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Buccal cellulitis reevaluated
Insights
Acute buccal cellulitis in children often involves bacteremia and can present with meningitis. Direct mucous membrane invasion is the likely cause, not middle ear spread.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Buccal cellulitis is a common pediatric infection.
- Understanding its etiology and pathogenesis is crucial for effective treatment.
Purpose of the Study:
- To investigate the clinical characteristics, etiology, and pathogenesis of acute buccal cellulitis in children.
- To identify diagnostic methods and causative pathogens.
Main Methods:
- Retrospective and prospective study of 72 children with acute buccal cellulitis.
- Analysis of clinical data, including age, affected side, and presence of otitis media.
- Microbiological investigations: cellulitis aspirate cultures and urine bacterial antigen tests.
Main Results:
- Median age of patients was 11 months; 55% had bacteremia.
- Three children without meningeal signs had meningitis.
- Cellulitis aspirate cultures and urine antigen tests aided etiologic diagnosis.
- Infections were clinically indistinguishable regardless of the bacteria.
- Right cheek involvement was more common; ipsilateral otitis media was infrequent (32%).
Conclusions:
- Buccal cellulitis pathogenesis likely involves direct mucous membrane invasion.
- Early diagnosis and appropriate management are essential.
- Further research into specific bacterial roles is warranted.
Abstract:
We studied 72 children (17 prospectively) with acute buccal cellulitis. The median age was 11 months. Fifty-five percent of patients were bacteremic, and three children without meningeal signs or symptoms had concomitant meningitis. Cellulitis aspirate cultures (eight of 35 positive) and urine bacterial antigen tests (13 of 27 positive) were useful in making an etiologic diagnosis. Infections due to other bacteria were clinically indistinguishable from those due to Haemophilus influenzae type b. The right cheek was affected more often than the left, and only 23 (32%) of 72 patients had otitis media ipsilateral to the involved cheek. The pathogenesis of buccal cellulitis likely involves direct mucous membrane invasion rather than spread from the ipsilateral middle ear.