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]
Overview
Orbital cellulitis occurs most commonly from typical bacterial infections. In some cases, mycobacteria or fungal organisms may also be implicated. By far, the most common underlying condition is ethmoid sinusitis. It has been reported as the cause in 90-98% of orbital cellulitis cases. Thus, the most commonly reported pathogens 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.Though some causes may be uncommon; orbital cellulitis is a medical emergency. Thus, it is pertinent to consider all possible etiologies and the most common pathogens according to the clinical scenario.[1][2][3][4][5][6]
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.[7]
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 has also been reported that in patients above the age of 15-16, cultures are more likely to grow a mixed, polymicrobial flora with both aerobic and anaerobic bacteria.[3]
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.[1][5][6]
Though some causes of orbital cellulitis may be uncommon, it is pertinent to consider all possible etiologies and associated conditions' most common pathogens according to the clinical scenario:[2][7]
- Sinusitis: Staphylococcus aureus, Streptococcus spp., H. influenza
- Dacryocystitis, dacryoadenitis, and other lacrimal duct abnormalities: Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenza
- Traumatic/Foreign body: Staphyloccus aureus, Streptococcus epidermidis, Enterococcus spp., Escherichia coli, Eikenella spp.
- Spread from superficial infections of the face or adjacent soft tissue: Staphylococcus aureus, Streptococcus pyogenes
- Dental caries/abscess: Bacteroides spp. anaerobes, and gram negative rods
- Iatrogenic/post-surgical procedures: Staphylococcus aureus, Streptococcus spp.
- Immunocompromised patient: Mucormycosis, Aspergilliosis, M.Tuberculosis
- Diabetic patients with or without history of diabetic ketoacidosis: Pseudomonas aeruginosa, Klebsiella pneumoniae
Cause by Organ System
Causes in Alphabetical Order
References
- ↑ 1.0 1.1 1.2 1.3 Hasanee K, Sharma S (2004). "Ophthaproblem. Orbital cellulitis". Can Fam Physician. 50: 359, 365, 367. PMC 2214559. PMID 15318671.
- ↑ 2.0 2.1 2.2 2.3 2.4 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.
- ↑ 3.0 3.1 3.2 Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis
- ↑ 4.0 4.1 American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology
- ↑ 5.0 5.1 Nageswaran S, Woods CR, Benjamin DK, Givner LB, Shetty AK (2006). "Orbital cellulitis in children". Pediatr Infect Dis J. 25 (8): 695–9. doi:10.1097/01.inf.0000227820.36036.f1. PMID 16874168.
- ↑ 6.0 6.1 Chaudhry IA, Al-Rashed W, Arat YO (2012). "The hot orbit: orbital cellulitis". Middle East Afr J Ophthalmol. 19 (1): 34–42. doi:10.4103/0974-9233.92114. PMC 3277022. PMID 22346113.
- ↑ 7.0 7.1 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.