PRESEPTAL/ORBITAL CELLULITIS IN THE POST - H. INFLUENZAE VACCINE ERA. 984

Prior to the development of the H. influenzae vaccine, a significant number of preseptal (PS) and orbital (O) infections were associated with H. influenzae type b (HIb) bacteremia. We reviewed 134 patients (pts) with the discharge diagnosis of either PS or O cellulitis from 5/85 to 6/95. We excluded pts with an underlying immunodeficiency or significant direct trauma. There were 106 cases of PS cellulitis and 28 cases of O cellulitis. The mean age of the patients was 66 ± 50 mos. The mean age of pts with PS cellulitis was less than those with O cellulitis (56 vs 92 mos; p <.005). The youngest pt with O cellulitis was 32 mos. 133/134 pts had blood cultures (bcs). 3.8% of pts had a positive bc. 2/55 bcs were positive for HIb between 1985-90. Both were in infants with PS cellulitis (4 and 8 mos). From 1990-95 3/78 bcs were positive (S. pneumo, Group F Strep, non-typable H. influenzae); the first isolate was from a pt with PS cellulitis, the other isolates were from pts with O cellulitis. HIb has not been isolated from a pt with PS or O cellulitis since 7/87 (101 pts).