Evaluation of Pediatric Patients with Orbital and Preseptal Cellulitis

Year 2015, Volume: 40 Issue: 2, 267 - 274, 28.09.2015

Eren Çağan , Ahmet Soysal Mustafa Bakır

https://doi.org/10.17826/cutf.04587

Abstract

Purpose: Cellulitis in the orbital region is a relatively frequently observed ocular disease. Differential diagnosis of preseptal and orbital cellulitis is clinically possible. However physical examination may be insufficient for some differential diagnoses. The majority of pediatric patients with orbital and preseptal cellulitis present with complications of sinusitis. If left untreated it may cause vision loss and life-threatening intracranial complications. In this study we investigated the clinical findings, efficacy of treatment and complications of patients with orbital and preseptal cellulitis. Material and Methods: The files of all 28 in-patients with orbital and preseptal cellulitis who applied to our third stage pediatric clinic in the two years between January 2011 and January 2013 were retrospectively investigated. The demographic data, clinical presentation, predisposing factors, treatments and complications were analyzed. Results: Seven orbital cellulitis and 21 preseptal cellulitis patients fulfilling diagnostic criteria were included in the study. Twenty-five patients were treated with intravenous ampicillin-sulbactam and/or seftriakson. The most important predisposing factor in both patient groups was sinusitis while other predisposing factors were tooth abscess, conjunctivitis, chicken pox and leukemia. In five of every seven patients (71.4%) with orbital cellulitis, sinusitis is diagnosed. These five patients have ethmoidal sinusitis. Of every 21 patients with preseptal cellulitis, five (23.8%) have sinusitis. Of these five patients three have ethmoidal sinusitis. In the preseptal cellulitis group the median hospital stay was five days (3-21) while in the orbital cellulitis group the median stay was 21 days (8-35). In the preseptal cellulitis group while the median CRP was 15 mg/dL (1-141), median leukocyte count was 10600 u/L (800-23400) and median neutrophil count was 10100 u/L (200-21400), in the orbital cellulitis group the median CRP was 20 mg/dL (1-91), median leukocyte count was 14042±5498 u/L and median neutrophil count was 10571±2818 u/L. There was no statistically significant difference between the groups (p>0.05). The positivity in both swab cultures and blood cultures was at a very low level. All patients were discharged with full recovery. No patient required primary orbital surgical intervention. Conclusion: Preseptal cellulitis is more frequently observed than orbital cellulitis. The most important predisposing factor for orbital cellulitis is sinusitis. Patients with preseptal cellulitis suspected clinically may be diagnosed

Keywords

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Pediatrik Orbital ve Periorbital Selülitli Hastaların Değerlendirilmesi

Abstract

Amaç: Orbital bölgenin selüliti rölatif olarak sık görülen bir oküler hastalıktır. Preseptal ve orbital selülit klinik olarak ayırcı tanısı yapılabilir. Ancak bazen ayırıcı tanı için fizik muayene yeterli olmayabilir. Orbital ve preseptal selülit çocuk hastalarda çoğunlukla sinüzit komplikasyonu olarak ortaya çıkar. Tedavi edilmediği takdirde görme kaybı ve hayatı Araştırma Makalesi / Research Article 267 Çağan ve ark. Cukurova Medical Journal tehdit eden intrakraniyal komplikasyonlara yol açabilir. Biz bu çalışmada orbital ve preseptal selüliti olan hastaları klinik bulgularını, tedavi etkinliklerini ve komplikasyonlarını inceledik. Materyal ve Metod: Ocak 2011- Ocak 2013 tarihleri arasında iki yıl içinde üçüncü basamak çocuk kliniğine başvuran tüm orbital ve preseptal selüliti olan ve yatırılarak izlenen 28 hastanın dosyaları retrospektif olarak incelendi. Hastaların demografik verileri, klinik prezentasyonları, predispozan faktörleri, tedavileri, ve komplikasyonları açısından analiz edildi. Bulgular: Tanı kriterlerini dolduran yedi orbital selülitli, 21 hasta preseptal selülitli hasta çalışmaya alındı. Yirmi beş hasta intravenöz ampisilin-sulbaktam ve/veya seftriakson ile tedavi edildi. En önemli en önemli predispozan faktör her iki hasta grubunda da sinüzit iken diğer predispozan faktörler diş apsesi, konjiktivit, suçiçeği ve lösemiydi. Orbital selüliti olan yedi hastanın beşinde (%71.4) sinüzit tespit edildi. Sinüziti olan bu beş hastada da etmoidal sinüzit vardı. Preseptal selülitli 21 hastanın beşinde (%23.8) sinüzit saptandı ve bu beş hastanın üçünde ethmoidal sinüzit olduğu tespit edildi. Preseptal selülit grubunda hastanede kalış süresi ortanca beş gün (3-21) iken orbital selülit grubunda ortanca 21 gün (8- 35) idi. Preseptal selülit grubunda CRP ortanca 15 mg/dL (1-141), lökosit sayısı ortanca 10600 u/L (800-23400) ve nötrofil sayısı ortanca 10100 u/L (200-21400) iken orbital selülit grubunda ise CRP ortanca 20 mg/dL (1-91), ortalama lökosit sayısı 14042±5498 u/L, ortalama nötrofil sayısı 10571±2818 u/L olarak bulundu. Gruplar arasında istatistiksel olarak anlamlı fark yoktu (p>0.05). Hem sürüntü kültürlerinde hemde kan kültür pozitifliği oldukça düşük düzeydeydi. Tüm hastalar tam klinik düzelme ile taburcu edildi. Hiçbir hastaya primer orbita cerrahi müdahale gerekmedi. Sonuç: Preseptal selülit orbital selülitlerden daha sık görülmektedir. Orbital selülitte en önemli predispozan faktör sinüzittir. Klinik olarak preseptal selülit düşündüren hastalarda radyolojik olarak orbital selülit tespit edilebilir. Bu nedenle preseptal selülitli hastalarda da radyolojik görüntüleme yapılması düşünülmelidir.

Keywords

Flukonazol, Antifungal, Candida, Çocuk

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