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Meningitis complicating acute bacteremic facial cellulitis
Abstract:
Eighty cases of acute bacteremic facial cellulitis, 34 buccal and 46 preseptal, were reviewed from the years 1977 through 1982. The epidemiology, clinical presentation, laboratory parameters and course of cellulitis in these two locations were similar. The white blood cell count was over 15,000 in three-fourths of the patients. Haemophilus influenzae type b was cultured from the blood of 67 patients, Streptococcus pneumoniae from 12 and Streptococcus pyogenes from 1. Seven patients had culture-proved meningitis, six with H. influenzae type b and one with S. pneumoniae. Five of these patients had sparse clinical evidence of meningitis, and three of these had meningitis apparent by culture only. We conclude that meningitis may occur in association with acute bacteremic facial cellulitis and may be inapparent both clinically and by initial laboratory examination. We suggest aggressive initial evaluation and treatment of these infants pending culture results.
Insights
Acute bacteremic facial cellulitis in infants can be associated with meningitis, even when clinical signs are minimal. Early evaluation and treatment are crucial for better outcomes in these cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Ophthalmology
Background:
- Facial cellulitis is a common pediatric infection.
- Bacteremic facial cellulitis requires careful evaluation for potential complications.
Observation:
- Eighty cases of acute bacteremic facial cellulitis (buccal and preseptal) were reviewed.
- Common pathogens included Haemophilus influenzae type b and Streptococcus pneumoniae.
- Elevated white blood cell counts were noted in most patients.
Findings:
- Seven patients (9%) developed culture-proven meningitis.
- Meningitis was often clinically inapparent or only detected by blood/cerebrospinal fluid cultures.
- Haemophilus influenzae type b was the most frequent cause of associated meningitis.
Implications:
- Meningitis can co-exist with bacteremic facial cellulitis and may present subtly.
- Aggressive initial assessment and prompt treatment are recommended for infants with facial cellulitis.
- Early diagnosis and management are vital to prevent severe outcomes from meningitis.