PRESEPTAL AND ORBITAL CELLULITIS IN CHILDHOOD - A CHANGING MICROBIOLOGIC SPECTRUM

Objective: The authors sought to determine whether the microbiologic s pectrum of preseptal and orbital cellulitis had changed over the past decade. Design: A retrospective chart review of all inpatient and outp atient children with an ICD-9 diagnosis of preseptal or orbital cellul itis seen at Vanderbilt University Medical Center since the introducti on of the Haemophilus influenzae type-B (HiB) vaccine (1986-1996). Mai n Outcome Measures: Blood and abscess cultures from children with pres eptal and orbital cellulitis were tabulated. Results: During this peri od, 70 cases of preseptal cellulitis were seen. Blood cultures were ob tained in 59 cases; only 6 were positive. Five cultures grew Streptoco ccus species. The one positive H. influenzae culture occurred in 1987 in a child who did not receive the HiB vaccine, There have been no new patients with preseptal cellulitis and H. influenzae bacteremia at Va nderbilt for 10 years. There were ten cases of orbital cellulitis, of which blood or abscess or both were cultured in eight. Six cases had p ositive cultures. Four cultures grew Streptococcus species. The other two grew H. influenzae and mixed H. influenzae/grampositive cocci. Con clusion: The incidence of hemophilus-associated bacteremia in patients with preseptal cellulitis has decreased dramatically over the past 10 years. Streptococcus species now are the predominant cause, Orbital c ellulitis due to H. influenzae may still occur, but it is much less li kely. A more conservative approach to the diagnosis and management of preseptal and orbital cellulitis may be warranted.