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ORBITAL AND PERIORBITAL CELLULITIS IN CHILDHOOD: EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS

Z.Yehoshua, E.Aloni, A.Pollack, H.Leiba. ORBITAL AND PERIORBITAL CELLULITIS IN CHILDHOOD: EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS. Dept. of Opthalmology , Kaplan Medical Center, Rehovot. Purpose. To describe the epidemiological and clinical features of orbital cellulitis (OC) and

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ORBITAL AND PERIORBITAL CELLULITIS IN CHILDHOOD: EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS

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  1. Z.Yehoshua, E.Aloni, A.Pollack, H.Leiba ORBITAL AND PERIORBITAL CELLULITIS IN CHILDHOOD: EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS Dept. of Opthalmology , Kaplan Medical Center, Rehovot

  2. Purpose To describe the epidemiological and clinical features of orbital cellulitis (OC) and periorbital cellulitis (POC) in our district

  3. Subject & Methods • Retrospective study • Records of children admitted to Kaplan Medical Center with Dx OC/POC* 08/1998 – 09/2002 * OC=orbital cellulitis POC=periorbital cellulitis

  4. Subject & Methods Dx of POC and OC was made according to Chandler criteria : Stage I Inflammatory edema-Preseptal Stage II Orbital cellulitis -Postseptal Stage III Subperiosteal abscess Stage IV Orbital abscess Stage V Cavernous sinus thrombosis

  5. Collected data : Age Sex Origin Clinical signs Symptoms Laboratory work-up Xray and CT Cultured pathogens Immunization status Preadmission treatment Inpatient management Length of hospitalization Recurrence Subject & Methods

  6. Results • 147 children : POC - 144 ( 98% ) OC - 3 ( 2% ) • Orbital cellulitis : subperiosteal abscess - 2 orbital cellulitis - 1 OC=orbital cellulitis POC=periorbital cellulitis

  7. Results

  8. Results Etiology:

  9. Results Blood cultures • Positive (all POC) 4/34 Strep. species :-strep. pneumonia -strep. Gr A -strep. viridans Staph. Aureus • No case of Hemophilus influenza

  10. Results Immunization status: • Up to date immunization – 85% • Missed last scheduled vaccination – 6% • No data – 8%

  11. Results Prevalence of POC per month

  12. Results Treatment: • Preadmission – 32% (PO) • On admission – 100% (IV) Augmentin single/comb. - 74% • IV antibiotic failure : subperiosteal abscess - 2 pts. orbital cellulitis - 1 pt. surgical drainage

  13. Results Recurrence of POC –9 pts. Dacrocystitis - 4 pts. Sinusitis - 2 pts. Insect bite -2 pts. Unknown -1 pts.

  14. Discussion • The introduction of the HiB vaccine caused a sharp decline in: - The number of POC & OC cases per year - The rate of culture positive isolates - The Hemophilus related POC & OC • In our study – no case of Hemop. influenza

  15. Discussion • Strep. species are becoming the predominant pathogen • POC is much more common than OC • Sinusitis is an important underlying factor in almost all cases of OC

  16. Summary • POC - skin trauma, dacrocystitis, sinusitis, insect bite • OC – sinusitis • Pathogen- strep/staph , no H. influenza • The majority of the periorbital cases occurred during the winter months

  17. Thank you!

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