Orbital cellulitis causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Tarek Nafee, M.D. [3]
Split by bacterial causes, fungal causes and mycobacteria
Discuss thoroughly sinusitis and what bacteria is associated with that.(Strep, Staph, H. Influenza)
Mention less common causes in order of relavence - Bacteremia , Iatrogenic and their implicated most common pathogens.
Mention also possible for fungal infxn by mucormycosis in immunocompromised as the most severe ENT infxn in immunocompromised.
Overview
Common causes of orbital cellulitis are infections with either Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, or beta-hemolytic streptococci.
Causes
Orbital cellulitis occurs most commonly from bacterial infection. In some cases, mycobacteria or fungal organisms may also be implicated.[1][2][3][4] Difficulty arises in identifying a specific organism due to challenges in culturing the retroseptal orbital region. Blood cultures are typically positive in 4% of patients with orbital cellulitis with the highest reported rate of positive result of 31%. Mucosal swabs of nasal and preseptal mucosa show a slightly higher positive culture result of 51%; however, their accuracy is a topic of debate considering the normal flora in these tissues. The most likely source of a positive culture in confirmed orbital cellulitis patients is a surgical specimen from an abscess or nasal sinus aspirate. This procedure is not routinely performed on all patients with orbital cellulitis, thus this represents a subsection of the population.[5]
Cause by Pathogen
The most commonly reported pathogens, regardless of culturing method were "Staphylococcus aureus", "Streptococcus spp.", and "Haemophilus influenza". With the rise of microbial resistance in more recent years, Methicillian-Resistant Staphylococcus Aureus (MRSA) must be considered as a potential cause and correlated with geographic prevalence. MRSA has been cultured in as high as 73% of cases in a retrospective study of orbital cellulitis patients. Alternatively, with the dissemination of *Haemophilus influenza type b (Hib)* vaccine, the incidence of *Haemophilus spp.* caused orbital cellulitis has decreased significantly.[1][2]
It is important to note that, although rare, in immunocompromised patients we begin to see an increase in incidence of fungal and mycobacterial sources of infections. The most common fungal infections encountered in this population were Mucormycosis and Aspergilliosis. *Mycobacterium tuberculosis* has also been reported in immunocompromised patients in endemic regions.[2]
Cause by Etiology
Another effective way to categorize the causes of orbital cellulitis is according to the underlying etiology or source of infection. By far, the most common underlying condition is ethmoid sinusitis. It has been reported as the cause in 90-98% of orbital cellulitis cases. Other ways in which orbital cellulitis may occur is from infection in the blood stream and from an eyelid skin infection. Upper respiratory infection, sinusitis, trauma to the eye, ocular or periocular infection and systemic infection all increase one’s risk of orbital cellulitis. Staphylococcus aureus, Streptococcus pneumoniae and beta-hemolytic streptococci are three bacteria that can be responsible for orbital cellulitis.
Cause by Organ System
Causes in Alphabetical Order
References
- ↑ 1.0 1.1 Kamilov KhKh, Artemova EP (1990). "[Activation of immunity in patients with recurrent goiter]". Khirurgiia (Mosk) (6): 112–5. PMID 2214559.
- ↑ 2.0 2.1 2.2 Lam Choi VB, Yuen HK, Biswas J, Yanoff M (2011). "Update in pathological diagnosis of orbital infections and inflammations". Middle East Afr J Ophthalmol. 18 (4): 268–76. doi:10.4103/0974-9233.90127. PMC 3249811. PMID 22224014.
- ↑ Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis
- ↑ American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology
- ↑ Baring DE, Hilmi OJ (2011). "An evidence based review of periorbital cellulitis". Clin Otolaryngol. 36 (1): 57–64. doi:10.1111/j.1749-4486.2011.02258.x. PMID 21232022.