The Diagnostic Value of the Leukocyte Shift Index in Purulent-Septic Rhinosinusogenic Complications in Children

The aim of this study was to investigate the diagnostic value of the leukocyte shift index (LSI) in inflammatory pathology of the paranasal sinuses (PNS) with the rhinosinusogenic orbital complications (RSOC) in pediatric patients. Methods and Results: The study involved 50 patients (26 boys and 24 girls) with diseases of the PNS and RSOC (reactive edema of the eyelids, orbital tissue, and purulent-septic complications of the eyelids and orbit) aged from 1 to 17 years (mean age of 6.66±0.63 years). Group 1 included 29 patients (16 boys and 13 girls) with reactive edema of the eyelids and orbital tissue. Group 2 included 21 patients (10 boys and 11 girls) with purulent-septic RSOC. As a marker for determining the activity of the inflammatory process and the disorders of the immunological reactivity of the body, LSI (leukocyte shift index) was calculated. In general, the LSI value was 1.61±0.21 in Group 1 and 3.45±0.49 in Group 2 (P=0.001). Among patients aged between 3 and 12 years, the LSI was 1.66±0.30 in Group 1 and 3.93±0.79 in Group 2 (P=0.012). The results obtained indicate that LSI can be used to predict purulent-septic RSOC in inflammatory diseases of PNS in patients aged between 3 and 12 years. LSI values from 1.36 to 1.96 may predict the development of reactive edema of the eyelids and orbital tissue; from 3.14 to 4.72 - the development of purulent-septic complications of the eyelids and orbit. Conclusion: The results obtained can be useful in predicting the clinical course of the RSOC in inflammatory pathology of PNS in patients in the age group of 3-12 years.

Pediatrics Orbital and Preseptal Cellulitis: A 2-year Experience

Objectives: To investigate the epidemiology, clinical features, and treatment of hospitalized pediatric cases of preseptal and orbital cellulitis in a central university hospital in Zahedan, Iran. Methods: Retrospective study of children/adolescents admitted to a central university hospital with orbital and preseptal cellulitis from 2016 to 2018. Results: Forty patients, including 29 cases of preseptal cellulitis and 11 cases of orbital cellulitis, were included in the study. The prevalence of orbital and preseptal cellulitis was approximately the same in both sexes. Mean age was 2.86 ± 0.56 years (ranges 12 days to 13 years) in patients with orbital cellulitis and 2.82 ± 0.67 years (range, 2 months to 8 years) in patients with preseptal cellulitis. The most common clinical and paraclinical findings were edema of the eyelids and increased ESR, respectively. Sinusitis is the most common underlying cause, which was present in 63.63% of cases of orbital cellulitis and 34.48% of cases of preseptal cellulitis. The most frequent antibiotics used in this study were ceftriaxone, cloxacillin, and vancomycin. Conclusions: The most common clinical and paraclinical findings were edema of the eyelids and increased ESR, respectively. Sinusitis is the most common underlying cause. Timely treatment of sinusitis may prevent orbital and preseptal cellulitis.

To the issue of differential diagnosis of listeriosis

A clinical example shows the erroneous diagnosis of listeriosis in a 15-year-old child hospitalized in the infectious department. The child was admitted with severe symptoms of intoxication, febrile fever, difficulty in nasal breathing, hyperemia of the mucous membranes of the oropharynx, tonsillitis, cervical lymphadenitis, facial tissue pasteness with swelling of the eyelid and conjunctivitis of the left eye, hepatosplenomegaly. A laboratory examination revealed pronounced leukocytosis up to 24 thousand, lymphocytosis, atypical mononuclear cells up to 9%, IgM and IgG to EBV capsid protein, IgM to CMV, IgM and IgG to listeria. But with a repeated double study of IgM and IgG to Listeria were not detected. The initial positive result was possibly due to the presence of cross-reacting antibodies in EBV mononucleosis. The final diagnosis was made: Infectious mononucleosis of mixed (EBV, CMV) etiology. Chronic polypous rhinosinusitis, exacerbation. Reactive edema of the eyelids against the background of inflammation of the sinuses.Given the variety of clinical forms of listeriosis and their similarity with the manifestations of other infections, for the full diagnosis of listeriosis infection, it is advisable to evaluate the epidemiological and medical history data, as well as use an extended spectrum of laboratory confirmation of the diagnosis.

Septic Thrombosis of Orbital Vessels Due to Cutaneous Nasal Infection

The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. Patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.

AN INFECTIOUS OPHTHALMIA OF CATTLE

Twenty-four cases of an acute ophthalmia of cattle have been observed. The infection is characterized by photophobia, severe congestion of the vessels of the eyeball, conjunctivitis, congestion and edema of the membrana nictitans, edema of the eyelids, accompanied by a thick, yellowish white mucus or mucopurulent exudate. In certain cases corneal ulcers and extensive corneal opacities developed. From all cases a characteristic diplobacillus was obtained. The organism was usually observed in the exudate in large numbers. The morphology, the hemolytic properties, and the proteolytic activities readily assist in its identification. Instillation of a few drops of bouillon suspensions of pure cultures beneath the eyelids of normal cattle gave rise to characteristic inflammations. The organism is not pathogenic for laboratory animals.