Streptococcal preseptal cellulitis complicated by the toxic Streptococcus syndrome

Preseptal cellulitis with Streptococcus pyogenes complicated by streptococcal toxic shock syndrome: A case report and review of literature

Preseptal cellulitis, an infection of the eyelid and skin around the eye, can be distinguished from orbital cellulitis. It is common in children and is rarely complicated. Streptococcus pyogenes is one of the major pathogens causing preseptal cellulitis. Here, we report a case of a 46-year-old man with carcinoma of unknown primary presenting preseptal cellulitis of S. pyogenes complicated by streptococcal toxic shock syndrome and multiple metastatic abscesses involving right eyelid, subcutaneous tissue in the scalp, mediastinum, bilateral pleural spaces, pericardial space, and the left knee. Although he required a prolonged hospitalization, antibiotic therapy and multiple courses of debridement led to full recovery. A literature review revealed that there were only four cases of preseptal cellulitis with S. pyogenes in adults and two cases were complicated by streptococcal toxic shock syndrome. The cases had either trauma or immunocompromising factors similar to our patient. All patients survived with antibiotic therapy and debridement, and the functional outcome was favorable. In summary, preseptal cellulitis caused by S. pyogenes can be severe in adult cases where immunocompromising factors and type of strain may play a role in the severity of the disease. Awareness of the risk of severe complications, treatment with appropriate antibiotic therapy, and timely debridement are crucial for favorable prognoses.

Periorbital necrotizing fasciitis -- a review

Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft-tissue defects affecting function and cosmesis.

The hot orbit: orbital cellulitis

Orbital cellulitis is an uncommon condition previously associated with severe complications. If untreated, orbital cellulitis can be potentially sight and life threatening. It can affect both adults and children but has a greater tendency to occur in the pediatric age group. The infection most commonly originates from sinuses, eyelids or face, retained foreign bodies, or distant soources by hematogenous spread. It is characterized by eyelid edema, erythema, chemosis, proptosis, blurred vision, fever, headache, and double vision. A history of upper respiratory tract infection prior to the onset is very common especially in children. In the era prior to antibiotics, vision loss from orbital cellulitis was a dreaded complication. Currently, imaging studies for detection of orbital abcess, the use of antibiotics and early drainage have mitigated visual morbidity significantly. The purpose of this review is to describe current investigative strategies and management options in the treatment of orbital cellulitis, establish their effectiveness and possible complications due to late intervention.

Rozległy ropień przedprzegrodowy jako późne powikłanie pourazowe oczodołowe – przegląd piśmiennictwa i opis przypadku

Preseptal orbital cellulitis and orbital abscess are rare post-traumatic late orbital complications. Authors reported a case of anterior orbital abscess following craniofacial trauma in a 47-year-old men. Diagnostic procedures, therapeutic intervention were presented and literature reviewed.

Fulminant orbital cellulitis with complete loss of vision

Bacterial orbital cellulitis is a condition that rarely presents with complete loss of vision. A case is reported of a 69-year-old man who presented with fulminant onset of proptosis, significant ophthalmoplegia and no perception of light. Computed tomography showed no evidence of paranasal sinus disease. Despite treatment with intravenous flucloxacillin, ceftriaxone and metronidazole, and later, penicillin after Streptococcus pyogenes was grown from tissue culture, there was no improvement in vision; however ocular motility returned to normal.

Toxic shock syndrome: case report of a postpartum female and a literature review

Toxic shock syndrome is one of the best understood of the systemic inflammatory response syndromes. The mechanisms of disease have been extensively studied; however, no therapies have been developed that can effectively reverse the syndrome once the inflammatory response has begun. Although toxic shock syndrome classically has been associated with tampon use, multiple other etiologies exist including postpartum toxic shock, which usually affects patients in the immediate weeks following delivery. We present a case of toxic shock in a woman 10 weeks postpartum and review the literature regarding both menstrual-related and nonmenstrual-related toxic shock.

Periocular necrotizing fasciitis: a review of five cases

OBJECTIVE

The purpose of the study is to display a spectrum of clinical presentations of periocular necrotizing fasciitis caused by group A streptococci and to discuss recent trends and treatment of this disease.

DESIGN AND INTERVENTION

A case series of five patients (four female and one male) was seen between July 1990 and January 1995 in four university centers. All had clinical evidence of periocular necrotizing fasciitis and grew group A streptococci on wound cultures or had serologic evidence of streptococcal infection. Details of patient presentation, treatment, and outcome are examined.

RESULTS

The five patients showed a spectrum of clinical severity from a necrotizing infection confined to the eyelid to a potentially fatal, severe shock-like syndrome characterized by sepsis and multiorgan system failure. A history of trauma often was absent. Patients were treated successfully by a combination of appropriate antibiotics and surgical debridement.

CONCLUSIONS

Group A streptococci can cause severe necrotizing infections of the eyelids. Early recognition and prompt treatment can be essential to these patients' survival.

Streptococcal toxic shock syndrome complicating preseptal cellulitis

PURPOSE

Although substantial morbidity is uncommon in preseptal cellulitis, the incidence of severe infection resulting from group A streptococcal infection is increasing.

METHODS

A 62-year-old man was initially examined for preseptal cellulitis sustained after minor trauma to his brow. The patient rapidly experienced shock and multisystem organ failure. Intensive medical therapy prevented circulatory collapse and death.

RESULTS

A diagnosis of streptococcal toxic shock syndrome secondary to group A beta hemolytic streptococcal infection was made based on culture results and clinical course.

CONCLUSIONS

The ophthalmologist plays an essential role in diagnosing this condition. Aggressive and timely treatment are essential to preventing death.