II. Epidemiology
- Relatively rare in the U.S. due to Hib Vaccine and Pneumococcal Conjugate Vaccine
- Age <5 years old (esp. <12 months of age)
III. Causes
- Haemophilus Influenzae Type B (most common cause, esp. pre-Hib Vaccine era)
- Streptococcus Pneumoniae
V. Signs
- Significant cheek swelling accompanied by erythema and purple discoloration of the malar region
- Mild Trismus
- Low grade fever
VI. Differential Diagnosis
- See Malar Rash
-
Facial Erysipelas (Group A Streptococcal Cellulitis)
- Focal area on face of Paresthesia or pain, followed by rash developing, often in malar distribution
- May be preceded by Pharyngitis
-
Staphylococcus aureus
Cellulitis
- On the face, Staphylococcal Cellulitis may be indistinguishable from streptococcal Erysipelas
-
Parvovirus B19 (Fifth Disease)
- Facial erythema (slapped cheek appearance) spares the chin and periorbital region
- Dental Abscess extension
- Wells’ syndrome
VII. Management
- See Facial Erysipelas
- Exercise caution in the post-Hib Era with Buccal Cellulitis and consider management as Facial Erysipelas
- Buccal Cellulitis was historically treated to cover for HaemophilusInfluenzae Type B
- Ceftriaxone 50 mg/kg IV every 24 hours has been used for severe infections
- Trimethoprim Sulfamethoxazole (Septra, Bactrim) has been used for oral Antibiotic management
VIII. Prevention
IX. References
- (2019) Sanford Guide, accessed on IOS 11/20/2019
- Walker (1990) Am J Emerg Med 8(6):542-5 [PubMed]