Methicillin-resistant ascending facial and orbital cellulitis in an operation Iraqi Freedom troop population.
OBJECTIVE
To present a descriptive case series of methicillin-resistant ascending facial and orbital cellulitis in an Operation Iraqi Freedom troop population.


METHODS
A physician's transfer records of patients cared for and or transferred from the 31st and 86th Combat Support Hospitals during Operation Iraqi Freedom between September 2004 and March 2005 were reviewed. Cases of facial and orbital cellulitis caused by a nasal mucosal source were included in the case series.


RESULTS
Five cases of ascending facial and/or orbital cellulitis caused by an aggressive nasal source are reported. All nasal microabscess cultures demonstrated methicillin-resistant Staphylococcus aureus species. None of the patients complained of nasal pain as the chief complaint, and all patients overlooked the follicular abscess at or inside the nares.


CONCLUSIONS
Occult nasal infections with methicillin-resistant Staphylococcus aureus can be the source of an aggressive ascending facial and orbital cellulitis. The nasal source can be overlooked because of the distracting presentation of the orbital and systemic findings. With the increasing prevalence of community-acquired methicillin-resistant Staphylococcus aureus infections, a nasal examination and nasal culture can greatly assist in the diagnosis and management of patients presenting with orbital cellulitis without a clear source of infection.
Boden
John H
JH
Department of Ophthalmology, Madigan Army Medical Center, Tacoma, Washington, USA. john.boden@amedd.army.mil
Ainbinder
Darryl J
DJ
D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D005148:Facial Dermatoses / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007493:Iraq; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008889:Military Personnel; D015242:Ofloxacin / Q000627:therapeutic use; D054517:Orbital Cellulitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013407:Sulbactam / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014640:Vancomycin / Q000627:therapeutic use; D014857:Warfare
D002981:Clindamycin; C035444:sultamicillin; D014640:Vancomycin; D000667:Ampicillin; D015242:Ofloxacin; D013407:Sulbactam