DIAGNOSTIC AND THERAPEUTIC CHALLENGES OF CERVICO FACIAL CELLULITIS WITH HEMATOLOGICAL INVOLVEMENT IN AFRICA: ASYSTEMATIC REVIEW

Abstract

Background: Cervicofacial cellulitis (CFC) with hematological involvement
represents a severe form of maxillofacial infection associated with high
morbidity and mortality in the African context. This review aims to analyze the specific diagnostic and therapeutic challenges of these complex forms.
Materials and methods: A systematic search was conducted in five electronic databases (MEDLINE/PubMed, Scopus, Web of Science, African Journals Online, and African Index Medicus) to identify studies reporting cases of CFC with hematological involvement in Africa from January 2010 to December 2023. Methodological quality was assessed using the Newcastle-Ottawa scale. Standardized data extraction included demographic, clinical, laboratory, therapeutic, and outcome characteristics. Statistical analysis was performed
using RevMan 5.4 software with descriptive statistics presented as means ± standard deviations for continuous variables and percentages for categorical variables. Heterogeneity was assessed using I² test, and factors associated with mortality were identified through univariate and multivariate logistic regression analysis.
Results: Twenty-six studies including 183 cases were included. Mean age was 34.7 ± 12.3 years with male predominance (M/F ratio 1.74). Main hematological abnormalities included severe anemia (76.5%), neutrophilic leukocytosis (89.6%), and thrombocytopenia (43.2%). Major complications comprised sepsis (68.3%), disseminated intravascular coagulation (34.8%), and septic shock (22.4%). Overall mortality rate was 18.6%. Multivariate analysis identified five independent mortality risk factors: consultation delay >7 days (aOR = 3.8; 95% CI: 2.1-6.9), mediastinitis (aOR = 5.2; 95% CI: 2.7-9.8), DIC (aOR = 4.7; 95% CI: 2.3-9.5), septic shock (aOR = 6.8; 95% CI: 3.5-13.2), and severe anemia <8 g/dL (aOR = 2.9; 95% CI: 1.5-5.6). Conclusion: This systematic review demonstrates that CFC with hematological involvement represents a medical-surgical emergency in Africa, requiring a multidisciplinary approach. Based on our findings, optimizing management requires early diagnosis of hematological abnormalities and aggressive therapy combining broad-spectrum antibiotics, surgery, and hematological support.