Celulitis facial por Staphylococcus aureus con metástasis infecciosas y evolución tórpida. Caso pediátrico / Facial cellulitis due to Staphylococcus aureus with metastatic infection and torpid course. A pediatric case report

La bacteriemia por Staphylococcus aureus se define como el aislamiento de dicho germen en al menos un cultivo de sangre. Las metástasis infecciosas se originan por diseminación hematógena y su posterior localización en un sitio distinto al órgano en donde se originó el proceso infeccioso. La prevalencia en la presentación de estos focos infecciosos secundarios es baja en la edad pediátrica, por lo que representa un desafío diagnóstico. Se presenta el caso de un paciente pediátrico con una celulitis facial por Staphylococcus aureus, con metástasis infecciosas y evolución tórpida.

Bacteremia due to Staphylococcus aureus is defined as the isolation of this microorganism in at least one blood culture. A metastatic infection is caused by the hematogenous dissemination and subsequent location of the microorganism in a site other than the one where the infection started. The prevalence of these secondary sources of infection is low in the pediatric population, which is a diagnostic challenge. Here we describe the case of a pediatric patient with facial cellulitis due to Staphylococcus aureus, with metastatic infection and torpid course.

A retrospective study of lower limb cellulitis in a regional hospital in Ghana

Background: Cellulitis is a non-necrotizing inflammation of the dermis of skin and subcutaneous tissues. Lower limb cellulitis is a common cause of hospitalization in Ghana but scarcely reported. Objective: To document management and outcomes of lower limb cellulitis at the Ashanti Regional Hospital in Ghana. Materials and Methods: Retrospective review of patients admitted to the Ashanti Regional Hospital with a diagnosis of lower limb cellulitis from November 2016 to October 2018. We reviewed patients' clinical records for data on patient demographics, risk factors, clinical presentation, treatment modality and outcome of cellulitis. A p-value of less than 0.05 was considered to be statistically significant. Results: Eighty two (82) patients with lower limb cellulitis were admitted over the study period. There were 47 (57.3%) females and 35 (42.7%) males. The mean age of patients was 38.8 years (standard deviation 21.6065). Among females, the majority, 10 (21.3%) were in the 6th decade whilst the majority, 9 (25.7%) of males were in the 4th decade. All the patients presented with swelling of the lower limb involving the left lower limb in 38(46.3%) and right in 44(53.7%) cases. The leg was the most common location involved 60 (73%). The mean duration of swelling prior to admission was 5. 2 days (SD 3.196). Antibiotics treatment resulted in complete resolution in 29 (35.4%) cases and complications in 53 (54.5%), cases requiring surgical treatment in 31(58.5%) patients. Conclusion: Lower limb cellulitis had a high complication rate influenced by duration of symptoms prior to hospitalization and antibiotic therapy

Host inflammatory response to polypropylene implants: insights from a quantitative immunohistochemical and birefringence analysis in a rat subcutaneous model

ABSTRACT Objectives To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. Materials and Methods Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. Results A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). Conclusions The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.

A prevalencia de complicacoes orbitarias entre criancas e adultos com rinossinusite aguda / The prevalence of orbital complications among children and adults with acute rhinosinusitis

OBJETIVO: Investigar as complicações orbitais em crianças e adultos com sinusite. MÉTODO: Os pacientes que frequentam clínica de Otorrinolaringologia com sinusite de janeiro de 2010 até janeiro de 2012 foram incluídos. Os pacientes foram classificados em dois grupos, de acordo com sua idade. O primeiro incluiu crianças idade inferior a 16 anos e, o segundo, pacientes com mais de 16 anos. Quadro clínico, seio envolvido, gestão e resultados foram comparados. RESULTADOS: O número total de pacientes foi 616. Complicações orbitais foram observadas em 36 pacientes (5,8%). Destes, 26 pacientes (72,2%) eram crianças (21 tinham presseptal e cinco tiveram celulite orbitária) e dez pacientes (27,8%) eram adultos (cinco com pré-septal, três com celulite orbitária e dois com abscesso). A complicação mais comum foi celulite orbital presseptal (72,2%), seguida de celulite e abcesso orbital (22,2% e 5,6%, respectivamente). O seio mais comum envolvido foi etmoidal em crianças e sinusopatia mista em adultos. A maioria dos pacientes respondeu ao tratamento médico. CONCLUSÃO: As complicações orbitárias da sinusite são mais comuns em crianças do que em adultos e têm prognóstico favorável. .

OBJECTIVE: To investigate orbital complications in children and adult with sinusitis. METHOD: Patients attending ENT clinic with sinusitis from January 2010 until January 2012 were included. Patients were classified into two groups according to their age. First involved children aged less than 16 and second included adults older than 16 years. Clinical picture, sinus involved, management and outcome were compared. RESULTS: The total number of patients were 616. Orbital complications were seen in 36 patients (5.8%). Twenty six patients (72.2%) were children (21 had preseptal and 5 had orbital cellulitis) and ten patients (27.8%) were adults (5 with preseptal, three with orbital cellulitis and 2 with abscess). The most common orbital complication was preseptal cellulitis (72.2%) followed by orbital cellulitis and abscess (22.2% and 5.6% respectively). The commonest sinus involved was ethmoidal in children and mixed sinus pathology in adults. The majority of patients responded to medical treatment. CONCLUSION: Orbital complications of sinusitis are commoner in children than adults and have favorable prognosis. Keywords: Sinusitis, cellulitis, preseptal, abscess. .

Poor dental hygiene in pregnancy leading to submandibular cellulitis and intrauterine fetal demise: case report and literature review

Ludwig's angina is an infectious process involving submandibular, sublingual, and submental spaces that can rapidly progress to hemodynamic instability and airway obstruction. A 38-year-old unbooked multipara of low socioeconomic status with a poor oral and dental hygiene presented with bilateral submandibular cellulitis and intrauterine fetal demise. She delivered vaginally, and subsequently drainage was done for cellulitis. The report highlights the importance of dental hygiene during pregnancy, lest life-threatening complications like Ludwig's angina occur, complicating the course of pregnancy

Infected orthokeratinized odontogenic cyst: a rare cause of facial cellulitis

Orthokeratinized odontogenic cysts (OOCs) are relatively uncommon developmental cysts lined with orthokeratinized epithelium consisting of a prominent granular layer and a basal layer of low cuboidal flattened cells that show no tendency for nuclear palisading. These cysts have been considered a distinct entity from odontogenic keratocysts since they exhibit a less aggressive behavior and a very low rate of recurrence. Developmental odontogenic cysts can become infected but serious complications, such as potentially life-threatening cellulitis, are rare. This report describes a rare case of facial cellulitis secondary to an infected OOC located in the mandible of a 27-year-old man. The relevant literature about the clinical-pathological features of OOC is reviewed.

Os cistos odontogênicos ortoceratinizados (COOs) são cistos de desenvolvimento revestidos por epitélio ortoceratinizado constituído por uma camada granulosa proeminente e uma camada basal de células cuboidais achatadas que não mostram tendência à paliçada. Esses cistos foram considerados uma entidade distinta dos ceratocistos, uma vez que apresentam um comportamento menos agressivo e uma taxa muito baixa de recorrência. Cistos odontogênicos de desenvolvimento pode tornar-se infectados, mas complicações graves como a celulite, potencialmente ameaçadora da vida, são raros. Este relato descreve um caso raro de celulite facial secundária a um COO infectado localizado na mandíbula de um homem de 27 anos de idade. A literatura relevante sobre as características clínicopatológicas do COO foi revisada.

Epidemiology of cobra bite in Manipal, Southern India.

Envenomation by poisonous snakes is considered as an occupational hazard. Cobra bite is commonly encountered in the South Asian countries. The prospective research was conducted in the Department of Forensic Medicine, Kasturba Medical College, Manipal to study the epidemiology, manifestations and treatment of cobra snakebite cases admitted to Kasturba Hospital, Manipal during August 2003 and November 2005. Twenty cases of cobra bite were reported during the study period. The victims of cobra bite predominantly were females. Mean age of victims was 41.9 years. Maximum cases occurred during the summer and pre-monsoon months, during daytime and involved the upper limbs. Ptosis was the chief neurotoxic feature followed by dysarthria. Cellulitis as a complication was observed in most of the cases. Polyvalent Anti Snake Venom (ASV) vials were used as specific treatment. No mortality was reported during the study period.

Fatal cellulitis caused by Apophysomyces elegans.

A case of cellulitis of the left lateral side of the face caused by the zygomycete Apophysomyces elegans in a healthy male following a road traffic accident is reported. The contaminated soil was the source of fungus. Broad aseptate fungal hyphae were seen in the necrosed tissues. Extensive tissue debridement and treatment with amphotericin B were not successful in controlling the rapid invasion of the tissues by the fungus. Patient developed angioinvasion, severe cellulitis and finally succumbed to the infection three weeks after admission.

Pott's puffy tumor following an insect bite.

Pott's puffy tumor, a feature of osteomyelitis of the frontal bone, is a rare entity, especially in adults. Sir Percival Pott originally described this condition as a complication of trauma to the frontal bone. This is also a recognized complication of fronto-ethmoidal sinusitis. We present a rare case of Pott's puffy tumor caused by an insect bite presenting initially as a preseptal cellulitis and explore its pathogenesis and management.

Sinusite aguda em crianças: estudo retrospectivo de complicações orbitárias / Acute sinusitis in children: a retrospective study of orbital complications

Das complicações da sinusite, as que envolvem a região orbitária são mais freqüentes. OBJETIVO: Este trabalho tem por objetivo mostrar a incidência de celulite orbitária (CO) como complicação de sinusite aguda em crianças. Forma de Estudo: Retrospectivo. MÉTODO: Após autorização específica, foram avaliados todos os prontuários de pacientes pediátricos, com idade até 12 anos, com diagnóstico de complicação orbitária por sinusite, admitidos na Clínica de ORL e Pediátrica do HPEV no período de 1985 a 2004. Os casos foram analisados segundo o sexo, idade, quadro clínico, seio paranasal acometido, período médio de internação, exames de imagem realizados e tratamento instituído. RESULTADO: No período de 1985 a 2004, foram diagnosticados 25 pacientes portadores de CO, apresentando uma incidência de 6 por cento, predomínio do sexo masculino, com média de idade de 6,5 anos. O seio paranasal mais acometido foi o maxilar. 24 pacientes apresentavam edema periorbitário. Todos os 25 pacientes apresentavam velamento sinusal ao Rx. Um paciente apresentava deslocamento do globo ocular e proptose e a TC mostrava abscesso subperiosteal. O período médio de internação foi de 4 dias. 25 pacientes receberam tratamento antibiótico endovenoso e 2 foram submetidos a tratamento cirúrgico associado. CONCLUSÃO: A incidência de complicações orbitárias pós-sinusite são infreqüentes, com diagnóstico precoce evoluem bem com tratamento clínico. A cirurgia pode ser necessária em alguns casos.

Among the complications of sinusitis, those that involve the orbital region are the most frequent. AIM: the objective of this paper is to show an incidence of orbital cellulites (OC) secondary to acute sinusitis in children. Study design: retrospective. METHODS: After board approval, the charts of all pediatric patients diagnosed with orbital complications secondary to sinusitis, seen at the Pediatric and at the ENT clinics of the HPEV, between 1985 and 2004, were evaluated. The data was analyzed considering gender, age, clinical presentation, period of hospitalization, image study, and treatment. RESULTS: from 1985 to 2004, 25 patients were diagnosed with OC secondary to sinusitis, presenting an incidence of 6 percent . Males predominated, the median age was 6.5 years, and the maxillary was the most frequently involved sinus. Twenty-four patients presented mild peri-orbital swallowing. All 25 patients presented X-Ray alterations. One patient with proptosis had a subperiosteal abcess seen on the CT-scan. The average time of hospitalization was 4 days. All 25 patients received IV antibiotics, 2 required surgery. CONCLUSION: The incidence of orbital complications secondary to sinusitis is low, and although the majority of cases are early diagnosed and respond well to medication treatment, a surgical intervention may be required.

Computed tomographic patterns of orbital cellulitis due to sinusitis / Padrões tomográficos de celulite orbitária secundária à sinusite

PURPOSE: To describe the CT findings of orbital cellulitis due to sinusitis. METHODS: The records and CT scans of 45 consecutive patients with orbital cellulitis due to sinusitis treated at the Hospital of the Medical School of Ribeirão Preto were analyzed by a radiologist and two orbital surgeons. RESULTS: Three major types of CT changes were observed: diffuse fat infiltration, subperiosteal abscess and orbital abscess. Diffuse fat infiltration (characterized by an increased density of the extra- or intraconal fat) was seen in 11 patients (24.44 percent). A subperiosteal abscess was diagnosed in 28 patients (62.23 percent). A surgically proved orbital abscess was detected in 6 patients (13.33 percent). CONCLUSIONS: In all cases of orbital cellulitis due to sinusitis intraorbital changes can be detected by CT scans either as a diffuse infiltration of the orbital fat or as a detachment of the periorbita (subperiosteal abscess) or a true orbital abscess. Category I of Chandler orbital cellulitis classification (inflammatory edema) must be understood as a stage of a process that is already happening within the orbit and, as the term "preseptal cellulitis" means a palpebral infection, this designation should not be used to stage orbital cellulitis.

OBJETIVO: Descrever os achados tomográficos em celulites orbitárias secundárias à sinusite. MÉTODOS: Os prontuários e filmes tomográficos de 45 pacientes consecutivos com celulite orbitária secundária à sinusite tratados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto foram analisados por um radiologista e dois cirurgiões de órbita. RESULTADOS: Três principais tipos de alterações tomográficas foram observadas: infiltração difusa da gordura, abscesso subperiósteo e abscesso orbitário. Infiltração difusa da gordura (caracterizada por aumento da densidade da gordura extra ou intraconal) foi vista em 11 pacientes (24,44 por cento). Abscesso subperiósteo foi diagnosticado em 28 pacientes (62,23 por cento). Abscesso orbitário comprovado cirurgicamente foi detectado em 6 pacientes (13,33 por cento). CONCLUSÕES: Em todos os casos de celulite orbitária secundária à sinusite foram detectadas mudanças intra-orbitárias na tomografia computadorizada: infiltração difusa da gordura orbitária, descolamento da periórbita (abscesso subperiósteo) ou abscesso orbitário verdadeiro. A categoria I da classificação de celulite orbitária de Chandler (edema inflamatório) deve ser entendida como estágio de um processo que já está ocorrendo dentro da órbita. Nesse sentido, a expressão "celulite pré-septal" que designa infecção palpebral não deve ser usada para nomear a categoria I da classificação de Chandler.

Aislamientos de Aeromonas hydrophila en el Hospital Nacional de Niños 1995-1998 / Isolation of Aeromonas hydrophila in the Hospital Nacional de Niños 1995-1998

Se presenta una revisión de los aislamientos de la bacteria Aeromonas hydrophila en el Laboratorio del Hospital Nacional de Niños de Costa Rica, entre enero de 1995 y diciembre de 1998. En este periodo de 4 años se aislaron 48 cepas de A. hydrophila, 1 e A. sobria y 1 de a. veronii biovar sobria. El 4,8 por ciento de las cepas fueron aisladas de mordeduras de serpiente, infectadas. Se discute la susceptibilidad de la bacteria a los antimicrobianos y se señala la diferencia de reacción a ellos in vitro e in vivo. Se llama la atención sobre la posibilidad de infección intra hospitalaria por este agente. En este estudio esas infecciones se reportaron en el 11 por ciento de los 48 aislamientos

Inflamación aguda de la órbita. Celulitis orbitaria / Acute orbital inflammation. Orbital cellulitis

Se hace la revisión de 72 casos de celulitis orbitaria, estudiados en el Hospital "Luis Sánchez Bulnes" de la Asociación Para Evitar la Ceguera en México, en un período de 14 años, de 1982 a 1996, analizando la prevalancia, etipatogenia, curso del padecimiento, respuesta al tratamiento y complicaciones presentadas

Amaurosis unilateral irreversible secundaria a esfenoetmoiditis / Unilateral irreversible visual loos due to sphenoethmoiditis

La celulitis orbitaria secundaria a sinusitits paranasal se caracteriza por proptosis, alteraciones en la movilidad ocular, edema palpebral, quemosisi y/o hiperemia conjuntival previos a disminución o pérdida de la función visual. En caso de sinusitis posterior o esfenoetmoidal, la pérdida temprana y rápidamente progresiva de la función visual puede anteceder o acompañar a signología orbitaria inflamatoria leve, pudiendo ser dicha pérdida resultado de la combinación de edema intracanalicular o alteraciones vasculares del nervio óptico. Se describe el caso de una paciente pediátrica con diagnóstico de esfenoetmoiditis y pérdida unilateral permanente de la función visual a pesar del tratamiento médico y quirúrgico

Complicated sigmoid diverticulosis.

BACKGROUND: To evaluate the outcome of patients treated for complications of sigmoid diverticular disease. METHODS: Fifteen patients (11 women; aged 54-80 years) were treated over a 6-year period in a community hospital. Five patients presented with perforation and peritonitis, 3 with colovesical fistula, 2 with colovaginal fistula, 2 with recurrent phlegmon and 3 with bleeding. Six patients (5 with perforation, 1 colovesical fistula with hematuria) underwent emergency surgery. Six patients (2 with colovesical fistula, 2 colovaginal fistula and 2 recurrent phlegmon) underwent planned sigmoid resection. All 3 patients with bleeding were treated conservatively. RESULTS: One patient with a colovesical fistula and severe hematuria died 72 hours later with septicemia. All 5 patients with peritonitis survived; two had an eventful post-operative period and were in hospital for nearly 3 months. All 5 developed wound sepsis. Six patients who had a planned procedure had uneventful recovery. The 3 patients who presented with bleeding recovered. CONCLUSION: Complicated diverticular disease carries a high morbidity and mortality especially when operated on as an emergency. Interval sigmoid resection should be offered to patients who have recovered from an acute complication.

Síndrome de Wells o celulitis eosinofílica: su asociación con el sarcoptes scabiei var. hominis / Well's syndrome (eosinophilic cellulitis): it's association with sarcoptes scabiei var. hpminis

El síndrome de Wells o celulitis eosinofílica es una rara afección de naturaleza inflamatoria que se caracteriza por su polimorfismo clínico y su monomorfismo histopatológico en lo que se refiere a la presencia de depósitos de gránulos de eosinófilos. Frecuentemente se inicia con síntomas prodrómicos de quemazón o prurito y formación de placas eritematosas y edematosas semejante a una celulitis.Luego de varios días evolucionan presentando lesiones más pálidas, induradas y con aspecto de una morfea. Desaparecen luego de pocas semanas sin dejar secuelas. Otras manifestaciones son más raras, como pápulas, vesículas y ampollas. En la histología se observa en la fase de inicio un intenso edema de la dermis papilar con infiltración de toda la dermis reticular e hipodermis de eosinófilos e histiocitos, con participación de la epidermis según sean las manifestaciones clínicas: vesículas, ampollas. En el período de estado los gránulos de los eosinófilos se adhieren a las fibras de colágeno mostrando las características 'figuras en llama". Distintos factores etiológicos se han mencionado. Presentamos una paciente de 60 años de edad que consultó por nódulos eritematosos, firmes, irregularmente redondeados, entre 5 a 15 mm de diámetro, localizados en caras anterior y posterior del tronco, muy pruriginosos y de 3 meses de evolución. La histopatología confirmó el diagnóstico del síndrome de Wells. El laboratorio mostró en sangre periférica una eosinofilia, aumento de linfocitos T DR+, IL-8, TNFa, IgE y complejos inmunes circulantes positivos. Seis meses antes presentó clinicamente una sarna comprobada por el hallazgo de restos del sarcoptes scabiei. Fué tratada con medicación local con desaparición de los síntomas en 1 mes. Como mecanismos fisiopatológicos mencionamos la participación de la inmunidad humoral por la presencia de complejos inmunes circulantes, probablemente con antígenos del sarcoptes scabiei unidos a una IgE. Estos se depositarían en los tejidos desencadenando una serie de mecanismos patogénicos donde interviene la inmunidad celular linfocito T CD4+ Th2 con activación de determinadas citoquinas, como la IL-5, que al igual que el TNFa, son quimiotácticos para los eosinófilos con degranulación de la proteina básica mayor que se depositaría en los tejidos. Sería el primer caso en la bibliografía de un síndrome de Wells de etiología parasitaria por el Sarcoptes scabiei var. hominis

Infecciones de tejidos blandos / Soft tissue infections

Se revisan 20 casos de infecciones de tejidos blandos hospitalizados en el Servicio de Cirugía del Hospital San Juan de Dios (1990-1998). De estos, 10 correspondieron a fasceítis, 9 a celulitis y 1 caso de erisipela. La etiología fue predominantemente polimicrobiana en la fasceítis necrotizante (80 por ciento) y monomicrobiana en la celulitis (55 por ciento). La evolución clínica fue favorable en el 100 por ciento de los casos de erisipela y celulitis, los cuales requirieron solamente tratamiento antimicrobiano. Falleció el 20 por ciento de los pacientes con fasceítis necrotizante y otro debió ser sometido a amputación. El tratamiento de estos casos es fundamentalmente quirúrgico, asociado a terapia antimicrobiana