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Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob 2020; 19:32. [PMID: 32731900 PMCID: PMC7391705 DOI: 10.1186/s12941-020-00375-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum, the current findings suggest that viridans group streptococci, S. aureus, Prevotella, and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark.
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hentze
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark
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Ţenţ PA, Juncar M, Mureșan O, Arghir OC, Iliescu DM, Onișor F. Post-traumatic occipital psoriatic plaque complicated by extensive necrotizing fasciitis of the head and neck: a case report and literature review. J Int Med Res 2018; 46:3480-3486. [PMID: 30058420 PMCID: PMC6134640 DOI: 10.1177/0300060518788490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Necrotizing fasciitis (NF) is a severe infection involving the superficial fascial layers, subcutaneous cellular tissue, and possibly skin. It usually has a fulminant evolution, rapidly leading to death in the absence of early diagnosis and aggressive surgical treatment. We herein report a rare case of NF secondary to a traumatized occipital psoriatic plaque in an alcoholic 47-year-old woman and compare this case with the published literature. The NF extended to the entire scalp, right face, and posterior and lateral cervical region. Despite the initially guarded prognosis, the patient’s survival emphasizes the importance of aggressive surgical treatment with wide excision of all necrotic structures without any aesthetic compromise.
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Affiliation(s)
- Paul Andrei Ţenţ
- 1 Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
| | - Mihai Juncar
- 1 Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
| | - Ovidiu Mureșan
- 2 Department of Oral and Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Oradea, Romania
| | - Oana Cristina Arghir
- 3 Pulmonology Department, Faculty of Medicine, Ovidius University of Constanţa, Constanta, Romania
| | - Dan Marcel Iliescu
- 4 Anatomy Department, Faculty of Medicine, Ovidius University of Constanţa, Constanta, Romania
| | - Florin Onișor
- 2 Department of Oral and Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Oradea, Romania
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Abdurrazaq TO, Ibikunle AA, Braimah RO. Cervical Necrotizing Fasciitis: A Potentially Fatal Disease with Varied Etiology. Ann Med Health Sci Res 2016; 6:251-256. [PMID: 28480101 PMCID: PMC5405638 DOI: 10.4103/amhsr.amhsr_33_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Necrotizing fasciitis was recognized centuries ago by physicians. It is a rapidly progressive and potentially fatal soft-tissue infection that is typified by soft-tissue necrosis, especially affecting the subcutaneous tissues and fascia. Cervico-facial necrotizing fasciitis is said to be uncommon, but when it occurs, it is often of odontogenic origin and has severe consequences if not promptly treated. Possible underlying systemic diseases and the source of infection should be addressed and treated appropriately. We present two cases of extensive cervicofacial necrotizing fasciitis, one of which was idiopathic in origin and the other with gross involvement of the chest and abdominal walls. Both were treated successfully. Immediate resuscitation of the patients, administration of empirical antibiotics, treatment of underlying systemic conditions and early, aggressive and serial debridement were the bedrock of management in these cases.
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Affiliation(s)
- T O Abdurrazaq
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - A A Ibikunle
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - R O Braimah
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Olusanya AA, Gbolahan OO, Aladelusi TO, Akinmoladun VI, Arotiba JT. Clinical Parameters and Challenges of Managing Cervicofacial Necrotizing Fasciitis in a Sub-Saharan Tertiary Hospital. Niger J Surg 2015; 21:134-9. [PMID: 26425068 PMCID: PMC4566320 DOI: 10.4103/1117-6806.162572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial necrotizing fasciitis (CNF) in the University College Hospital, Ibadan. MATERIALS AND METHODS Information such as biodata, site of infection, systemic conditions, widest span of defect, management provided, hospital stay, and outcome of management was prospectively collected on all patients with CNF who presented at the Department of Oral and Maxillofacial Surgery between January 2007 and December 2013. The patients were managed according to a devised protocol of antibiotic therapy, serial debridement and honey dressings. RESULTS Twenty-four cases of CNF were seen. There were 9 males and 15 females while 70.9% of the patients belonged to the low socioeconomic class. The mean span of wound defect was 12.2 (±8.844) cm. The mean hospital stay was 27.8 (±23.1) days, and scar formation was the most common complication encountered. CONCLUSION Our study represents the largest series of CNF from a Nigerian health facility presently. The management of necrotizing fascitis in the maxillofacial region poses a significant challenge to both the surgeon and the patient. However, the mortality rate of CNF in our center appears comparatively low.
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Affiliation(s)
- Adeola A Olusanya
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | - Olalere O Gbolahan
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | - Timothy O Aladelusi
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | - Victor I Akinmoladun
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | - Juwon T Arotiba
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
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Gausepohl JS, Wagner JG. Survival from cervical necrotizing fasciitis. West J Emerg Med 2015; 16:172-4. [PMID: 25671035 PMCID: PMC4307710 DOI: 10.5811/westjem.2014.12.21553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 12/03/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022] Open
Abstract
Cervical necrotizing fasciitis (CNF) is an uncommon, yet clinically significant infection that rapidly progresses to involve the deep neck spaces. Early recognition and aggressive surgical intervention and debridement are important, as this disease is associated with a high morbidity and mortality. In this report, we present a case of CNF and descending mediastinitis from a non-odontogenic source in a patient presenting with neck swelling and odynophagia.
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Affiliation(s)
- Jeniffer S Gausepohl
- Los Angeles County + University of Southern California Health Network, Department of Emergency Medicine, Los Angeles, California
| | - Jonathan G Wagner
- Los Angeles County + University of Southern California Health Network, Department of Emergency Medicine, Los Angeles, California
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NGUYEN D, YAACOB Y, HAMID H, MUDA S. Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre's-Like Syndrome. Malays J Med Sci 2013; 20:70-78. [PMID: 24643401 PMCID: PMC3957351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 03/16/2013] [Indexed: 06/03/2023] Open
Abstract
Lemierre's syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS.
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Affiliation(s)
- Dang NGUYEN
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Yazmin YAACOB
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Hamzaini HAMID
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Sobri MUDA
- Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
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Danic Hadzibegovic A, Sauerborn D, Grabovac S, Matic I, Danic D. Necrotizing fasciitis of the neck after total laryngectomy. Eur Arch Otorhinolaryngol 2012; 270:277-80. [PMID: 22430034 DOI: 10.1007/s00405-012-1992-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 03/02/2012] [Indexed: 11/30/2022]
Abstract
Necrotizing fasciitis (NF) is an unusual, life threatening, rapidly advancing infection characterized by widespread fascial and subcutaneous tissue necrosis and gangrene of the skin. It most commonly affects the extremities, abdominal wall and perineum, whereas cervical NF is rare. NF of the head and neck is often caused by both aerobic and anaerobic microorganisms found in the upper aerodigestive tract. Usually, cervical NF originates from odontogenic, tonsillar and pharyngeal infection, and it is very rarely a complication of surgical procedure. Without immediate surgical treatment, cervical NF leads to mediastinitis and fatal sepsis. There is only one case of cervical NF after total laryngectomy described in the literature. We report two cases of cervical NF after total laryngectomy, selective neck dissection and primary vocal prosthesis insertion. In both cases, the infection spreads to thoracic region and in one of them NF was associated with Lemierre's syndrome, i.e., thrombosis of the internal jugular vein. In both patients, vocal prosthesis was inserted during the infection and did not influence the healing process.
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Affiliation(s)
- Ana Danic Hadzibegovic
- Department of ENT, Head and Neck Surgery, General Hospital Dr. Josip Bencevic, Osijek School of Medicine, Josip Juraj Strossmayer University, Andrije Stampara 42, 35000, Slavonski Brod, Croatia
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Khadakkar SP, Harkare VV, Deosthale NV, Gupta A. Necrotising fasciitis of the neck and anterior chest wall. Indian J Otolaryngol Head Neck Surg 2011; 63:87-9. [PMID: 22754850 DOI: 10.1007/s12070-011-0209-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 03/28/2009] [Indexed: 11/27/2022] Open
Abstract
Necrotising fasciitis is a rare but rapidly progressive and potentially life threatening infection of the soft tissue, involving subcutaneous tissue and deep fascial layer. It may affect any part of the body, but the extremities, abdominal wall, and perineum are most commonly affected. Here we present a case of necrotising fasciitis of the neck and anterior chest wall which is a rare presentation. The risk factor of the disease was uncontrolled diabetes mellitus. We could treat this patient successfully by early recognition, aggressive surgical debridement, intravenous antibiotics, fractional doses of insulin to control diabetes and other supportive measures.
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Cavel O, Gil Z, Khafif A, Leider-Trejo L, Segev Y, Werner B, Pivarov A, Fliss DM. Necrotizing Fasciitis of the Skull Base and Neck in a Patient with AIDS and Non-Hodgkin's Lymphoma. Skull Base 2007; 16:201-5. [PMID: 17471319 PMCID: PMC1766461 DOI: 10.1055/s-2006-950387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Necrotizing fasciitis is a rapidly progressing, life-threatening soft tissue bacterial infection found more frequently in immunocompromised subjects and rarely in the head and neck. We report a rare case of a patient with acquired immunodeficiency syndrome (AIDS) and non-Hodgkin's lymphoma (NHL) who presented with a high fever and supraorbital cellulitis 1 week after undergoing chemotherapy. He received intravenous antibiotic therapy but soon developed dyspnea and trismus with rapid extension of the cellulitis to the face, ipsilateral infratemporal fossa (ITF), and bilateral neck. An awake tracheotomy was followed by surgical exploration and drainage and debridement of the supraorbital and ITF areas, parotid gland, and bilateral neck. He received intravenous antibiotic therapy and the surgical wound was regularly debrided for 10 days. Following a gradual recovery, the patient was discharged 2 weeks later. Early antibiotic therapy, wide surgical exploration, and a secured airway are the therapeutic mainstay for necrotizing fasciitis of the skull base and neck.
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Affiliation(s)
- Oren Cavel
- Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ziv Gil
- Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avi Khafif
- Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Leonor Leider-Trejo
- Institute of Pathology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoram Segev
- Institute of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Werner
- Clinical Immunology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Pivarov
- Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M. Fliss
- Department of Otolaryngology, Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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