Pediatric orbital cellulitis: Case report of an unusual etiology and pathogen

Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with fractures or direct inoculation, and there are no reports to the contrary. Here, we make the first report of a possible etiology by which orbital cellulitis developed in a 14-year-old boy even without skin breach or bony fractures; as well as a rare causative pathogen. He presented with facial abscess and progressive orbital cellulitis after blunt facial trauma, requiring functional endoscopic sinus surgery with needle aspiration of facial abscess externally. Cultures showed growth of Streptococcus constellatus/Parvimonas micra, and he received further antibiotics with full recovery. The pathophysiology of orbital cellulitis in this patient is attributed to vascular congestion and local pressure from maxillofacial contusion and maxillary hemoantrum, with impaired paranasal sinus ventilation encouraging anaerobic bacterial growth. Further progression led to facial abscess formation and intraorbital spread with orbital cellulitis. The pediatric demographic is injury-prone, and self-reporting of symptoms can be delayed. Hence, increased suspicion of complicated injuries and orbital cellulitis may be required when managing maxillofacial contusions so that prompt treatment can be given.

A 10-year-old child with acute torticollis due to polymicrobial deep neck infection

Torticollis in children can be a sign of a potentially dangerous disease; the correct diagnosis is not always obvious on history and physical examination. The use of point-of-care ultrasound (POCUS) helps to limit the differential diagnosis and direct appropriate further laboratory and radiology-performed evaluation. We present a case of a 10-year-old child whose deep neck infection (DNI) was timely diagnosed in the paediatric emergency department by early use of POCUS and drained under POCUS guidance after admission to the hospital. The culture from the fluid grew Eikenella corrodens, Streptococcus constellatus and Prevotella buccae. This case demonstrates that DNIs occur in children with acute acquired torticollis, even without fever and demonstrates the importance of early use of POCUS in cases where DNI is a potential diagnosis. Moreover, this case emphasises the importance of microbiological identification of DNIs that can be the key to successful treatment.

Piomiositis en un adulto con diabetes mellitus

Paciente varón de 63 años de edad, diabético y en tratamiento con insulina, con dolor y aumento de volumen a nivel del hemitórax anterior izquierdo, con estudio de ecpgrafía y tomografía compatible con colección a nivel del músculo pectoral mayor. En la punción se obtuvo un material purulento y fétido, confirmándose el diagnóstico de piomiositis. Se aisló Streptococcus constellatus en el cultivo del pus. Con pobre respuesta a tratamiento médico inicial, requirió drenaje quirúrgico y cobertura antibiótica amplia.

Empyema caused by Streptococcus constellatus: a case report and literature review

Background Streptococcus constellatus is a member of Streptococcus anginosus group (SAG) that tends to cause pyogenic infections in various sites. However, Streptococcus constellatus is easily ignored by routine clinical laboratory tests for its prolonged anaerobic culture environment. Case presentation A 71-year-old man was admitted to our hospital due to productive cough, fever, chest pain and shortness of breath for 3 weeks. Chest computed tomography showed patchy opacities and right-sided pleural effusion, so a chest tube was inserted and purulent and hemorrhagic fluid was aspirated. The routine etiological examinations of the pleural effusion were all negative, and next-generation sequencing (NGS) detected Streptococcus constellatus. Intravenous piperacillin-tazobactam 4.5 g every 8 h was used accordingly. The patient recovered and subsequent chest computed tomography confirmed the improvement. Conclusions We reported a case of empyema secondary to Streptococcus constellatus infection, which was identified by NGS, instead of bacterial culture. This case highlights the utility of NGS in detecting pathogens negative in traditional bacterial tests.

The Efficacy of a Diode Laser on Titanium Implants for the Reduction of Microorganisms That Cause Periimplantitis

The paper presents the optimisation of a safe diode laser irradiation process applied to the surface of titanium implants in order to reduce microbial numbers in the treatment of inflammation classified as periimplantitis. The study comprised isolation and identification of microorganisms inhabiting surfaces of dental implants, crowns, teeth and saliva from patients with fully symptomatic periimplantitis. Microorganisms were detected by a culture-dependent method and identified with the use of MALDI-TOF mass spectrometry. The isolated microorganisms were inoculated on the surface of a new implant and then irradiated by a diode laser (wavelength of 810 ± 10 nm) in one, two or three repetitions and biocidal efficacy was assessed. To evaluate impact of laser irradiation on roughness, morphology and structure of the implant surface, optical profilometry, scanning electron microscopy and optical microscopy were used. Examination of the tested surfaces and saliva revealed the presence of Gram-positive and Gram-negative bacteria and one fungal species. In all patients, cultures from the endosseous part of the implant revealed the presence of the pathogenic and pyogenic bacterium Streptococcus constellatus. In 13 out of 20 samples laser-irradiated in duplicate and triplicate, all microorganisms were eliminated. The irradiation used did not cause any changes in the properties of the implant surface.

Sphenoid sinusitis: a rare cause of ischaemic stroke

We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew Streptococcus constellatus, a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.