Cellulitis in childhood invasive pneumococcal disease: a population-based study.
OBJECTIVE
There are few detailed data on the age-specific incidence and clinical pattern of pneumococcal cellulitis in children. We conducted a retrospective review of cellulitis as a subset of prospectively collected laboratory-identified invasive pneumococcal disease (IPD) and performed a systematic review of published literature.


METHODS
Prospective laboratory surveillance in urban regions of New South Wales, Australia, 1 June 1997-31 December 2001. Medical notes reviewed for each identified case and defined literature search strategy applied.


RESULTS
There were 1067 cases of IPD in children aged 0-17 years; 38 (3.3%) were cellulitis (32 periorbital, 6 buccal). Compared with other types of IPD, a greater proportion of cellulitis cases occur in children<2 years (30/38, 79% vs. 617/1029, 60.0%; P=0.004) in whom underlying illness was less common (0/30, 0% vs. 53/590, 9%; P=0.06). Initially, another diagnosis was made in 13 (34%) of cases; only five had a lumbar puncture, all normal. Of the 239 cases of pneumococcal cellulitis documented in the literature, 28 (11.7%) had the diagnosis made by means other than positive blood culture and 95% were facial or orbital with underlying illness (6%) and associated meningitis (1.9%) uncommon.


CONCLUSIONS
Cellulitis is an uncommon focus in IPD in children, and is almost always facial. Most cases occur under 2 years of age, are seldom associated with meningitis or other complications, and are frequently not recognised on admission.
Gubbay
Jonathan B
JB
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney, Sydney, New South Wales, Australia.
McIntyre
Peter B
PB
Gilmour
Robin E
RE
D000293:Adolescent; D017677:Age Distribution; D002481:Cellulitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000150:complications* / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D017678:Sex Distribution; D014505:Urban Population