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La cellulite orbitaria in età pediatrica: una proposta di gestione diagnostico-terapeutica
Orbital Cellulitis in Children: A Proposal for its Diagnostic and Therapeutic Approach
Daniele Zama1, Luigi Altimari2, Martina Ruscelli2, Luca Pierantoni1, Monia Gennari1, Francesco Toni3, Caterina Campoli4, Livio Presutti5, Marcello Lanari1
1Unità di Pediatria d’Urgenza, Pronto Soccorso e Osservazione Breve Intensiva, IRCCS Azienda Ospedaliero-Universitaria di Bologna
2Scuola di Specializzazione in Pediatria, Università di Bologna
3Unità di Neuroradiologia Pediatrica, IRCCS Istituto delle Scienze Neurologiche di Bologna
4Unità di Malattie Infettive, IRCCS Azienda Ospedaliero-Universitaria di Bologna
5Unità di Otorinolaringoiatria e Audiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna
Gennaio 2024 - pagg. 17 -25 | DOI: 10.53126/MEB43017
Abstract
The incidence of orbital cellulitis in the paediatric age is around 1.6/100,000 cases per year. Most cases are mild and limited to the preseptal space; however, severe and complicated cases are possible. Paediatricians should be able to recognize high-risk adverse outcome conditions that require prompt intervention. Clinical evaluation supported by laboratory workup is the key for the diagnosis. Intraorbital and intracranial complications may be ruled out through diagnostic imaging. Depending on the extension of the infection, clinicians may choose between conservative treatment with antibiotic therapy or surgical drainage at first. The paper proposes an algorithm to aid clinicians in the management of paediatric orbital cellulitis through the description of three emblematic clinical cases observed in the Paediatric Emergency Room.
Riassunto
La cellulite orbitaria ha incidenza in età pediatrica pari a 1.6 casi/100.000. Nella maggior parte dei casi si tratta di forme pre-settali lievi, tuttavia sono possibili quadri gravi con aumentato rischio di complicanze, anche potenzialmente fatali. È fondamentale per il pediatra saper riconoscere i casi ad alto rischio di evoluzione sfavorevole, che necessitano pertanto di trattamento tempestivo. La valutazione clinica, supportata dagli esami di laboratorio, rappresenta il primo strumento per orientare il sospetto diagnostico. La diagnostica per immagini ha lo scopo di escludere lo sviluppo di complicanze intraorbitarie o intracraniche. A seconda dell’estensione clinico-radiologica del quadro si opterà per il trattamento medico, mediante terapia antibiotica, oppure chirurgico in primis. Attraverso la descrizione di tre casi clinici emblematici dalla nostra esperienza in Pronto Soccorso Pediatrico e in Pediatria d’Urgenza, proponiamo un algoritmo per facilitare la gestione diagnostico-terapeutica delle celluliti orbitarie nel bambino.
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Corrispondenza: martina.ruscelli@studio.unibo.it