Orbital Cellulitis In Children Research Articles

Reevaluating clinical signs of orbital cellulitis

We sought to determine clinical signs predictive of orbital cellulitis in children with periorbital swelling to help guide decision making for imaging.

Diagnosis and treatment of orbital complications of acute sinusitis in 51 children

Objective:To analyze the clinical features, diagnosis and treatment of acute sinusitis related orbital cellulitis in children. Methods:The data of 51 cases with acute sinusitis comorbid with orbital cellulitis in Tianjin Children's Hospital from April 2016 to March 2021 were retrospectively analyzed. According to the extent of infection, the patients were divided into two groups:pre-septal orbital cellulitis（7 cases） and post-septal orbital cellulitis（44 cases）. The general clinical characteristics, clinical manifestations, laboratory examination and treatment were compared between the two groups. Among them, 23 cases（6 in pre-septal orbital cellulitis group and 17 in post-septal orbital cellulitis group） were cured by medicine treatment; 28 cases were cured by surgical treatment after failure of medicine treatment. Results:There was no significant difference in age, gender and medical history between the two groups. Redness, swelling, heat and pain in eyelid was the most common clinical manifestations of orbital cellulitis in children, followed by fever, headache, runny nose, eye fixation, and vision loss. WBC count and neutrophils percentage were significantly higher in post-septal orbital cellulitis group. All children were followed up for 3 months to 3 years， 1 case was lost to follow-up， 50 cases had no recurrence and recovered well. Conclusion:Orbital cellulitis is a common and rapid developing complication of sinusitis in children. Early diagnosis and effective anti-infection treatment are very important for prognosis. Orbital CT plays an important role in the determination and evaluation of this complication. When conservative treatment is ineffective, surgical drainage in time can reduce the occurrence of serious ocular sequelae.

Epidemiology and Management of Orbital Cellulitis in Children.

The epidemiology of orbital cellulitis likely has evolved due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) and the adoption of pneumococcal conjugate vaccination. In the absence of published guidelines, management is highly variable. We characterized epidemiology and management over an 11-year period. A retrospective cohort study of children 0 to 21 years of age with orbital cellulitis +/- subperiosteal orbital abscess hospitalized at a large quaternary children's hospital from January 2008 to June 2018. We reviewed charts for demographic characteristics, clinical features, management, and outcomes. Using multivariable logistic regression, we evaluated predictors of surgical intervention and assessed whether corticosteroid use or antibiotic duration was related to clinical outcomes. Among 220 patients, methicillin-susceptible S. aureus was the most common organism (26.3%), with MRSA found in only 5.0%. Rates of vancomycin use fluctuated annually from 40.9% to 84.6%. Surgery was performed in 39.5% of the patients. Corticosteroids, used in 70 patients (32.1%), were unrelated to treatment failure (n = 9), defined as persistent signs and symptoms or initial clinical improvement followed by worsening (P = .137). The median antibiotic duration was 17 days (interquartile range 14-26). After controlling for age, gender, proptosis, eye pain with movement, eyelid swelling, neutrophil count, and corticosteroid use, treatment failure was not significantly associated with receipt of ≥ 3 weeks of antibiotic therapy (8/84, 9.5%) compared with > 2 but < 3 weeks (0/51, 0.0%) or ≤ 2 weeks (1/85, 1.2%) (adjusted odds ratio = 5.83 for ≥ 3 vs ≤2 weeks; 95% confidence interval: 0.58, 59.0). Although MRSA was rare, empiric vancomycin use was high. Treatment failure was uncommon in patients who received ≤ 2 weeks of therapy, suggesting that shorter durations are adequate in some patients.

Orbital Cellulitis in Children: Experience of the Pediatric Service at Mohammed v Military Hospital

Background: Orbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the vital and functional prognosis. This study aimed to analyze the epidemiological, therapeutic and evolutional aspects of orbital cellulitis cases treated at the pediatric service at Mohamed V military hospital.&#x0D; Patients and methods: retrospective study including all the children aged between 1 month and 15 years treated for orbital cellulitis at the pediatric service of the Mohamed V Hospital over a period of 3 years (1st January 2016-31st December 2019).&#x0D; Results: 24 cases of orbital cellulitis were gathered. Age varied between 1 month and 15 years with a median of age of 6. years. Feminine predominance (58%) was noted .&#x0D; The disease mainly involved the sinus (32%).Clinically, fever was present in 10 patients (41%),palpebral edema was universal, proptosis was noted in 5 cases(20.8%),chemosis and ptosis were noted in 4 cases(16.6%),bacteriological&#x0D; testing identified micro-organisms in 3 cases. An orbital CT scan was performed in all cases of our study, showing preseptal cellulitis in 14 cases (58.3%), orbital cellulitis in 3 cases(12.5%),and orbital abscess in 7 cases.&#x0D; The medical treatment consisted of ceftriaxone, metronidazole and aminoside or amoxicilline clavulanic acid, corticosteroid therapy prescribed in 5 cases. Surgical treatment was indicated in 3 patients.&#x0D; The outcome of All cases was favorable.&#x0D; Conclusion: The majority of our cases had a positive evolution highlighting the advantage of an early diagnosis, and adapted antibiotic and a multidisciplinary patient care making the need for surgery rarely necessary.

Impact of Steroids as Adjuvant Therapy in Acute Bacterial Infections of Childhood.

Impact of Steroids as Adjuvant Therapy in Acute Bacterial Infections of Childhood.

1384 Managing Peri-Orbital and Orbital Cellulitis: A New Multi-Specialty Care Pathway

Abstract Aim 1) To review current practice in the diagnosis and management of peri-orbital and orbital cellulitis in children at a London University Teaching Hospital. 2) To design and implement a streamlined, multi-specialty care pathway to improve the quality of care. Background Clinical differentiation between peri-orbital cellulitis and orbital cellulitis is often difficult, especially in young children. Early recognition and aggressive, multi-specialty treatment are required in order to prevent any vision and life-threatening sequelae. Method A retrospective case note analysis was performed for all paediatric patients with suspected peri-orbital or orbital cellulitis over a nineteen-month period. Extensive literature review was undertaken to ascertain current best practice in diagnosis and management. A streamlined, multi-specialty care pathway was developed, ratified by specialist departments, and introduced to optimise safety and quality of care. Results The results correlate with trends found in recent literature. 94.3% of patients had a blood culture taken with only 9.1% being positive. There were inadequate eye (37.1%) and endonasal (17.1%) cultures. Wide variation was noted in the criteria for imaging and in the antibiotic regimen used. 25.7% of patients received any nasal treatment. Suboptimal specialist review was identified in both orbital (60%) and peri-orbital (50.0%) cellulitis. Conclusions The new care pathway clearly informs investigation and empiric treatment based on initial risk stratification. The paediatric team is now the main, named care provider responsible for coordinating specialist input.

Microbiology and outcome of pediatric orbital cellulitis in a Tertiary Eye Care Center in Saudi Arabia after the routine administration of Haemophilus influenzae Type B vaccine.

PURPOSE:To evaluate the incidence of pediatric Haemophilus influenzae related orbital cellulitis after the routine administration of the H. influenzae vaccine in Saudi Arabia and to identify the most common pathogens, predisposing factors, related complications, and the need for surgical intervention.METHODS:A retrospective chart review was performed of patients with a discharge diagnosis of orbital cellulitis who presented to the King Abdul Aziz University Hospital, Riyadh, Saudi Arabia. Saudi children born between 2000 and 2016 were included.RESULTS:Thirty-one cases were included and 8 had positive cultures. No cases of H. influenzae were found. Of all the positive culture, the most common pathogens isolated were Staphylococcus aureus, Streptococcus pneumoniae and group A Streptococcus in 3 cases (37.5%), 2 cases (25%) and 2 cases (25%). The most common predisposing factor was sinusitis in 90.3% of cases. Sixteen patients (51.6%) developed complications. Fifteen patients (48.3%) developed subperiosteal abscesses, 1 patient (3.22%) developed a lid abscess, 2 patients (6.45%) developed recurrent orbital cellulitis, and 1 patient (3.22%) developed persistent strabismus. Only 10 (31.25%) patients underwent surgical intervention during admission.CONCLUSION:The vaccine seems to be effective at eliminating the orbital cellulitis potentially related to H. influenzae. The most common current pathogens were Gram-positive Staphylococcus and Streptococcus species. Sinusitis remains the most common cause of orbital cellulitis in children. In select cases, medical treatment can resolve the infections however, close observation is warranted.

A child with refractory orbital cellulitis after water pipe smoking

Orbital cellulitis in children rarely occurs secondary to smoking water pipe. A 3-year-old girl who presented with fever, eyelid swelling, pain, and proptosis of the left eye for 4 days after water pipe consumption. The patient was given the usual course of antibiotics for a few days along with subperiosteal abscess drainage however no improvement was noticed for a week. Cultures were positive for methicillin-resistant Staphylococcus aureus and pseudomonas aeruginosa. Intravenous dexamethasone was co-administered in three courses for 3 weeks, during which residual symptoms was slowly resolving. In conclusion, attempt of dexamethasone in children can shorten hospital stay and augment full recovery.

Orbital complications of pediatric rhinosinusitis: A single institution report.

Rhinosinusitis is one of the most common infections of childhood. Rhinosinusitis usually limits itself in the pediatric age group, however orbital and intracranial complications may arise in some of the patients. The purpose of the study was to retrospectively analyse the previous treatments and outcomes in pediatric rhinosinusitis patients with orbital complications. The effect and prognosis of medical treatment and endoscopic sinus surgery are reported in this study. Twenty-five pediatric patients diagnosed with complicated rhinosinusitis between January 2008 - February 2016 were included in the study. Orbital complications, examination findings, radiological imaging and blood counts were retrospectively collected from patient files. The duration of hospitalization, source of the infection, complications, previous medical and surgical treatments were also retrospectively assessed. Average age of the patients were 8.84 ± 4.02 years (range: 1-16 years). The mean length of stay in hospital was 6.72 ± 3.28 days. Hospitalization in surgically treated group was higher than primarily medically treated group. However this difference could not reach to a statistically significant level (p > 0.05). Mean hospitalization time was found 5.21 ± 2.51 and 8.43 ± 2.87 days in patients diagnosed with preseptal cellulitis and subperiosteal abscess respectively. Hospitalization in patients with subperiosteal abscess was higher than preseptal cellulitis and a statistically significant difference was detected (p < 0.05). Morbidity and mortality of orbital complications which are the most common complications of pediatric rhinosinusitis, could significantly be reduced by using appropriate treatment methods and an early diagnosis. Conservative therapy is an effective method for patients with preseptal cellulitis and most cases of orbital cellulitis in children.

Les cellulites orbitaires chez l’enfant : à propos de 60 cas

This was a retrospective study including 60 children (67 eyes) diagnosed with orbital cellulitis. Two groups were defined according to the clinical form: pre- or retroseptal. We studied 29 cases (34 eyes) of preseptal cellulitis and 31 cases (33 eyes) of retroseptal cellulitis. The mean age was 4 years. The male: female ratio was 1.3. The prescription of anti-inflammatory drugs and antibiotics prior to hospitalization was noted in respectively four and 10 patients. Eyelid edema was the principal sign (100% of cases); exophthalmia was noted in 19 eyes, ptosis in 27 eyes and chemosis in 10 eyes. Oculomotor disorders were present in 4 eyes. The mean C-reactive protein level was 53.15±27mg/l in preseptal cellulitis and 92.09±21mg/l in the retro-septal cases. Orbital computed tomography was performed in 31 patients and MRI in 5 patients. The pathway of entry of the orbital infection was primarily from the sinuses (23 cases). All of our patients had received broad spectrum intravenous antibiotic therapy. Three children had a cavernous sinus thrombosis and had been treated with anticoagulant therapy. Surgical drainage was performed in five patients. The course was favorable and without sequelae for all the patients. Two independent risk factors for retroseptal involvement were identified: the prescription of anti-inflammatory drugs prior to hospitalization, and sinus involvement. Orbital cellulitis in children is a serious infection and requires close collaboration between the ophthalmologist, otolaryngologist, and pediatrician in order to be diagnosed and treated early so as to improve the prognosis for vision and life.

1523. Clinical Epidemiology of Children with Orbital Cellulitis

BackgroundThe microbiology of pathogens causing orbital cellulitis in children is evolving over time, with studies from around 10 years ago describing MRSA as responsible for anywhere from 0 to 13% of cases of orbital cellulitis. However, the prevalence of community-acquired MRSA infections has declined over the past decade. A current understanding of the bacteria most commonly found to be responsible for orbital cellulitis would be important to inform the empiric antibiotic regimens for cases of orbital cellulitis in which no microbiologic data are available.MethodsThis is a single-center retrospective cohort study of children ≤18 years hospitalized with orbital cellulitis at Children’s National Medical Center between January 1, 2017 and July 31, 2018. We excluded children with immunocompromising conditions, cystic fibrosis, underlying craniofacial abnormality, or recent craniofacial or otolaryngologic surgery. Baseline clinical characteristics, microbiologic data, clinical outcomes, and antibiotic treatment data were abstracted through structured chart review and summarized with descriptive statistics.ResultsWe identified 68 children that met inclusion criteria, with an average age of 8.2 years; 66.2% were male, 48.5% were African American, and 14.7% were Hispanic. Most (67.6%) had no underlying medical problems, 14.7% had asthma, and 22.1% had allergic rhinitis. The median duration of symptoms prior to presentation was 4 days. An abscess or phlegmon was identified in 41 of the 68 (60.3%). Three patients (4.4%) developed intracranial complications. About one-quarter (27.9%) of all patients in the cohort underwent surgical drainage. The most commonly identified pathogens were viridans group streptococci (7/19, 36.8%), followed by Staphylococcus aureus (4/19, 21.1%). Anti-MRSA therapy was provided empirically in almost all (95.6%) of patients.ConclusionOne-quarter of all patients hospitalized for orbital cellulitis underwent surgical drainage, and viridans group streptococci and S. aureus were the most commonly isolated pathogens. While MRSA was isolated in only one patient (5.2%), almost all received empiric anti-MRSA therapy. Disclosures All authors: No reported disclosures.

Orbital cellulitis - Incidence, management and outcome from coastal hospitals

Orbital cellulitis is a potentially life-threatening and an uncommon emergency condition in children. There are little published data from incidence and prevalence in the developing country. This study was done to identify incidence, etiology and management of orbital cellulitis in children from two service hospitals in east and west coast of India. Methods : The two multispecialty service hospitals cater tertiary level care to dependant population with 80700 children between ages 1 month to 12 years. This study was a 2 years retrospective observational study using hospital based electronic information system and electronic case records from Jan 2017 to Dec 2018 between ages of 1 month to 12 years. Results : A total of 15 children with orbital cellulitis were included in the study giving incidence of 9.29 per 100000 in children Conclusion: The annual incidence of orbital cellulitis in our dependant population was 9.29 per 100000 per year. In children, it commonly follows upper respiratory infection or furunculosis of the face. Intravenous antibiotics and surgical management yields optimum result.

Systemic corticosteroids may be beneficial for managing severe or refractory orbital cellulitis in children.

The authors have no conflicts of interest to declare.

Fifteen-minute consultation: Preseptal and orbital cellulitis.

'It is midnight and you are called to see a thirteen-year-old boy who has been brought to the paediatric emergency department with a 24-hour history of swelling and redness of his left eye. He has had a 'runny nose' for a couple of days. He is systemically well. His upper and lower lids are red and swollen such that his eye is not open fully, though you elicit normal eye movements when you open his eye. Pupils are equal and reactive with no afferent pupillary defect. Visual acuity and colour vision are normal on examination.' In this article, we consider the approach to preseptal and orbital cellulitis in children including the initial assessment and management options.

Imaging of orbital cellulitis in children: about 56 cases

Les cellulites orbitaires de l'enfant sont rares mais potentiellement graves, le diagnostic est principalement basé sur l'examen clinique et l'imagerie (tomodensitométrie ou IRM). Le but de ce travail est d'illustrer le rôle de l'imagerie, essentiellement la TDM, dans le diagnostic et la prise en charge de cette pathologie. Il s'agit d'une étude rétrospective portant sur 56 cas de cellulite orbitaire, colligés durant six années au service de radiologie de l'hôpital mère-enfant du CHU Mohammed VI de Marrakech (de janvier 2011 à octobre 2017), explorés par TDM crânio-orbitaire. L'âge moyen des patients était de 5 ans, avec une légère prédominance féminine. La porte d'entrée était dominée par l'atteinte sinusienne retrouvée chez 22malades. L'analyse des résultats tomodensitométriques a noté 37 cas de cellulite préseptale (66%), 3 cas de cellulite rétroseptale isolée (5%), 16 cas de cellulite mixte (28%), 8 cas d'exophtalmie (14%) et 4 cas d'abcès sous-périosté (7%). Les cellulites orbitaires de l'enfant sont des infections graves, entravant le pronostic vital à court terme et le pronostic fonctionnel visuel à moyen et long terme, le diagnostic positif est clinique. L'imagerie joue un rôle important dans le diagnostic topographique et étiologique, ainsi que pour guider le traitement.

Cellulites orbitaires et péri-orbitaires de l’enfant. Profil épidémiologique, clinique, thérapeutique et évolutif

Orbital cellulitis in childrenis a rare but potentially serious condition. The goal of this study is to analyze the epidemiological, clinical, therapeutic aspects and typical course of orbital and periorbital cellulitis in children, so as to propose a clinical management protocol adapted to our context. During the retrospective study period (2008-2014), 28 cases were hospitalized in the pediatric department at the Mohammed VI university medical center in Marrakech. Eighty-five percent of the cases were diagnosed as preseptal cellulitis, and 15% as retroseptal cellulitis. The age of the patients ranged from 6 months to 14 years with a mean age of 3 years. We report a female predominance with a prevalence of 58%. In our study, the most common cause is extension of infection from sinusitis. Clinically, fever was present in 19 patients (68%), eyelid edema was universal, proptosis and chemosis were noted in 2 cases, and ptosis in one patient. Bacteriological testing identified micro-organisms in 6 cases. Orbital computed tomography performed in 57% of the cases showed preseptal cellulitis in 12 cases, orbital cellulitis in one case, a subperiosteal abscess in 2 cases, and orbital abscess in one case. Medical treatment was based on amoxicillin-clavulanic acid or the combination of ceftriaxone, metronidazole±aminoglycoside. However, surgical drainage was necessary in 1 case. The outcome of all cases was favorable. Orbital cellulitis in children is usually preseptal, and amoxicillin-clavulanic acid is considered to be the standard empiric treatment.

Treatment of Orbital Complications Following Acute Rhinosinusitis in Children.

The orbital complications account for about 80% of all complications secondary to acute rhinosinusitis. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications. To evaluate the therapeutic efficacy of conservative therapy for the patients with orbital cellulitis and endoscopic sinus surgery (ESS) performed on patients with subperiosteal abscess (SPA) secondary to acute rhinosinusitis in children. Retrospective cross-sectional study. The retrospective study included 31 pediatric patients with orbital complications secondary to acute rhinosinusitis. In all cases, intensive treatment was initiated with a combination of oral or intravenous antibiotics, glucocorticoid and gelomyrtol forte after admission. ESS was performed if an improvement in the condition of patients did not occur after 48 hours. However, the patients with orbital SPA, motility disorders of eyeball or decreased vision received ESS immediately within 24 hours. Sixteen patients were cured by conservative therapy and 15 patients by ESS. All of the signs and symptoms disappeared after conservative therapy or ESS. There were no recurrences within the follow-up period of 1 to 8 years. Conservative therapy is an effective method for patients with inflammatory edema and most cases of orbital cellulitis in children. SPA can be cured by ESS.

Analysis of acute sinusitis or nasal furuncle derived orbitalcellulitis in children: review of 18 cases

Objective:To analyze the diagnosis and treatment of acute sinusitis or nasal furuncle derived periorbital cellulitis in children.Method:The clinical data of 18 children with acute sinusitis or nasal furuncle derived orbital cellulitis was analyzed retrospectively.Result:Sixteen cases(88.89%) had acute sinusitis and 2(11.11%) had furuncle of nose.All cases were treated with antibiotics and steroids.And 16 cases were cured and the other two received surgery.The median length of hospitalization was 7.33 days(5-13 days).Conclusion:Sufficient antibiotics combined with steroids and local treatment is critical in treating pediatric orbital cellulitis.Timely and decisive surgical intervention can effectively control the progression of disease.

Pediatric nasal orbital cellulitis in Shenzhen (South China): Etiology, management, and outcomes

ObjectivesThe study aimed to investigate the clinical characteristics, diagnosis, and treatment of orbital cellulitis in children in Shenzhen, China, and to improve the experience of antibiotic therapy for the treatment of orbital cellulites. MethodsThis retrospective study reviewed data from 20 children admitted to Shenzhen Children's Hospital between January 2009 and December 2013, with a diagnosis of nasal orbital cellulitis, severe enough to warrant hospitalization. Thirteen subjects (65%) were male and 7 (35%) were female. The median age was 3.5 years (2 months–7.2 years). The relationship between serum C-reactive protein (CRP), white blood cell count, and length of hospitalization were analyzed. The patients were categorized into 2 groups according to treatment: Those treated with a combination of cefoperazone plus sulbactam sodium vs. those treated with other antibiotic treatment regimens. ResultsLevels of serum CRP (29.8 ± 22.0 mg/L) at the time of admission were positively correlated with length of hospitalization (6.3 ± 4.1 days, r = 0.46, P < 0.05). The length of time necessary for CRP levels to return to normal range after admission (3.4 ± 1.8 days) was also significantly correlated length of hospitalization ((6.3 ± 4.1)days) (r = 0.81, P < 0.01). The hospital days whose CRP can be decreased to normal within 3 days (4.3 ± 1.7 days) after antibiotic treatment were significantly shorter than the others (9.1 ± 5 days) (t = 2.61, P < 0.05). The length of hospitalization (4.3 ± 1.9 days) for patients (n = 12) receiving combined cefoperazone and sulbactam sodium antibiotic treatment was significantly shorter than the length of stay (9.3 ± 4.7 days) for those patients (n = 8) treated with other antibiotic regimens (t = 2.83, P < 0.05). Bacterial pathogens were identified in 4 patients (20%), including 3 cases of Staphylococcus aureus and 1 case of Streptococcus anginosus. Acquired methicillin-resistant Staphylococcus aureus (MRSA) were found in the three pus cultures. ConclusionEarly efficient antibiotic treatment over the first three days may shorten the course of nasal orbital cellulitis and potentially prevent the formation of orbital abscesses. Clinical factors that were significantly related to patient recovery included improved clinical signs and normalization of blood CRP levels. Our results also indicate that combined cefoperazone and sulbactam sodium is effective and should be recommended for the treatment of pediatric orbital cellulitis.

Preseptal and orbital cellulitis in children

Abstract Orbital cellulitis predominantly affects children. This disease is potentially sight and life threatening and requires prompt recognition, investigations and treatment. An understanding of the anatomical features of the orbit its adnexa and neighbouring paranasal sinuses are essential in the evaluation and management of inflammations of the orbit. In this article we review the anatomy and discuss current thinking with respect to aetiological factors, the clinical presentation, the differential diagnosis, complications, investigations and management of orbital cellulitis.