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

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental Dental infection, tooth abscess
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat Ethmoid sinusitis, otitis media, sinusitis
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Peribulbar anesthesia, surgical trauma
Infectious Disease Aeromonas hydrophila, anaerobes, arcanobacterium, aspergillosis, aspergillus, bacterial rhinosinusitis, bacteroides, beta-hemolytic streptococci, dacryocystitis, dental infection, eikenella corrodens, enterococcus, ethmoid sinusitis, haemophilus influenzae, haemophilus parainfluenzae, infected mucocele, klebsiella pneumoniae, moraxella catarrhalis, MRSA, MSSA, mucor, mucorales, mucormycosis, mycobacterium tuberculosis, neisseria gonorrhea, osteomyelitis of the orbital bones, otitis media, peptostreptococcus, pseudomonas aeruginosa, rothia mucilaginosa, sinusitis, staphylococcus aureus, streptococcus anginosus, streptococcus milleri, streptococcus pneumoniae, streptococcus pyogenes, streptococcus, tooth abscess, varicella
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic Blepharoplasty, dacryocystitis, dacryocystorhinostomy, eyelid surgery, ophthalmic surgery, orbital decompression, orbital fracture, osteomyelitis of the orbital bones, radial keratotomy, retinal surgery, strabismus surgery
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Mycobacterium tuberculosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma Orbital fracture, trauma
Urologic No underlying causes
Miscellaneous Foreign body, phlebitis of the facial veins


Causes in Alphabetical Order

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References

  1. 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. 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.
  3. Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis
  4. American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology
  5. 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.

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