Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum

Area of Science:

• Ophthalmology
• Infectious Diseases
• Pediatrics

Background:

• Preseptal and orbital cellulitis are common pediatric infections.
• The Haemophilus influenzae type-B (HiB) vaccine was introduced in 1986.
• Changes in causative pathogens may impact clinical management.

Purpose of the Study:

• To evaluate the microbiologic spectrum of pediatric preseptal and orbital cellulitis.
• To determine if the spectrum has changed in the decade following HiB vaccine introduction.

Main Methods:

• Retrospective chart review of children diagnosed with preseptal or orbital cellulitis (1986-1996).
• Analysis of blood and abscess cultures.
• Data collected from Vanderbilt University Medical Center.

Main Results:

• 70 cases of preseptal cellulitis: Streptococcus species predominated (5/6 positive blood cultures).
• No H. influenzae bacteremia in preseptal cellulitis cases after 1987.
• 10 cases of orbital cellulitis: Streptococcus species also predominated (4/6 positive cultures).
• H. influenzae was identified in 2 orbital cellulitis cases.

Conclusions:

• H. influenzae bacteremia is now rare in pediatric preseptal cellulitis.
• Streptococcus species are the leading cause of both preseptal and orbital cellulitis.
• Orbital cellulitis due to H. influenzae remains possible but less frequent.
• A more conservative diagnostic and management approach may be appropriate.