Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum.

OBJECTIVE: The authors sought to determine whether the microbiologic spectrum of preseptal and orbital cellulitis had changed over the past decade.

DESIGN: A retrospective chart review of all inpatient and outpatient children with an ICD-9 diagnosis of preseptal or orbital cellulitis seen at Vanderbilt University Medical Center since the introduction of the Haemophilus influenzae type-B (HiB) vaccine (1986-1996).

MAIN OUTCOME MEASURES: Blood and abscess cultures from children with preseptal and orbital cellulitis were tabulated.

RESULTS: During this period, 70 cases of preseptal cellulitis were seen. Blood cultures were obtained in 59 cases; only 6 were positive. Five cultures grew Streptococcus 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 Vanderbilt for 10 years. There were ten cases of orbital cellulitis, of which blood or abscess or both were cultured in eight. Six cases had positive cultures. Four cultures grew Streptococcus species. The other two grew H. influenzae and mixed H. influenzae/gram-positive cocci.

CONCLUSION: 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 cellulitis due to H. influenzae may still occur, but it is much less likely. A more conservative approach to the diagnosis and management of preseptal and orbital cellulitis may be warranted.