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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 22, Issue 3, Pages 97-100
http://dx.doi.org/10.1155/2011/626809
Review

Presentation and Management of Pediatric Orbital Cellulitis

Sergio Fanella,1,2 Alex Singer,3 and Joanne Embree1,2

1Section of Infectious Disease, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
2Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
3Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Copyright © 2011 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Orbital cellulitis is a serious, vision-threatening infection.

OBJECTIVE: To review the epidemiology and clinical data of pediatric orbital cellulitis in Manitoba.

METHODS: A 12-year retrospective review was conducted of all children (younger than 18 years of age) with orbital cellulitis admitted to Manitoba’s only tertiary pediatric centre. Admission rates for orbital cellulitis were compared over three distinct time periods, based on licensure and funding levels of the heptavalent pneumococcal conjugate vaccine (PCV7) in Manitoba.

RESULTS: Thirty-eight patients with orbital cellulitis were identified. Of these, 11% were of Aboriginal ethnicity in contrast with 30% to 40% of children who were admitted for other respiratory illnesses. Subperiosteal abscesses occurred in 31.5%. Only eight patients (21%) required surgery. Follow-up imaging after presentation usually did not indicate a need for subsequent surgical drainage. The mean number of orbital cellulitis cases per 1000 admissions for the following periods – before PCV7 licensure, after licensure and before full provincial funding, and after licensure and full funding – were 0.39, 0.53 and 0.90, respectively. No significant difference was noted among any of the periods as PCV7 coverage increased.

CONCLUSIONS: The rate of subperiosteal abscesses was lower than other reports. This may be due to the median age at presentation. In contrast to admissions for most other respiratory infections at the Winnipeg Children’s Hospital (Winnipeg, Manitoba), Aboriginal ethnicity was uncommon. Surprisingly, rates of admissions for orbital cellulitis appeared to show an increasing trend with increasing access to PCV7 in Manitoba, although overall the number of cases was very small. Studies into the changing microbiology of orbital cellulitis and sinusitis are warranted.