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Pediatric orbital subperiosteal abscess outbreak in Iran: characteristics and causes

  • Oculoplastics and Orbit
  • Published:
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Abstract

Purpose

To evaluate demographics, characteristics, and management of pediatric patients with subperiosteal abscesses (SPA) secondary to orbital cellulitis and discuss the etiology of a dramatic rise in SPA.

Methods

Data were gathered by retrospective chart review of patients admitted to a tertiary referral eye hospital (Farabi Eye Hospital) diagnosed with orbital cellulitis with subperiosteal abscess from October 2022 to March 2023 (six months). Data on demographic information, clinical examination, radiographic evidence of sinusitis, orbital cellulitis, SPA, surgical and non-surgical management taken, isolated bacteria, and duration of hospital stay were gathered.

Results

24 patients were admitted during these six months, with a diagnosis of orbital SPA secondary to paranasal sinusitis, confirmed by an orbital Computed Tomography (CT) scan. The age range was 11 months to 16 years. 75% of patients were male. All patients had a history of flu-like illness before developing orbital cellulitis. All patients had concurrent sinusitis, and 18 underwent initial surgical abscess drainage. The ethmoid sinus was the most involved, and most patients had a medially located SPA. Abscess volume ranged from 0.78 to 7.81 cm3 (mean: 3.52 cm3). One patient had concurrent central retinal artery occlusion due to orbital cellulitis.

Conclusions

In this study, we report a dramatic increase in the incidence of SPA referred to our hospital. Larger abscess volumes and an increased number of cases that needed initial surgical drainage are also of note. An influenza outbreak in the autumn and winter, undiagnosed Corona Virus Disease 2019 (COVID-19) infection, increased antimicrobial resistance due to excessive off-label use of antibiotics during the COVID-19 pandemic, and more virulent bacterial infections are the most probable hypotheses to justify this observation.

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Authors and Affiliations

  1. Department of Orbital and Oculoplastic Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Pedram Afshar, Amirhossein Aghajani, Navid Mohsenzadeh, Mostafa Heidari, Seyed Mohsen Rafizadeh & Mohammad Taher Rajabi

  2. Department of Pathology and Microbiology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Zohreh Abedinifar

Authors
  1. Pedram Afshar
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  2. Amirhossein Aghajani
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  3. Navid Mohsenzadeh
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  4. Mostafa Heidari
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  5. Seyed Mohsen Rafizadeh
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  6. Zohreh Abedinifar
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  7. Mohammad Taher Rajabi
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Corresponding author

Correspondence to Seyed Mohsen Rafizadeh.

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Ethical approval

Permission to review the medical records was approved by the Hospital’s Ethics Committee of Farabi Eye Hospital. This work is adherent to the ethical principles of the Declaration of Helsinki.

Informed consent

A written informed consent was obtained from all individual participants or their legal caregivers included in the study. The patient’s caregiver, shown in Fig. 1, signed a consent form to illustrate the patient’s photo in the article.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Afshar, P., Aghajani, A., Mohsenzadeh, N. et al. Pediatric orbital subperiosteal abscess outbreak in Iran: characteristics and causes. Graefes Arch Clin Exp Ophthalmol 262, 623–630 (2024). https://doi.org/10.1007/s00417-023-06266-z

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  • DOI: https://doi.org/10.1007/s00417-023-06266-z

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