Intracranial infection associated with preseptal and orbital cellulitis in the pediatric patient.
OBJECTIVE
To identify risk factors in children admitted with preseptal or orbital cellulitis with associated intracranial infection.


METHODS
A retrospective chart review identified 10 patients (< or = 18 years) with a diagnosis of preseptal or orbital cellulitis and a concurrent or subsequent diagnosis of intracranial infection.


RESULTS
Diagnoses confirmed by imaging included sinusitis (n = 10), preseptal cellulitis (n = 4), orbital cellulitis (n = 6), orbital subperiosteal abscess (n = 5), Pott's puffy tumor (n = 4), epidural empyema (n = 2), epidural abscess (n = 6), and brain abscess (n = 2). The timing of diagnosis of intracranial infection ranged from hospital day 1 to 21. All but 1 patient had positive microbial cultures. Seven of 10 patients had positive microbial cultures from two or more sites, 70% of which were polymicrobial; Streptococcus species and Staphylococcus species were the most commonly isolated bacterial pathogens. All patients required both medical and surgical therapy; all 10 patients underwent sinus surgery; 8 patients required neurosurgical craniotomy; and 5 patients underwent orbital surgery. There were no deaths.


CONCLUSIONS
Intracranial involvement should be suspected in any patient age > or = 7 years with preseptal or orbital cellulitis associated with orbital subperiosteal abscess, Pott's puffy tumor, concurrent sinusitis, complaints of headache, and continuing fever despite intravenous antibiotics. Given the high incidence of polymicrobial infection found on cultures in this series, broad-spectrum antibiotics are strongly indicated. When imaging the orbits and sinuses in such patients, we recommend including the brain to rule out intracranial involvement.
Reynolds
Dorothy J
DJ
Department of Ophthalmology, North Shore--Long Island Jewish Health System, Great Neck, NY, USA.
Kodsi
Sylvia R
SR
Rubin
Steven E
SE
Rodgers
I Rand
IR
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000150:complications* / Q000175:diagnosis; D020806:Central Nervous System Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002648:Child; D015169:Colony Count, Microbial; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D009916:Orbital Diseases / Q000150:complications* / Q000175:diagnosis; D010521:Periosteum; D012189:Retrospective Studies; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents