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Orbital Cellulitis in Children PDF
Orbital Cellulitis in Children PDF
The Pediatric Infectious Disease Journal Volume 25, Number 8, August 2006 695
Nageswaran et al The Pediatric Infectious Disease Journal Volume 25, Number 8, August 2006
received an oral antibiotic along with a parenteral agent were Literature Review. To compare our results on age distribution
counted as parenteral days. Oral antibiotic duration was with previous studies, the PubMed database was searched for
defined as the number of days prescribed (intended); confir- studies that contained information on orbital cellulitis. The
mation that all doses were taken after hospital discharge was search strategy used was orbital cellulitis or orbital abscess
not available. This project was approved by the institutional or subperiosteal abscess limited to English literature, human
review board of the Wake Forest University School of Med- subjects, children 0 18 years, and the period 1985 through
icine. 2005. Studies were selected for review if they (1) described
Statistical Analysis. Student t tests were used for between- series with more than 5 cases of orbital cellulitis in North
groups comparisons for continuous variables with normal America; (2) were published subsequently to or were unavail-
distributions. Mann-Whitney U tests were used when distri- able for inclusion in the 1987 publication by Israele and
butions of continuous variables were likely nonnormal. 2 Nelson4; and (3) clearly distinguished orbital cellulitis from
methods, with continuity correction for 2- -2 tables, were preseptal (periorbital) cellulitis on the bases of physical
used for associations of categorical variables. Analyses were findings (ie, presence of proptosis, ophthalmoplegia) and/or
conducted using SPSS 13.0 (SPSS, Inc., Chicago, IL). CT scan findings demonstrating postseptal involvement. Ne-
TABLE 1. Characteristics of 41 Cases of Orbital Cellulitis at the Brenner Childrens Hospital, 1992 to 2002
Age, years, mean SD (median) 7.5 5.0 (8.8) 0.9 16.3 2.7 1.5 (2.6) 0.9 6.1 11.7 2.3 (11.2) 8.716.3
range*
Male, No. (%) 30 (73) 16 (84) 14 (64) 0.26
White, No. (%) 32 (78) 15 (79) 17 (77) 0.99
Seasonality October-March, 23 (56) 11 (58) 12 (54) 0.99
No. (%)
Antibiotics before admission, 33 (80) 16 (84) 17 (77) 0.87
No. (%)
Days of antibiotics before 3.1 2.4 3.0 2.2 3.2 2.6 0.86
admission
Days of nasal congestion before 6.4 8.6 (3) 0 30 8.7 9.9 (4) 0 30 4.4 6.9 (2.5) 0 30 0.12
diagnosis, mean SD,
(median) range
Fever on or after presentation 27 (66) 11 (58) 16 (73) 0.50
(101F), No. (%)
Maximum temperature recorded, 101.2 1.7 101.0 1.9 101.4 1.6 0.40
F, mean SD
White blood cell count (WBC) on 15.1 6.5 (14) 6 34 17.2 6.7 (16) 8 34 13.4 5.9 (12) 6 28 0.06
admission, thousands, mean
SD (median) range
WBC 15,000, No. (%) 19 (46) 12 (63) 7 (32) 0.09
Ophthalmologic signs
None, No. (%) 11 (27) 9 (47) 2 (9) 0.016
Proptosis, No. (%) 25 (61) 8 (42) 17 (77) 0.048
Any ophthalmoplegia, No. (%) 19 (46) 3 (16) 16 (73) 0.001
Both, No. (%) 14 (34) 1 (5) 13 (59) 0.001
Left eye, No. (%) 23 (56) 12 (63) 11 (50) 0.60
Orbital cellulitis characteristics
Orbital cellulitis, no abscess or 7 (17) 5 (26) 2 (9) 0.24
phlegmon, No. (%)
Subperiosteal abscess (or 24 (59) 11 (58) 13 (59)
phlegmon), No. (%)
Orbital abscess subperiosteal 10 (24) 3 (16) 7 (32)
abscess, No. (%)
Any surgical procedure, No. (%) 29 (71) 11 (58) 18 (82) 0.18
Drainage only, No. (%) 12 (29) 4 (21) 8 (36) 0.22
Drainage plus Ethmoidectomy, 17 (41) 7 (37) 10 (45)
No. (%)
Length of hospitalization, days,
mean SD
All patients 5.8 2.9 5.3 3.1 6.3 2.8 0.38
Medical treatment only (n 12) 4.2 1.9# 3.6 1.7 5.2 2.1 0.23
Any surgical procedure (n 29) 6.5 3.0# 6.4 3.4 6.5 2.9 0.97
SD standard deviation.
*Range given as minimum and maximum.
For those who had received antibiotics before admission.
Fever after presentation was not associated with receipt of antibiotics before admission.
Each analysis conducted as a 2- -2 table.
Includes 1 postseptal phlegmon that was not a frank abscess. Eight cases also had subperiosteal abscesses.
Analysis was with a 3- -2 table, with no surgery as the third category.
#
P 0.011 for difference between medical and surgical treatment groups in length of stay (Mann-Whitney U test).
7
TABLE 2. The Microbiology Associated With Orbital
Cellulitis Among 20 Children With Positive Cultures
6
Total Abscess
Organism
5 Isolates Isolates
Number of Cases
Aerobes
4 -or nonhemolytic streptococci* 7 3
Group A -hemolytic streptococci 3 2
Staphylococcus aureus* 3 3
3
Haemophilus influenzae 3 2
Group C -hemolytic streptococci* 2 2
2 Eikenella corrodens* 2 2
Arcanobacterium hemolyticum* 1
Moraxella catarrhalis* 1 1
1
Anaerobes
Peptostreptococcus* 4 3
0 Bacteroides species* 2 2
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Fusobacterium necrophorum* 1
Anaerobic bacterium, unspecified* 1
Age in Years
*One or more isolates were from 1 or more of 7 children with polymicrobial culture results.
FIGURE 1. Age distribution of 41 children with orbital celluli-
One was H. influenzae type b from a sinus culture (isolated in 1993 from a 16-mo-old).
tis. There were few cases between the ages of 4 and 7 years, Isolated in same blood culture in a child with a negative abscess culture.
which may imply a bimodal age distribution.
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