis to reduce unnecessary antibiotic use.

Etiology and clinical features of orbital cellulitis in adults

Objective To investigate the etiology and clinical features of orbital cellulitis in adults. Methods The data of 54 adults with orbital cellulitis from Jan. 2010 to Dec. 2017 were analyzed retrospectively. The clinical manifestations of patients infected by orbital and adjacent tissues were compared with those without these causese. Results There were 33 cases (61.11%) with orbital and adjacent tissue infection. The differences in subfascial effusion, extraocular muscle thickening, optic nerve involvement and severe complications were statistically significant between the two groups (P<0.05). Conclusion The spread of local and adjacent tissues is still the main infection channel of adult orbital cellulitis, dacryocystitis is the main cause. Severity of disease is more serious in those without local and adjacent tissue lesions. Key words: Cellulitis, orbital, adult; Etiology; Clinical features

Epidemiological characteristics of orbital cellulitis among adult population in the Split region, Croatia.

There are few diseases in ophthalmology which could have afatal outcome, one of them is orbital cellulitis. The aim of this article is to give epidemiological analysis of orbital cellulitis in adult patients in the Split region, Croatia. The study was based on aretrospective review of medical records of 53adult patients with orbital cellulitis treated during the period of 26years from 1991 to 2016 at the Department of Ophthalmology in the University Hospital of Split. The incidence of orbital cellulitis in adults in the Split region was 0.57. The mean age of the patients was 53.5 ± 19.0 years. Patients were male in 47.2% of the cases and female in 52.8%. The distribution of orbital cellulitis according to seasons shows that it was most common during winter with 20 (37.7%) and in autumn with 16 (30.2%) cases and less frequent in summer with 6 (11.3%) and in spring 11 (20.8%) cases. The most common cause of orbital cellulitis was sinusitis in 33 (62.2%) patients. In total, there were 16 (30.2%) surgical interventions. Orbital cellulitis in adult patients is a relatively rare disease but with a possible fatal ending and damage to vision. It should be diagnosed quickly and treated adequately, very often in cooperation of an ophthalmologist with an otorhinolaryngologist and amaxillofacial surgeon. Orbital cellulitis appears to be more common in colder months, because sinusitis occurred more often then. It is treated with adequate antibiotic application but in almost one third of cases a surgical intervention was necessary.

Interventions for the prevention of recurrent erysipelas and cellulitis.

Interventions for the prevention of recurrent erysipelas and cellulitis.

The Burden of Facial Cellulitis Leading to Inpatient Hospitalization

The purpose of the present study was to present nationally representative estimates of hospitalizations primarily attributed to facial cellulitis and to conduct an exploratory analysis on identifying factors associated with outcomes, such as hospital charges, length of stay (LOS), disposition status, and occurrence of infectious complications. The present study is a retrospective analysis of the Nationwide Inpatient Sample (NIS) for 2012 and 2013. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of "682.0" in the primary diagnosis field of NIS (reason for hospitalization) was used to identify cases with facial cellulitis. All patients at least 18years old who were hospitalized for facial cellulitis were included. Outcome variables examined in the present study were hospital charges, LOS, disposition status, and occurrence of infectious complications. Descriptive statistics and a multivariable linear regression model were used to examine association between independent variables and patient disposition and infectious complications. In 2012 and 2013, 74,480 hospitalizations involved facial cellulitis in adults at least 18years old in the United States. Most were women (mean age, 47.5yr). Most patients were routinely discharged home. Age was associated with an increase in odds of discharge to another facility. Variables associated with decreased odds of bacterial infections were age and black or Hispanic race. Women with at least 1comorbidity had higher odds of mycoses. Statistically relevant predictors of longer than average LOS were age, race, insurance, presence of sepsis, and location. This study presented nationally representative estimates of hospitalizations attributed primarily to facial cellulitis in the adult population in the United States in 2012 and 2013. The presence of a comorbid condition predicted worse outcomes. Public health efforts should focus on targeting high-risk patients and providing monitoring or early treatment of face cellulitis.

Retropharyngeal cellulitis complicated by cervical spondylodiscitis: A case report

Secondary to pharyngeal trauma such as endotracheal intubation, endoscopy and after foreign body ingestion, or removal may develop retropharyngeal cellulitis in adults. These infections occur mainly in children between 1 to 8 years of age with 75% of cases occurring before the age of 5 years. Retropharyngeal cellulitis is a serious deep space infection which can extend from neck to the mediastinum. Herein, we represent a case of 24-year-old female patient who presented with neck pain, odynophagia, and malaise two months after accidental ingestion of a little pin. Uncomplicated removal of this pin was followed by development of retropharyngeal cellulitis and cervical spondylodiscitis. The patient was successfully treated with intravenous and oral antibiotics for 12 weeks without need to surgical intervention. We believe that early and aggressive medical treatment can eradicate nonsuppurative complicated retropharyngeal infection without the need for surgery. J Microbiol Infect Dis 2015;5(4): 180-183 Key words: Pharyngeal trauma, cervical spondylodiscitis, cellulitis

Oral Clindamycin Compared With Sequential Intravenous and Oral Flucloxacillin in the Treatment of Cellulitis in Adults

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Periorbital and orbital cellulitis in adults

ObjectiveThe pathogenesis and management of periorbital cellulitis (POC) and orbital cellulitis (OC) is distinct in the adult population. We evaluated the clinical features, radiological characteristics, etiologies and management of hospitalized adults with POC and OC. MethodsA retrospective chart review of patients ≥18 years of age, hospitalized with POC and OC over a 20-year period. ResultsThe charts of 91 patients were identified, of whom 75 were diagnosed with POC and 16 with OC. No age or gender preference was noted in either group (P=0.149). The most common etiology of OC was infected scleral buckle or orbital implant (43.7%) followed by sinusitis (18.8%). Both were significantly more prevalent in the OC group than in the POC group. In the POC group, skin infection was the most common etiology (33.3%), followed by dacryocystitis (22.7%). Twelve patients (75%) with OC and 12 patients (16%) with POC underwent surgical drainage of their infection (P=0.001). ConclusionPOC and OC in adults have different distributions, predisposing factors and management than in children. The patient's medical history is of crucial importance, as it may help diagnose the entity. External periocular etiologies, such as skin infection, dacryocystitis, conjunctivitis, insect bite and allergic reaction causes POC and very rarely become OC, whereas sinusitis and infected orbital implants are a significant cause for OC. An infected implant is a unique cause of OC and high suspicion of orbital involvement should be raised in any sign of infection in these patients.

Oral flucloxacillin and phenoxymethylpenicillin versus flucloxacillin alone for the emergency department outpatient treatment of cellulitis: study protocol for a randomised controlled trial

BackgroundOral flucloxacillin, either alone or in combination with phenoxymethylpenicillin, is a commonly prescribed antibiotic for the treatment of cellulitis, particularly in Ireland and the United Kingdom. This study aims to establish the non-inferiority of oral monotherapy (flucloxacillin alone) to dual therapy (flucloxacillin and phenoxymethylpenicillin) for the outpatient treatment of cellulitis in adults.Methods/designThis study is a multicentre, randomised, double-blind, placebo-controlled trial of adults who present to the emergency department (ED) with cellulitis that is deemed treatable on an outpatient basis with oral antibiotics. After fulfilling specified inclusion and exclusion criteria, informed consent will be taken. Patients will be given a treatment pack containing 7 days of treatment with flucloxacillin 500 mg four times daily and placebo or flucloxacillin 500 mg four times daily and phenoxymethylpenicillin 500 mg four times daily. The primary outcome measure under study is the proportion of patients in each group in which there is greater than or equal to a 50% reduction in the area of diameter of infection from the area measured at enrolment at the end-of-treatment visit (7 to 10 days). Secondary endpoints include a health-related quality of life measurement as rated by the SF-36 score and the Extremity Soft Tissue Infection Score (not validated), compliance and adverse events. Patients will be followed up by telephone call at 3 days, end-of-treatment visit (EOT) at 7 to 10 days and test-of-cure (TOC) visit at 30 days. To achieve 90% power, a sample size of 172 patients per treatment arm is needed. This assumes a treatment success rate of 85% with oral flucloxacillin and phenoxymethylpenicillin, an equivalence threshold Δ = 12.5% and an α = 0.025. Non-inferiority will be assessed using a one-sided confidence interval on the difference of proportions between the two groups. Standard analysis including per-protocol and intention-to-treat will be performed.DiscussionThis trial aims to establish the non-inferiority of flucloxacillin monotherapy to dual therapy in the treatment of uncomplicated cellulitis among ED patients. In doing so, this trial will bridge a knowledge gap in this understudied and common condition and will be relevant to clinicians across several different disciplines.Trial registrationEudraCT Number 2008-006151-42

P299 A rare case of extrapulmonary tuberculosis; acute tuberculous cellulitis in adult

Age-related macular degeneration (AMD) is a common disease that can result in severe visual impairment. Abnormal regulation of the complement system has been implicated in its pathogenesis, and CFH polymorphisms contribute substantially to risk. How these polymorphisms exert their effects is poorly understood. We performed enzyme-linked immunosorbent assay (ELISA) analysis on young, aged, and AMD choroids to determine the abundance of the membrane attack complex (MAC) and performed immunofluorescence studies on eyes from 117 donors to evaluate the MAC in aging, early AMD, and advanced AMD. Morphometric studies were performed on eyes with high- or low-risk CFH genotypes. ELISA confirmed that MAC increases significantly with aging and with AMD. MAC was localized to Bruch’s membrane and the choriocapillaris and was detectable at low levels as early as 5 years of age. Hard drusen were labeled with anti-MAC antibody, but large or confluent drusen and basal deposits were generally unlabeled. Labeling of retinal pigment epithelium was observed in some cases of advanced AMD, but not in early disease. Eyes homozygous for the high-risk CFH genotype had thinner choroids than low-risk homozygotes (P < 0.05). These findings suggest that increased complement activation in AMD and in high-risk genotypes can lead to loss of endothelial cells in early AMD. Treatments to protect the choriocapillaris in early AMD are needed.

Orbital Cellulitis Complicated by Central Retinal Artery Occlusion

The authors present a case of a 16-year-old boy who sought treatment in Storm Eye Institute for orbital cellulitis complicated by central retinal artery occlusion. He was examined for severe signs of orbital cellulitis, including decreased vision and an afferent pupillary defect. Intravenous antibiotics failed to provide timely improvement, and the patient was surgically managed with endoscopic orbital decompression. An ocular examination under anesthesia revealed retinal ischemia in the affected eye, and fluorescein angiography confirmed the diagnosis of central retinal artery occlusion. The patient's vision improved slightly following resolution of the infection. Central retinal artery occlusion is a rare complication of orbital cellulitis in adults and has yet to be reported in the pediatric population.

Letters to the Editor

Letters to the Editor

Effects of Complete Decongestive Therapy on the Incidence Rate of Hospitalization for the Management of Recurrent Cellulitis in Adults with Lymphedema

Study Design: Prospective case-control observational trial. Objectives: The purpose of this investigation was to examine how a comprehensive approach to the management of lymphedema incorporating the use of Complete Decongestive Therapy (CDT) influenced the cumulative incidence rate of hospitalization for the management of recurrent cellulitis in a cohort of adults with lymphedema and a known history of cellulitis. Background: Cellulitis is considered to be among the most serious medical complications experienced by adults with lymphedema. Unfortunately, there is a paucity of evidence to support the use of any specific intervention for the primary or secondary prevention of cellulitis in this patient population. Methods: All participants enrolled in this investigation were treated using CDT by a physical or occupational therapist with postgraduate training and certification in the management of lymphedema. These participants served as their own controls and the 24-month cumulative incidence rate of hospital admission for the medical management of cellulitis using intravenous antibiotic therapy was compared pre- and postintervention. Results: All participants involved in the investigation had a known history of cellulitis and were at risk for recurrent infections. Among participants who completed all phases of the study protocol, the majority were able to prevent the recurrence of cellulitis in their involved extremities following treatment for up to 18 months. Conclusions: The results of this investigation suggest that CDT may be an effective form of secondary prevention in adults with lymphedema. The observed risk reduction following the use of CDT is important because the prevention of recurrent cellulitis is a principal goal of lymphedema management and effective means of prevention have not been reported in the literature.

Changes in the classification and management of skin and soft tissue infections

Although skin and soft tissue infections (SSTIs) are extremely common in both primary and secondary care, there is a lack of validated evidence-based schemes for the classification of clinical presentation or severity, and there are few data available on treatment outcomes. The commonly used 'Eron classification' is based on the consensus views of an expert panel, while the Clinical Resource Efficiency Support Team (CREST) 'Guidelines on the Management of Cellulitis in Adults' have not been validated in clinical trials. In the current issue of JAC, investigators at Ninewells Hospital in Dundee, Scotland, report a retrospective study of patients with SSTIs who were treated with antibiotics. The patients were stratified into four classes of clinical severity, based on the presence or absence of sepsis and co-morbidity, and their standardized early warning score. The empirical treatment received by patients in each class was compared with the recommendations of the CREST guidelines. The findings do not make comfortable reading. Overall, 43% of patients (and 65% at the mildest end of the clinical spectrum) were overtreated, while mortality (at 30 days) and inadequate antimicrobial therapy increased with severity class. Strikingly, 35 different empirical antimicrobial prescribing regimens were noted. These findings, which are likely to reflect the situation in many hospitals, show that SSTIs remain a significant cause of mortality and that empirical therapy is bordering on the haphazard, with significant under treatment of severely ill patients.