Ophthalitis - Navel Infection

Key points

The infalite is a chronic inflammation of the navel, from which an abundant purulent and malodorous secretion emerges.

Ophthalitis: causes

The CAUSE of hyaluritis lies in polymicrobial infections. The most involved pathogens are: Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis .

Ophthalitis: symptoms

The recurrent SYMPTOMS are: malodorous secretion of pus from the navel, erythema, edema, tenderness to pressure and limited pain. Affected newborns often exhibit fever, hypotension, tachycardia and jaundice. Among rare COMPLICATIONS we must not forget sepsis, septic embolization and death.

Ophthalitis: drugs

The treatment of choice is constituted by the administration of antibiotics; possibly associate a supportive therapy to cope with secondary symptoms.

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Ophthalitis: definition

Also called granuloma or umbilical fungus, the infalite is a chronic inflammation of the navel (onfalo), from which purulent material, often smelly, comes out.

Recurrent omphalitis are documented especially among newborns and children; nevertheless, umbilical inflammations can occasionally also affect adults. The infalite is a rather rare pathological condition in industrialized countries; however, in less developed areas where access to drugs is not guaranteed, defalite remains a common cause of neonatal mortality.

From the American medical statistics analysis, it appears that malaria occurs in 5 patients per 1, 000 healthy subjects.

The infalite begins with symptoms very similar to those of infectious cellulite (redness, limited pain, swelling), so it is not uncommon for the two conditions to be confused.

The cause of malignancy often resides in a bacterial infection, therefore antibiotic therapy is the treatment of choice.

Causes

It is estimated that 70-75% of omphalitis is due to polymicrobial infections. The pathogens most involved in the etiopathogenesis are:

• Staphylococcus aureus (Gram +)
• Group A beta-hemolytic streptococcus, like Streptococcus pyogenes (Gram +)
• Escherichia coli ( Gram -)
• Klebsiella pneumoniae (Gram -)
• Proteus mirabilis (Gram -)

The infalite is often the result of a mix of infections sustained by gram-positive and gram-negative bacteria: less frequently, the infalite is caused by a single species of pathogens.

The patients most at risk of omphalitis are newborns (premature species), hospitalized patients undergoing invasive procedures, and immunocompromised patients. Sepsis and pneumonia are also predisposing factors to omphalitis.

In the newborn, the fall of the umbilical stump causes a small granulating wound: this sore constitutes a possible entrance door for bacteria (onfalite).

Symptoms

To learn more: Onfalite symptoms

COMMON SYMPTOMS

In the majority of cases, malaria appears to be a trivial umbilical inflammation, soon to be resolved with topical application and / or parenteral administration of specific antibiotics.

The most common symptoms are listed below:

• Purulent and foul-smelling secretion from the navel (always present)
• Periombelical erythema
• Edema
• Tenderness to pressure
• Circumscribed / burning pain

In addition to the symptoms listed above, premature babies suffering from omphalitis often show hypotension, fever, tachycardia, jaundice and difficulty eating.

COMPLICATIONS (RARE)

When not adequately treated, the symptomatic picture of hypertension can get complicated: in this case, the patient can observe ecchymoses, petechiae, bullous skin lesions and orange peel appearance near the navel. The symptoms just reported are predictors of complications, and suggest the involvement of more pathogens in the infection.

In some sporadic cases, the patient's clinical picture may precipitate: the umbilical infection can spread to involve the entire abdominal wall. In similar situations, the evolution of the infalite in necrotizing fasciitis, its most formidable complication, is conceivable.

Other complications include myonecrosis (or myonecrosis ), sepsis, septic embolization and death. In the case of complications from omphalitis, the concomitance of several symptoms is often observed in the affected patient:

• alteration of body temperature (fever / hypothermia)
• respiratory disorders (apnea, tachypnea, hypoxemia, etc.)
• gastrointestinal disorders (eg abdominal bloating)
• neurological alteration (irritability, hypo / hypertonia, etc.)
• drowsiness
• cardiovascular disorders (eg tachycardia, hypotension, etc.)

Ophthalitis: epidemiology

From the statistics reported in the scientific journal JOURNAL OF PEDIATRICS interesting results have emerged:

1. The overall incidence of malaria in industrialized countries varies from 0.2 to 0.7%
2. The incidence of omphalitis is higher than 0.7% in preterm infants compared to those born within the established deadline
3. The mortality rate among all newborns affected by omphalitis (including those with serious complications) varies from 7 to 15%
4. The degeneration of the infalite in necrotizing fasciitis gives a poor prognosis in 38-87%
5. The infalite can affect males and females without distinction; nevertheless, it is believed that males are more exposed to the risk of complications (including death)

Diagnosis and therapies

The diagnosis of omphalitis is clinical and consists in the medical observation of the umbilical stump (in the newborn). The diagnostic assessment is obtained by blood tests and biopsy of a sample.

In case of suspected omphalitis, a differential diagnosis must be made with congenital umbilical fistulas, also associated with purulent secretion from the navel.

Therapeutic treatment for NON-complicated inflammation is quite simple: the patient undergoes specific antibiotic therapy. Penicillins are particularly indicated for the treatment of mild omphalitis sustained by Staphylococcus aureus, while aminoglycosides are the preferred therapy for gram negative infections. For invasive infections, especially from anaerobes, it is recommended to combine more antibiotics, including metronidazole. Antibiotic antibiotic treatment in the newborn must last approximately 10-15 days, depending on the nature and severity of the infection.

Confalite complicated by necrotizing fasciitis requires a more aggressive approach to therapy.

In case of complications derived from the condition itself (eg hypotension or difficulty breathing), it is necessary to provide a targeted supportive therapy.

For further information: Drugs for the treatment of Onfalite »

Prevention

For the prevention of omphalitis in the newborn, it is recommended to apply directly on the umbilical stump antiseptic-antibiotic substances based on bacitracin or silver sulfadiazine. Some authors disapprove of this preventive practice, convinced that topical application of antiseptic substances cannot completely prevent malignancy.