Deep neck infections in children

• Published in: Journal of microbiology, immunology and infection immunology and infection, 2017-10, Vol.50 (5), p.627-633
• Main Authors: Huang, Chung-Ming, Huang, Fang-Liang, Chien, Ya-Li, Chen, Po-Yen
• Format: Article
• Language: English
• Subjects: Adolescent; Anti-Infective Agents - therapeutic use; Bacteria; Bacterial Infections - complications; Bacterial Infections - diagnosis; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Child; Child, Preschool; deep neck infection; Female; Humans; Infectious Disease; Male; Medical Education; Neck - microbiology; Neck - physiopathology; parapharyngeal abscess; Penicillins - therapeutic use; peritonsillar abscess; Peritonsillar Abscess - epidemiology; Peritonsillar Abscess - microbiology; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - microbiology; retropharyngeal abscess; Retropharyngeal Abscess - epidemiology; Retropharyngeal Abscess - microbiology; Retrospective Studies; Severity of Illness Index; Soft Tissue Infections - complications; Soft Tissue Infections - diagnosis; Soft Tissue Infections - epidemiology; Soft Tissue Infections - microbiology; Staphylococcus aureus - isolation & purification; Staphylococcus aureus - pathogenicity; submandibular abscess; Taiwan
• ISSN: 1684-1182; 1995-9133
• DOI: 10.1016/j.jmii.2015.08.020

Abstract Background/Purpose Deep neck infections (DNIs) often have a rapid onset and can progress to life-threatening complications. There are only a few reports on pediatric DNIs' clinical manifestations, diagnostic clues, and etiology in Taiwan. Methods A retrospective chart review of patients (aged ≤ 18 years) diagnosed with DNI from January 2005 to December 2014 was performed. DNIs were classified into retropharyngeal, parapharyngeal, peritonsillar, submandibular, and multispace abscesses. Results A total of 52 patients with DNI were identified. The most common site of DNI was the parapharyngeal space ( n  = 22, 42.3%). The most commonly associated antecedent illness was preceding upper respiratory tract infection (30.8%). The most common clinical presentation was neck mass or swelling (82.7%) and fever (75%). Pus drainage or needle aspiration was performed to obtain pus samples from the infection site for pus culture ( n  = 31). The most commonly isolated pathogen was Staphylococcus aureus ( n  = 7). Amoxicillin–clavulanic acid (56.6%) was the most commonly used antibiotics, followed by penicillin (15.1%). There was no long-term morbidity or mortality. Conclusion When a patient (regardless of age) presents with neck mass or swelling, the DNI should always be included in the differential diagnosis. The low culture rate in Taiwan and previous partial treatment of infections may have affected identification of pathogens in cultures. Performing Gram staining and acid-fast staining of pus, instead of culture alone, as early as possible before initiating the initial antimicrobial therapy are thus crucial. The recurrence of DNI should alert the physician to the possibility of an underlying bronchogenic cyst. Excision surgery is required to cure recurrent infections.