Meningitis complicating acute bacteremic facial cellulitis.

Eighty cases of acute bacteremic facial cellulitis, 34 buccal and 46 preseptal, were reviewed from the years 1977 through 1982. The epidemiology, clinical presentation, laboratory parameters and course of cellulitis in these two locations were similar. The white blood cell count was over 15,000 in three-fourths of the patients. Haemophilus influenzae type b was cultured from the blood of 67 patients, Streptococcus pneumoniae from 12 and Streptococcus pyogenes from 1. Seven patients had culture-proved meningitis, six with H. influenzae type b and one with S. pneumoniae. Five of these patients had sparse clinical evidence of meningitis, and three of these had meningitis apparent by culture only. We conclude that meningitis may occur in association with acute bacteremic facial cellulitis and may be inapparent both clinically and by initial laboratory examination. We suggest aggressive initial evaluation and treatment of these infants pending culture results.