title: Pneumococcal facial cellulitis in children.
abstract: OBJECTIVE
  To review the epidemiology and clinical course of facial cellulitis attributable to Streptococcus pneumoniae in children.
  
  
  METHODS
  Cases were reviewed retrospectively at 8 children's hospitals in the United States for the period of September 1993 through December 1998.
  
  
  RESULTS
  We identified 52 cases of pneumococcal facial cellulitis (45 periorbital and 7 buccal). Ninety-two percent of patients were <36 months old. Most were previously healthy; among the 6 with underlying disease were the only 2 patients with bilateral facial cellulitis. Fever (temperature: >/=100.5 degrees F) and leukocytosis (white blood cell count: >15 000/mm(3)) were noted at presentation in 78% and 82%, respectively. Two of 15 patients who underwent lumbar puncture had cerebrospinal fluid with mild pleocytosis, which was culture-negative. All patients had blood cultures positive for S pneumoniae. Serotypes 14 and 6B accounted for 53% and 27% of isolates, respectively. Overall, 16% and 4% were nonsusceptible to penicillin and ceftriaxone, respectively. Such isolates did not seem to cause disease that was either more severe or more refractory to therapy than that attributable to penicillin-susceptible isolates. Overall, the patients did well; one third were treated as outpatients.
  
  
  CONCLUSIONS
  Pneumococcal facial cellulitis occurs primarily in young children (<36 months of age) who are at risk for pneumococcal bacteremia. They present with fever and leukocytosis. Response to therapy is generally good in those with disease attributable to penicillin-susceptible or -nonsusceptible S pneumoniae. Ninety-six percent of the serotypes causing facial cellulitis in this series are included in the heptavalent-conjugated pneumococcal vaccine recently licensed in the United States.
authors.affiliation: Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27157, USA. lgivner@wfubmc.edu
authors.forename: L B
authors.initials: LB
authors.lastname: Givner
authors.forename: E O
authors.initials: EO
authors.lastname: Mason
authors.forename: W J
authors.initials: WJ
authors.lastname: Barson
authors.forename: T Q
authors.initials: TQ
authors.lastname: Tan
authors.forename: E R
authors.initials: ER
authors.lastname: Wald
authors.forename: G E
authors.initials: GE
authors.lastname: Schutze
authors.forename: K S
authors.initials: KS
authors.lastname: Kim
authors.forename: J S
authors.initials: JS
authors.lastname: Bradley
authors.forename: R
authors.initials: R
authors.lastname: Yogev
authors.forename: S L
authors.initials: SL
authors.lastname: Kaplan
mesh_terms: D002481:Cellulitis / Q000175:diagnosis* / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000166:cytology; D005148:Facial Dermatoses / Q000175:diagnosis* / Q000382:microbiology; D005334:Fever / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007964:Leukocytosis / Q000175:diagnosis; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D012189:Retrospective Studies; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification