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Difference Between Cellulitis And Abscess Pdf

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Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Goldstein, Sherwood L.

V. Furuncles, Carbuncles, Cellulitis, and Localized Abscesses of the Peritoneal Cavity

The prevalence of orbital complications among children and adults with acute rhinosinusitis. Patients were classified into two groups according to their age. First involved children aged less than 16 and second included adults older than 16 years.

Clinical picture, sinus involved, management and outcome were compared. The total number of patients were Orbital complications were seen in 36 patients 5. Twenty six patients The most common orbital complication was preseptal cellulitis The commonest sinus involved was ethmoidal in children and mixed sinus pathology in adults. The majority of patients responded to medical treatment. Orbital complications of sinusitis are commoner in children than adults and have favorable prognosis.

Keywords: Sinusitis, cellulitis, preseptal, abscess. Os pacientes foram classificados em dois grupos, de acordo com sua idade.

Sinusitis is usually associated with concurrent rhinitis, rhinosinusitis is the preferred term for this condition 1 , 2.

It is often diagnosed clinically. Imaging may be needed when complications related to local spread of disease are suspected such as abscess formation or when patient fails to respond to medical treatment 3. Acute rhinosinusitis occurs commonly in children and adults being more common in children 4.

The prognosis is favorable without complications in the majority of cases 5. Orbital involvement is reported to occur more in children than in adults 7. Ethmoidal sinus is the most commonly reported sinus to be involved in children. This is attributed to close relation between orbit and ethmoidal sinus in children with thin line separating between them 8 , 9. In adults, the development of frontal sinus makes it a frequent cause of orbital involvement along with maxillary sinus Sphenoid sinus involvement is rare and may lead to optic nerve involvement There is controversy in literature regarding prognosis of orbital complications secondary to acute rhinosinusitis among children and adults and its response to treatment 5 , 6 , Some studies showed that there is no difference regarding prognosis between children and adults while other showed that the prognosis is worse in adults.

We could not find a study in our area investigating the prognosis of orbital cellulitis among children and adults with acute rhinosinusitis. The aim of this study is to investigate the frequency of orbital complications in children and adult patients with sinusitis. Presentation, management and outcome were evaluated. Patients attending ENT clinic diagnosed to have sinusitis during the period between January and January were enrolled in the study.

Patients were selected from those who visited the ENT directly without referral from emergency room or other clinic. Only cases of acute sinusitis secondary to infection were included.

The diagnosis was clinical in majority of cases. Acute rhinosinusitis was considered when patient complained of at least four weeks of purulent nasal drainage and obstruction associated with facial pain, pressure or fullness. CT scan was done when abscess was suspected or when patient failed to respond to medical treatment. Patients with orbital complications were referred to ophthalmology clinic.

Ocular examination included best corrected visual acuity, anterior and posterior segment examination and extraocular motility examination. First group involved children aged less than 16 years and second group included adults older than 16 years.

We chose the age of 16 years to separate between the two groups because patients younger than 16 years in our hospital are evaluated in pediatric clinics and those older than 16 are evaluated in adult clinics. Clinical picture, sinus involved, management and outcome were compared in two groups. Treatment protocol included topical and oral antibiotics for patients with periorbital cellulitis, broad spectrum intravenous antibiotics for patients with orbital cellulitis and abscess.

Medications for pain relief and nasal decongestants were used in all patients. Surgical drainage of abscess was considered when it failed to respond to medical treatment or if located posterior to the globe.

P -value was used to determine statistical significance between the frequency of orbital complication in children and adults and considered significant when less than 0.

An approval of the ethical committee was obtained before starting the study number of protocol A total number of patients were enrolled in the study. Twenty six patients were children The most common orbital complication was preseptal cellulitis seen in In children, 21 out of 26 patients The most common sinus involved was ethmoidal sinus in children and mixed sinus pathology in adults. In children, sinuses involved were ethmoidal followed by mixed sinus pathology.

Maxillary sinus was affected in four patients. In adults mixed sinus pathology was the most common four patients. Frontal and maxillary sinuses were affected in three patients each. We did encounter any case of sphenoid sinus involvement in children and adults. Ten patients were admitted and surgery was done for one patient Table 2. Acute infection the paranasal sinus is a rather frequent disease in children. On the contrary, the incidence of orbital complications secondary to sinusitis is low 2.

Orbital as well as intracranial complications of ethmoidal and maxillary sinusitis are most often encountered in childhood The majority of cases in childhood respond to medical treatment.

On the other hand, severe morbidity and mortality occur if these complications are not appropriately treated. Such morbidity and mortality tend to occur in adults 4. Sinusitis is a clinical diagnosis in most cases. Radiology is rarely needed. It may be indicated in cases of ophthalmoplegia, proptosis, decreased visual acuity, failure of conservative treatment and when intraorbital and intracranial extensions are suspected 4 , 14 , The investigation of choice is CT scan or MRI with the later being superior if cavernous sinus thrombosis is suspected.

Orbital complications include preseptal cellulitis, orbital cellulitis and abscess development. Preseptal cellulitis can be diagnosed clinically. It is an infection of the eyelid and surrounding skin anterior to the orbital septum that does not penetrate the periorbita. Orbital cellulitis occurs when infection spreads posterior to the orbital septum and can lead to abscess if not adequately treated. Radiological examination is required when orbital abscess is suspected Signs that indicate abscess formation include decrease in visual acuity, proptosis, ophthalmoplegia and pain associated with eye movement.

Sometimes, it may be difficult to distinguish between preseptal and orbital involvement based on clinical observations alone especially with bilateral involvement. Such patients should be scanned and treated aggressively 3 , 17 , In our study, the prevalence of orbital cellulitis was low 5. The majority of the cases were children Most of the cases in children were preseptal cellulitis 21 out of 26 patients. Five patients A total number of 10 patients were adults. These findings support that sinusitis related complications tend to occur in children but severe involvement are commoner in adults 4 , 7 , The distinction between preseptal, orbital cellulitis and abscess is important as it affects management strategy.

Preseptal cellulitis can be treated on outpatient basis with oral and topical antibiotics. Orbital cellulitis requires hospitalization and intravenous antibiotics and orbital abscess may require surgical drainage. The aim of surgery is to decompress the orbit, drain an abscess or open infected sinuses. Delay in treatment may result in vision threatening complications The severe morbidity and mortality may result from intracranial complications including meningitis, cavernous sinus thrombosis and cerebral abscess.

In our series, all patients showed complete recovery with treatment. All patients with preseptal cellulitis responded to local and oral treatment and none of them were hospitalized. Admission and intravenous antibiotics were required in 10 patients those who had orbital cellulitis or abscess. Surgery was done only for one patient who needed drainage of sub periosteal abscess. Orbital complications are not frequent in patients with sinusitis.

They are more common in children than adults. The prognosis is favorable; however, they can lead to devastating complications if not properly treated.

Brook I. Acute sinusitis in children. Pediatr Clin North Am. Acute sinusitis in children: a retrospective study of orbital complications. Braz J Otorhinolaryngol. Orbital complications of sinusitis in children. J Otolaryngol.


Patient information : See related handout on skin and soft tissue infections , written by the authors of this article. Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. Management is determined by the severity and location of the infection and by patient comorbidities. Infections can be classified as simple uncomplicated or complicated necrotizing or nonnecrotizing , or as suppurative or nonsuppurative. Most community-acquired infections are caused by methicillin-resistant Staphylococcus aureus and beta-hemolytic streptococcus.

Boils, Abscess & Cellulitis

The prevalence of orbital complications among children and adults with acute rhinosinusitis. Patients were classified into two groups according to their age. First involved children aged less than 16 and second included adults older than 16 years.

All of Healthily's articles undergo medical safety checks to verify that the information is medically safe. View more details in our editorial policy. The main symptom of cellulitis is the affected area of skin suddenly turning red, painful swollen and hot. Cellulitis can have a wide range of causes, but the majority of cases are caused by a type of bacteria called group A streptococcus, or a different type of bacteria called staphylococcus aureus. This makes a person more vulnerable to cellulitis.

The most common SSTI presentations are abscesses and cellulitis. We reported the lifetime prevalence of SSTI, severity of infections, key risk factors, and associated sequelae. Pictorial questions were used to assess SSTI severity.

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The Pediatric Upper Extremity pp Cite as. Cellulitis and necrotizing fasciitis are soft tissue infections with similarities in their presentation; however they have a very different clinical course. Cellulitis is a superficial skin infection which may result from a cut, bite, or skin puncture or may be associated with a subcutaneous abscess or carbuncle. In contrast, necrotizing fasciitis is a potentially lethal infection of the subcutaneous tissue that, like cellulitis, can present with erythematous skin, swelling, fever, and pain. These earlier signs can be followed by bullae formation, skin sloughing, and tissue necrosis, as necrotizing fasciitis progresses.

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This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. In all of the complex relationships that have to do with infection that have been discussed here this morning, namely, the relative relationship between infecting organism and host resistance and the efficacy and resistance to various antibiotics, there are other factors which have to do with the nature of the lesion itself.

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