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Changing bacteriology of periorbital cellulitis
1Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Annals of Emergency Medicine
|December 1, 1996
Summary
In the post-Haemophilus influenzae type B (HIB) vaccination era, streptococcal bacteria are the primary cause of bacteremic periorbital cellulitis in children. Invasive Haemophilus influenzae infections are now rare, and meningitis is uncommon.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Vaccinology
Background:
- Periorbital cellulitis traditionally linked to Haemophilus influenzae.
- Standard diagnostic evaluation includes blood culture and CSF analysis for children.
- Impact of Haemophilus influenzae type B (HIB) vaccination on bacteremic periorbital cellulitis is under investigation.
Purpose of the Study:
- To determine the prevalence of H. influenzae bacteremia in pediatric periorbital cellulitis post-HIB vaccination.
- To assess the diagnostic yield of routine cerebrospinal fluid (CSF) analysis in these cases.
Main Methods:
- Retrospective case series of pediatric patients (2 months–17 years) diagnosed with periorbital cellulitis.
- Data collected from 1986–1994 at an urban university referral hospital.
- Chart review to ascertain prevalence of bacteremia and meningitis.
Main Results:
- Of 49 children, 10% had positive blood cultures, predominantly streptococcal species; one H. influenzae case occurred pre-vaccination.
- CSF analysis in 41% of patients revealed no abnormalities or positive cultures.
- Radiographic sinusitis was diagnosed in 19% of patients.
Conclusions:
- Streptococcal species are now the leading cause of bacteremic periorbital cellulitis.
- H. influenzae bacteremia is infrequent following HIB vaccination.
- Meningitis is uncommon, suggesting lumbar puncture may not be routinely necessary for well-appearing children. Sinusitis is common and often underdiagnosed.