Pneumococcal facial cellulitis in children

Objective. To review the epidemiology and clinical course of facial celluli tis attributable to Streptococcus pneumoniae in children. Design. Cases were reviewed retrospectively at 8 children's hospitals in th e United States for the period of September 1993 through December 1998. Results. We identified 52 cases of pneumococcal facial cellulitis (45 perio rbital and 7 buccal). Ninety-two percent of patients were <36 months old. M ost were previously healthy; among the 6 with underlying disease were the o nly 2 patients with bilateral facial cellulitis. Fever (temperature: <great er than or equal to>100.5 degreesF) and leukocytosis (white blood cell coun t: >15 000/mm(3)) were noted at presentation in 78% and 82%, respectively. Two of 15 patients who underwent lumbar puncture had cerebrospinal fluid wi th mild pleocytosis, which was culture-negative. All patients had blood cul tures positive for S pneumoniae. Serotypes 14 and 6B accounted for 53% and 27% of isolates, respectively. Overall, 16% and 4% were nonsusceptible to p enicillin and ceftriaxone, respectively. Such isolates did not seem to caus e disease that was either more severe or more refractory to therapy than th at attributable to penicillin-susceptible isolates. Overall, the patients d id well; one third were treated as outpatients. Conclusions. Pneumococcal facial cellulitis occurs primarily in young child ren (<36 months of age) who are at risk for pneumococcal bacteremia. They p resent with fever and leukocytosis. Response to therapy is generally good i n those with disease attributable to penicillin-susceptible or -nonsuscepti ble S pneumoniae. Ninety-six percent of the serotypes causing facial cellul itis in this series are included in the heptavalent-conjugated pneumococcal vaccine recently licensed in the United States.