Related Experiment Videos
Preseptal cellulitis secondary to Proteus species: a case report and review
J M Sears1, H M Gabriel, J Veith
1Illinois College of Optometry, Chicago, USA.
Background:
Preseptal cellulitis is a serious ocular condition that--if left untreated--has the potential to cross the septal barrier, spread to the posterior orbit, and may result in fatal complications. Because it is difficult to determine the pathogen responsible for any cellulitis without aspirating a culture sample, treatment is usually instituted by an assumption of the most common causative organisms, Staphylococcus or Streptococcus.
Case Report:
A 42-year-old black woman manifested signs and symptoms consistent with right preseptal cellulitis. Throughout treatment, visual acuity remained 20/20 for both eyes, extraocular muscles were unrestricted without pain, and anterior globe structures were clear. The patient was started on a regimen of 250-mg oral dicloxacillin four times a day. When no response was seen at 36 hours, the patient was changed to 500-mg oral ciprofloxacin every 12 hours. She responded to the 500-mg ciprofloxacin and recovered with no sequelae. An abscess, which had formed during the cellulitis, self expressed and this material was cultured. The cultures identified the responsible organism as Proteus species, an unexpected pathogen in a well-groomed patient.
Conclusion:
This case demonstrates the need to consider alternate pathogens when treating preseptal cellulitis, change medications accordingly, and consider alternate treatments as needed.
Insights
Preseptal cellulitis treatment requires considering uncommon pathogens like Proteus species. Promptly adjusting antibiotics based on culture results is crucial for effective recovery and preventing complications.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Preseptal cellulitis poses risks of orbital spread and fatal complications if untreated.
- Empirical antibiotic therapy often targets Staphylococcus or Streptococcus due to diagnostic challenges.
Observation:
- A patient presented with preseptal cellulitis, initially treated with dicloxacillin without improvement.
- Treatment was switched to ciprofloxacin, leading to recovery.
- An abscess self-expressed and was cultured, identifying Proteus species as the causative agent.
Findings:
- Proteus species, an unexpected pathogen, was identified in a patient with preseptal cellulitis.
- The case highlights the limitations of assuming common pathogens in cellulitis treatment.
Implications:
- Clinicians should consider a broader range of pathogens in preseptal cellulitis cases.
- Adjusting antibiotic therapy based on culture data is essential for optimal patient outcomes.
- Exploring alternative treatment strategies may be necessary when initial therapies fail.