-
European Archives of... Jul 2021The role of adjuvant systemic corticosteroids in the management of periorbital cellulitis and subperiosteal/orbital abscesses secondary to sinonasal infections is not... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The role of adjuvant systemic corticosteroids in the management of periorbital cellulitis and subperiosteal/orbital abscesses secondary to sinonasal infections is not well understood. Our objective was to systematically review the current evidence on the efficacy and side effects of systemic steroids when used in the management of periorbital cellulitis.
METHODOLOGY
A systematic review of literature was conducted in accordance with PRISMA guidance. A systematic search of MEDLINE, Embase and Cochrane databases, MetaRegister and ISI conference proceedings was conducted. The outcomes of interest were duration of inpatient stay, requirement for surgical intervention, adverse effects and recurrent/residual symptoms.
RESULTS
Four studies were identified involving 118 patients. Of these, 78 underwent treatment with systemic corticosteroids and 40 were controls. Meta-analysis demonstrated that the mean duration of inpatient stay was significantly shorter in the steroid group (WMD - 2.90 days; 95% CI - 3.07, - 2.73; p < 0.00001). There were no significant differences in requirement for surgical intervention (RR 0.93; 95% CI 0.50, 1.75; p = 0.83). Side effects were reported in 6/78 patients (7.7%), with 5 patients showing signs of hyperactivity and 1 patient with insomnia. These were mild except in one case, which required early cessation of corticosteroids. There was one case of recurrence of symptoms in each cohort (steroid vs. non-steroid) following discharge.
CONCLUSIONS
The evidence suggests that systemic corticosteroids may offer some benefit in the management of periorbital cellulitis secondary to sinonasal infections. However, there is significant heterogeneity and risk of bias. A well-designed randomised controlled trial may provide a better insight into the efficacy of systemic steroids for this condition.
Topics: Adrenal Cortex Hormones; Humans; Neoplasm Recurrence, Local; Orbital Cellulitis; Randomized Controlled Trials as Topic; Sinusitis; Steroids
PubMed: 32833055
DOI: 10.1007/s00405-020-06294-z -
BMJ Case Reports May 2024A girl in early childhood with no significant medical history developed left eye periorbital oedema and erythema. She was treated with intravenous antibiotics for...
A girl in early childhood with no significant medical history developed left eye periorbital oedema and erythema. She was treated with intravenous antibiotics for suspected severe periorbital cellulitis. Despite treatment, the patient's cellulitis progressed into necrotising fasciitis, and she was transferred for ophthalmology review and imaging. A CT scan and eye swab culture-confirmed periorbital cellulitis. Incidentally, pathology revealed significant pancytopenia suspicious of leukaemia. The patient underwent bone marrow biopsy and was diagnosed with B-cell acute lymphoblastic leukaemia (ALL). A multidisciplinary specialist assessment revealed no ocular evidence of leukaemia and no intraocular concerns. In medical literature, it is consistently found that cases of ALL initially manifesting as proptosis or eyelid oedema are invariably due to neoplastic infiltration. This case represents unique documentation where periorbital cellulitis is the initial presentation of B-cell ALL, underscoring the necessity to consider periorbital cellulitis as a possible differential diagnosis in ophthalmic manifestations of ALL.
Topics: Humans; Female; Orbital Cellulitis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Diagnosis, Differential; Anti-Bacterial Agents; Cellulitis; Staphylococcal Infections; Staphylococcus aureus; Tomography, X-Ray Computed
PubMed: 38749518
DOI: 10.1136/bcr-2023-259087 -
Emergency Medicine Journal : EMJ Mar 2004Orbital cellulitis and abscess formation are rare complications of sinusitis, however acute orbital inflammation is secondary to sinusitis in about 70% of cases. Delay...
Orbital cellulitis and abscess formation are rare complications of sinusitis, however acute orbital inflammation is secondary to sinusitis in about 70% of cases. Delay in diagnosis must not occur to avoid serious complications such as blindness and life threatening intracranial sepsis. A case is reported in which despite late referral, emergency surgical intervention was sight saving.
Topics: Adolescent; Cellulitis; Diagnosis, Differential; Eye Infections; Humans; Hypersensitivity; Male; Maxillary Sinusitis; Orbit; Orbital Diseases
PubMed: 14988362
DOI: 10.1136/emj.2002.004051 -
European Journal of Ophthalmology 2010Periorbital cellulitis is often difficult to distinguish from orbital cellulitis, which is a potentially lethal infection involving the contents of the orbit. A delay in...
PURPOSE
Periorbital cellulitis is often difficult to distinguish from orbital cellulitis, which is a potentially lethal infection involving the contents of the orbit. A delay in diagnosis and appropriate treatment may result in serious complications. We studied the predisposing factors, microbiologic data, clinical features, complications, and treatment of periorbital and orbital cellulitis in childhood.
METHODS
Eighty-three medical records of patients (mean age 3.7 ± 3.1 years) admitted to the Department of Pediatrics with a diagnosis of periorbital or orbital cellulitis during the 10-year period January 1997 to December 2007 were retrospectively studied.
RESULTS
In this series, periorbital cellulitis occurred more frequently (83%) than orbital cellulitis (17%). Of the children with periorbital cellulitis, 85% were younger than 5 years of age, while 62% of the children with orbital cellulitis were older than 5 years of age. The most common predisposing factors in periorbital cellulitis were upper respiratory infection (68%) and trauma to the eyelids (20%), while sinusitis was more frequently associated with orbital cellulitis (79%). Blood and skin cultures were usually negative. The most common isolated pathogens were Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus epidermidis. Forty-five of the 83 children were treated with intravenous ceftriaxone + clindamycin (mean duration 8.6 ± 5.5 days). Intravenous antibiotics alone was an effective management in most of the patients, but a small proportion (6%) required surgical intervention.
CONCLUSIONS
Upper respiratory infection and sinusitis are the most important predisposing factors for periocular infection. Streptococcus species are the predominant causative agents. Both diseases can usually be successfully treated with intravenous antibiotics, but some patients may require surgery to control extensive infection.
Topics: Anti-Bacterial Agents; Child, Hospitalized; Child, Preschool; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Hospitals, University; Humans; Male; Orbital Cellulitis; Respiratory Tract Infections; Retrospective Studies; Risk Factors; Sinusitis
PubMed: 20544674
DOI: 10.1177/112067211002000607 -
International Journal of Pediatric... Jan 2024Periorbital cellulitis in children are commonly caused by acute rhinosinusitis (ARS). This study investigated the association of ARS and the severity of periorbital...
OBJECTIVE
Periorbital cellulitis in children are commonly caused by acute rhinosinusitis (ARS). This study investigated the association of ARS and the severity of periorbital cellulitis in children.
STUDY DESIGN
Retrospective case-control study of children with periorbital cellulitis with ARS versus periorbital cellulitis without ARS.
SETTING
Patients were seen at West Virginia University Children's Hospitals between August 2011 to August 2022.
METHODS
Patients were divided into cases and controls based on presence or absence of ARS. ARS was defined based on clinical symptoms with objective presence of disease on CT scan. Patients' characteristics, treatment, hospital length of stay, and readmission were collected.
RESULTS
The sample consisted of 118 pediatric patients with orbital cellulitis. Patients with ARS were younger than patients without ARS (6.3 vs 8.5, p = 0.025), however there were no sex differences between two groups (p = 0.540). The ARS group had higher incidence of postseptal cellulitis (51.5% vs 9.6%, p < 0.001). As compared to patients without ARS, patients with ARS were more likely to be admitted (p < 0.001), have a longer length of stay (median of 3.5 days vs 0.5 days, p < 0.001), require IV antibiotics (95.3% vs 54.9%, p < 0.001), and require surgical intervention (23.1% vs 5.8%, p < 0.001). Readmission rate was similar between the two groups.
CONCLUSION
Children presenting with acute periorbital cellulitis who have ARS tend to have more severe infection requiring higher level of care. ARS should be assessed and incorporated into the plan of care of pediatric patients with periorbital infections.
Topics: Child; Humans; Infant; Orbital Cellulitis; Retrospective Studies; Case-Control Studies; Rhinosinusitis; Cellulitis; Sinusitis; Inflammation; Anti-Bacterial Agents; Orbital Diseases
PubMed: 38043186
DOI: 10.1016/j.ijporl.2023.111813 -
Cutaneous and Ocular Toxicology Jun 2011(1) To describe a case of necrotizing group A streptococcal periorbital infection in a patient receiving treatment with adalimumab (Humira, Abbott)-- a fully humanized...
OBJECTIVE
(1) To describe a case of necrotizing group A streptococcal periorbital infection in a patient receiving treatment with adalimumab (Humira, Abbott)-- a fully humanized monoclonal anti-TNF-α agent. (2) To identify bacterial species responsible for infection with different forms of biological therapy.
DESIGN
Single interventional case report and literature review.
CASE
A 57-year-old woman developed severe right-sided necrotizing periorbital infection whilst receiving treatment with adalimumab for rheumatoid arthritis (RA). Cultures grew Lancefield Group A Streptococcus pyogenes. An extensive literature search for reports of ocular infections associated with biological therapy was conducted.
RESULTS
Adalimumab therapy was discontinued and the patient was admitted to an intensive care unit. The patient made a complete recovery after receiving appropriate antibiotic therapy. Overall Gram-positive cocci are the most common infection associated with use of biological therapy.
CONCLUSIONS
Anti-TNF-α agents are powerful immune-modulating drugs with potentially serious side effects. This case is the first to link adalimumab to necrotizing periorbital infection. Resolved infection does not preclude reintroduction of anti-TNF therapy however, careful assessment of the risks versus benefits of therapy is required at the individual patient level.
Topics: Adalimumab; Anti-Bacterial Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Arthritis, Rheumatoid; Female; Humans; Immunosuppressive Agents; Middle Aged; Necrosis; Orbital Cellulitis; Streptococcal Infections; Streptococcus pyogenes
PubMed: 21077727
DOI: 10.3109/15569527.2010.533317 -
The British Journal of Ophthalmology Sep 2014Periorbital necrotising fasciitis (PNF) is a devastating infection of subcutaneous soft tissue and underlying fascia causing severe morbidity and even loss of life. Few... (Observational Study)
Observational Study
BACKGROUND
Periorbital necrotising fasciitis (PNF) is a devastating infection of subcutaneous soft tissue and underlying fascia causing severe morbidity and even loss of life. Few case reports of PNF exist and there are no prospective epidemiological studies.
METHODS
A prospective observational study was undertaken using the British Ophthalmological Surveillance Unit reporting system. Questionnaires were sent to reporting ophthalmologists in the UK seeking cases of PNF over a 2-year period.
RESULTS
30 new cases were confirmed. 16 of the reported cases followed a precipitating event, 9 cases followed trauma and 3 followed surgery. β-haemolytic Streptococcus A was the causative organism identified in 76%, either alone or with concurrent infection, and antibiotic sensitivities are discussed. Systemic complications occurred in the majority of cases (66.6%), with sepsis and death occurring in 10%. Over 50% of surviving patients had subsequent morbidity, reduced acuity (<6/18) being common.
CONCLUSION
PNF is a rare, dangerous condition. This study identified an incidence of 0.24 per 1,000,000 per annum in the UK. β-haemolytic Streptococcus A is the most common causative organism. Mortality remains a potential outcome, and survivors suffer significant morbidity. Early intravenous antibiotic management with a consensus favouring penicillin and clindamycin combined with debridement.
Topics: Adult; Aged; Aged, 80 and over; Eye Infections, Bacterial; Eyelid Diseases; Fasciitis, Necrotizing; Female; Humans; Incidence; Male; Middle Aged; Orbital Diseases; Prognosis; Prospective Studies; Risk Factors; Streptococcal Infections; Streptococcus pyogenes; Tomography, X-Ray Computed; United Kingdom
PubMed: 25136080
DOI: 10.1136/bjophthalmol-2013-304735 -
Journal of Microbiology, Immunology,... Mar 2003During the period from July 1, 1999 to September 30, 2000, 9 children with severe adenovirus infection were treated at Chang Gung Children's Hospital. The mean age was...
During the period from July 1, 1999 to September 30, 2000, 9 children with severe adenovirus infection were treated at Chang Gung Children's Hospital. The mean age was 22 months (range, 5-50 months). All of them had lower respiratory tract infections, which manifested as lobar or segmental pneumonia and pleural effusion. Eight (88.9%) of the 9 patients required intensive care and 4 of them required mechanical ventilation. Abnormal laboratory findings included leukocytosis, elevated C-reactive protein, anemia, and prolonged prothrombin time and partial thromboplastin time. Extrapulmonary complications included hepatitis (6 cases), encephalitis (3), conjunctivitis (3), periorbital ecchymosis (1), and coagulopathy (2). One patient died, resulting in a mortality rate of 12.5%. Follow-up at 3 months postdischarge, 5 patients (62.5% of survivors) had bronchiolitis obliterans and/or organizing pneumonia. Seven patients were infected by serotype 3 adenovirus, 1 patient by serotype 2, and another by serotype 11. In conclusion, the clinical, laboratory, and radiographic features of severe adenovirus infection may mimic bacterial infection. Rapid progression of the clinical course despite antibiotic therapy and the presence of unusual extrapulmonary symptoms are important clinical clues in the diagnosis of severe adenoviral infection.
Topics: Adenovirus Infections, Human; Adenoviruses, Human; Child, Preschool; Female; Humans; Infant; Male; Pleural Effusion; Pneumonia, Pneumococcal; Pneumonia, Viral; Severity of Illness Index; Taiwan
PubMed: 12741731
DOI: No ID Found -
Seminars in Ophthalmology Jul 2022Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic pathogen that can cause vision-threatening infections of the ocular surface, orbit, and... (Review)
Review
PURPOSE
Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic pathogen that can cause vision-threatening infections of the ocular surface, orbit, and periorbital structures. MRSA decolonization is a widespread technique employed outside of ophthalmology to reduce MRSA transmission and infection rates. Herein we explore whether decolonization protocols have a place in ophthalmology for combatting ocular MRSA infections.
METHODS
We conducted a focused review of the MRSA decolonization literature using PubMed and Cochrane databases to identify key studies in ophthalmology and the broader medical literature.
RESULTS
We summarize the relevance of the recent literature from an ophthalmic perspective, focusing on the clinical evidence supporting pre-operative MRSA decolonization. We also discuss current real-world decolonization practices, existing challenges, and propose recommendations for future opportunities to address these issues.
CONCLUSION
Incorporating pre-operative MRSA decolonization approaches discussed herein may offer a new frontier for enhancing the ophthalmic care of patients colonized with MRSA.
Topics: Humans; Methicillin-Resistant Staphylococcus aureus; Ophthalmologists; Staphylococcal Infections
PubMed: 35188074
DOI: 10.1080/08820538.2022.2039220 -
Tropical Doctor Apr 2004
Topics: Abscess; Diagnosis, Differential; Drainage; Eyelid Diseases; Humans; Infant; Male; Staphylococcal Infections
PubMed: 15117148
DOI: 10.1177/004947550403400224