Periorbital cellulitis. Clinical and laboratory findings in 146 episodes, including tear countercurrent immunoelectrophoresis in 89 episodes
K. R. Powell, S. B. Kaplan, C. B. Hall, M. A. Nasello Jr and K. J. Roghmann
Department of Pediatrics, University of Rochester (NY) School of Medicine and Dentistry.
Medical records of 144 children hospitalized for 146 episodes of
periorbital cellulitis were reviewed. During 44 episodes, systemically
administered antibiotics were given before hospitalization. Bacterial
pathogens were isolated in only two (5%) of 44 episodes in pretreated
patients compared with 33 (32%) of 102 episodes in patients who were not
pretreated. Thirty-one children who were not pretreated were bacteremic.
Compared with nonbacteremic children who were not pretreated, bacteremic
children were younger, more often had a history of upper respiratory tract
infection and fever, had a higher white blood cell count and temperature at
admission, and more often had a violaceous cellulitis. No difference
between groups existed in the frequency of a history of trauma or a local
lesion near the affected eye. Tear specimens from 13 of 89 children tested
by countercurrent immunoelectrophoresis (CIE) to detect Haemophilus
influenzae type b capsular polysaccharide were positive. Compared with
positive blood culture results, tear CIE has a sensitivity of 50% and a
specificity of 93%. Streptococcus pneumoniae infections were not detected
by CIE.
