Omphalitis - Navel Infection

of the navel, from which an abundant purulent and foul-smelling secretion comes out.

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

Omphalitis: symptoms
The recurrent SYMPTOMS are: foul-smelling discharge of pus from the navel, erythema, edema, achiness with pressure and limited pain. Affected infants often experience fever, hypotension, tachycardia and jaundice. Among the rare COMPLICATIONS, sepsis, septic embolization and death should not be forgotten. .

Omphalitis: drugs
The TREATMENT of choice consists of the administration of antibiotics; possibly associate a support therapy to cope with secondary symptoms.

chronic of the navel (onphalus), from which purulent, often foul-smelling material emerges. Recurrent omphalitis is documented mainly among infants and children; nevertheless, umbilical inflammations can occasionally also affect adults. Omphalitis is a rather rare pathological condition in industrialized countries; however, in less developed areas where access to drugs is not guaranteed, omphalitis remains a common cause of neonatal mortality.
From the American medical statistical analyzes, it is clear that omphalitis occurs in 5 patients out of every 1,000 healthy subjects.
Omphalitis begins with symptoms very similar to those of infectious cellulitis (redness, limited pain, swelling), therefore it is not uncommon for the two affections to be confused.
The cause of omphalitis often resides in a bacterial infection, therefore antibiotic therapy is the treatment of choice.

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Group A beta hemolytic streptococcus, such as Streptococcus pyogenes (Gram +)

Escherichia coli (Gram -)

Klebsiella pneumoniae (Gram -)

Proteus mirabilis (Gram -)

Omphalitis is often the result of a mix of infections caused by gram positive and gram negative bacteria: less frequently, omphalitis is caused by a single species of pathogen.
The patients most at risk of omphalitis are newborns (especially premature ones), hospitalized patients undergoing invasive procedures, and the immunocompromised. Sepsis and pneumonia are also predisposing factors for omphalitis.

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

COMMON SYMPTOMS

In most cases, omphalitis turns out to be a banal umbilical inflammation, which can soon be resolved with topical application and / or parenteral administration of specific antibiotics.
The most common symptoms are listed below:

• Purulent and foul-smelling discharge from the navel (always present)
• Periumbilical erythema
• Edema
• Pain on pressure
• Limited pain / burning

In addition to the symptoms listed above, i newborns premature babies with omphalitis often manifest hypotension, fever, tachycardia, jaundice and difficulty in feeding.

COMPLICATIONS (RARE)

When not adequately treated, the symptomatological picture of omphalitis can become complicated: in this case, the patient may observe ecchymosis, petechiae, bullous skin lesions and an orange peel appearance near the navel. The above symptoms are predictors of complications. , and suggest the involvement of multiple pathogens in the infection.
In some sporadic cases, the patient's clinical picture can precipitate: the umbilical infection can spread to involve the entire abdominal wall. In such situations, the evolution of omphalitis into necrotizing fasciitis, its most fearful complication, is conceivable.
Among other complications we also remember myonecrosis (or myonecrosis), sepsis, septic embolization and death. In case of complications from omphalitis, the concomitance of several symptoms is often observed in the affected patient:

• altered body temperature (fever / hypothermia)
• respiratory disorders (apnea, tachypnea, hypoxemia, etc.)
• gastrointestinal disturbances (e.g. abdominal bloating)
• neurological alterations (irritability, hypo / hypertonia, etc.)
• drowsiness
• cardiovascular disorders (e.g. tachycardia, hypotension, etc.)

Omphalitis: epidemiology

Interesting results emerged from the statistics reported in the scientific journal JOURNAL OF PEDIATRICS:

1. The incidence overall of omphalitis in industrialized countries varies from 0.2 to 0.7%
2. The incidence of omphalitis is greater than 0.7% in newborns preterm than those born within the established term
3. The mortality rate among all infants with omphalitis (including those with severe complications) ranges from 7 to 15%
4. The degeneration of omphalitis into necrotizing fasciitis gives a poor prognosis in 38-87%
5. Omphalitis can affect males and females alike; nevertheless, males are believed to be more at risk of complications (including death)

and biopsy of a sample.
In case of suspected omphalitis, a differential diagnosis should be made with congenital umbilical fistulas, also associated with purulent discharge from the navel.
The therapeutic treatment for NOT complicated omphalitis is quite simple: the patient undergoes specific antibiotic therapy. Penicillins are particularly suitable for the treatment of mild omphalitis sustained by Staphylococcus aureus, while aminoglycosides are the therapy of choice for gram negative infections. For invasive infections, especially anaerobic, it is recommended to combine more antibiotics, including metronidazole. for approximately 10-15 days, depending on the nature and severity of the infection.
Omphalitis complicated by necrotizing fasciitis requires a more aggressive treatment approach.
In case of complications deriving from the omphalitis itself (eg hypotension or breathing difficulties), it is necessary to provide a targeted support therapy.

For further information: Bacitracin or silver sulfadiazine-based antibiotic drugs for the treatment of omphalitis. Some authors disapprove of this preventive practice, convinced that the topical application of antiseptic substances cannot completely prevent omphalitis.