Cellulitis

<bold>FIGURE 64-1</bold> <bold>Cellulitis of the toe.</bold> The infection began adjacent to the nail as a paronychia but spread proximally to involve the shaft of the toe as cellulitis.

FIG. 11.34. Orbital cellulitis. This young girl has erythema and edema in the periorbital area (A), which could be caused by either orbital or periorbital infection. However, she has limitation of the extraocular muscles, which characterizes orbital cellulitis, as shown when she is staring straight ahead (B) and gazing upward (C). D: A computed tomography scan of the orbits demonstrates a mass lesion along the medial wall of the orbit in a child with ethmoid sinusitis and orbital infection....

FIG. 11.36. Cellulitis of the knee. Cellulitis in this patient developed at the site of a minor wound (A). The child was presented with fever and lymphangitic streaking (B).

FIG. 11.38. Cellulitis of the hand. When this patient arrived at the emergency department, he had developed cellulitis, or wound infection, of the hand after the repair of a laceration that was secondary to a dog bite. In many cases, bite wounds of the extremities are not managed with primary closure because of the risk of infection, particularly with Pasteurella multocida. His sutures were removed to allow drainage he received and treatment with intravenous antibiotics.

FIG. 22.40. A: This 12-year-old girl had been bitten by her dog and later hospitalized for cellulitis that improved on intravenous antimicrobials. B: When the infection recurred, a radiograph was obtained that showed a fracture from the initial dog bite. The patient was treated for osteomyelitis, and the infection resolved.

FIG. 22.40. A: This 12-year-old girl had been bitten by her dog and later hospitalized for cellulitis that improved on intravenous antimicrobials. B: When the infection recurred, a radiograph was obtained that showed a fracture from the initial dog bite. The patient was treated for osteomyelitis, and the infection resolved.

<bold><italic>Figure 14.28.</bold> A.</bold> Cellulitis. <bold>B.</bold> Erysipelas in a patient with Down syndrome.

The infection began adjacent to the nail as a paronychia but spread proximally to involve the shaft of the toe as cellulitis.

Fleisher  GR, Ludwig  W, Baskin  MN. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2003:fig 11-37.

Buccal cellulitis. Both of these infants have buccal cellulitis caused traditionally by a bacteremic infection with Haemophilus influenzae type b. The lesions of this disease are indurated and range from erythematous to reddish purple. In a child immunized against H. influenzae type b, Streptococcus pneumoniae may still cause buccal cellulitis with bacteremia.

From Fleisher  GR, MD, Ludwig  W, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

Buccal cellulitis. Both of these infants have buccal cellulitis caused traditionally by a bacteremic infection with Haemophilus influenzae type b. The lesions of this disease are indurated and range from erythematous to reddish purple. In a child immunized against H. influenzae type b, Streptococcus pneumoniae may still cause buccal cellulitis with bacteremia.

From Fleisher  GR, MD, Ludwig  W, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

Orbital cellulitis. This young girl has erythema and edema in the periorbital area (A), which could be caused by either orbital or periorbital infection. However, she has limitation of the extraocular muscles, which characterizes orbital cellulitis, as shown when she is staring straight ahead (B) and gazing upward (C). D: A computed tomography scan of the orbits demonstrates a mass lesion along the medial wall of the orbit in a child with ethmoid sinusitis and orbital infection. No abscess cavity is seen, suggesting that the infection is at the stage of a cellulitis that will respond to intravenous antibiotic therapy without drainage.

From Fleisher  GR, MD, Ludwig  W, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

Periorbital cellulitis. This boy has pronounced erythema and edema of the periorbital region. Without checking for proptosis and limitation of extraocular movements, periorbital cellulitis and orbital cellulitis appear indistinguishable. In some cases, a computed tomography scan is required to make the differentiation.

From Fleisher  GR, MD, Ludwig  W, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

Cellulitis of the knee. Cellulitis in this patient developed at the site of a minor wound (A). The child was presented with fever and lymphangitic streaking (B).

From Fleisher  GR, MD, Ludwig  W, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

Cellulitis of the knee. Cellulitis in this patient developed at the site of a minor wound (A). The child was presented with fever and lymphangitic streaking (B).

From Fleisher  GR, MD, Ludwig  W, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

A radiograph shows a sewing needle that embedded itself in the deep tissues of the sole of the foot. The child presented with dorsal erythema (B), from a cellulitis, but the finding of a small puncture wound (C), suggested a foreign body despite the absence of any history along this line.

From Fleisher  GR, MD, Ludwig  S, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

FIG. 11.36. Cellulitis of the knee. Cellulitis in this patient developed at the site of a minor wound (A). The child was presented with fever and lymphangitic streaking (B).