Buccal cellulitis

Abstract

Buccal cellulitis (BC) is an innocuous appearing infection of the cheek that is found in children and has a high incidence of concomitant bacteremia. Typically, the child is younger than 12 months and has a 2 to 8 hour prodrome of coryza and fever before developing the cellulitis on the cheek. A purplish hue on the cellulitic region is highly suggestive of Hemophilus influenzae bacteremia. The differential diagnosis is reviewed. A complete blood count, blood culture, and cellulitis aspirate culture, should be obtained on all patients with BC. Meningitis may be present despite the lack of meningeal signs. A lumbar puncture should be performed on all children at risk for bacteremic BC. The vast majority of these children are bacteremic and require parenteral antibiotics. A typical case of BC is presented and its management is reviewed.

Blood Cultures in the Evaluation of Children With Cellulitis

“…Many previous studies and standard textbooks advocate obtaining blood cultures in the evaluation of patients with cellulitis, but this recommendation was based historically on the high frequency of bacteremia with H influenzae. [1][2][3][4] In only 5 (2%) of 243 patients did the blood culture yield a true pathogen. Four of the five isolated pathogens were of the streptococcal species.…”

“…Blood cultures are commonly performed on children admitted for cellulitis, despite previous literature suggesting a low yield except in cases of Haemophilus influenzae. [1][2][3] Blood cultures have been advocated because of the high rate of bacteremia with H influenzae, 1 but the prevalence of this pathogen has dramatically decreased since the introduction of the H influenzae type b (Hib) vaccine in 1985. 2 The purpose of this study was to determine the yield of blood cultures obtained from children admitted for cellulitis in the post-Hib vaccine era.…”