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Bal KK, Aslan C, Gür H, Bal ST, Ustun RO, Unal M. Deep neck infections mortal complications: Intrathoracic complications and necrotising fasciitis. World J Clin Cases 2024; 12:6383-6390. [DOI: 10.12998/wjcc.v12.i30.6383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/26/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND We planned this study considering that complications of deep neck infections can be seriously life threatening.
AIM To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity.
METHODS This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1, 2024. When the patient files were retrospectively examined, 16 of 188 patients (8.5%) were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications.
RESULTS There were a total of 16 patients in this study, 9 males (56.25%) and 7 females (43.75%). All patients were adults (> 18 years) and the mean age was 50.37 years ± 15.37 years. Female patients had a mean age of 40.42 years ±13.38 years, whereas for male patients was 58.11 years ± 12.44 years.
CONCLUSION Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries, intensive care unit monitoring, and mechanical ventilator support. Higher rates of morbidity and mortality should be expected in these patients who are hospitalized for longer periods of time.
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Affiliation(s)
- Kemal Koray Bal
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Türkiye
| | - Can Aslan
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Türkiye
| | - Harun Gür
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Türkiye
| | - Seda Turk Bal
- Department of Emergency Medicine, Tarsus State Hospital, Mersin 33460, Türkiye
| | - Recep Okan Ustun
- Department of Aestetic, Division of Plastic and Reconstructive Surgery, University of Health Sciences Mersin City Hospital, Mersin 33230, Türkiye
| | - Murat Unal
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Türkiye
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Bivahagumye L, Gosselet V, Cambier S, Puechmaille M, Gibold L, Saroul N. Cytobacteriological testing of drainage pus from peritonsillar abscess is not contributive in clinical practice: A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:264-267. [PMID: 38631947 DOI: 10.1016/j.anorl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
PURPOSE Peritonsillar abscess (PTA) is a frequent pathology. Treatment consists in drainage of the collection, associated to probabilistic antibiotic therapy. The usefulness of cytobacteriological testing (CBT) of the drainage pus is controversial. MATERIAL AND METHODS A retrospective study of patients managed for PTA between 2013 and 2020 in our university hospital was performed. The main objective was to assess the usefulness of CBT in the management of PTA. The secondary objectives were to determine the bacteriological profile involved in the onset of PTA and to assess the rate of bacterial resistance to antibiotics prescribed on a probabilistic basis. RESULTS The study included 207 patients: 70 outpatients (33%) and 137 inpatients (67%). Probabilistic antibiotic therapy was implemented in 100% of patients. CBT was performed systematically and was negative in 106 patients, revealing oropharyngeal flora in 40% of cases, polymicrobial flora in 50% and sterile samples in 10%. In the 101 patients with positive CBT, the bacteria isolated were penicillin-sensitive in 99%. All patients were successfully treated. In the light of the bacteriological results, no changes were made to the probabilistic antibiotic therapy introduced on admission. CONCLUSION CBT on drainage pus had no impact on the management of PTA. CBT is therefore unnecessary in patients with no comorbidities and no signs of severity at admission.
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Affiliation(s)
- L Bivahagumye
- Service d'ORL et chirurgie cervico-faciale, CRNH, unité de nutrition humaine, université de Clermont-Auvergne, CHU de Clermont-Ferrand, 28, rue Montalembert, 63000 Clermont-Ferrand, France; Inra, CRNH, unité de nutrition humaine, université Clermont Auvergne, Auvergne, Clermont-Ferrand, France.
| | - V Gosselet
- Service d'ORL et chirurgie cervico-faciale, CRNH, unité de nutrition humaine, université de Clermont-Auvergne, CHU de Clermont-Ferrand, 28, rue Montalembert, 63000 Clermont-Ferrand, France
| | - S Cambier
- Service de biostatistiques, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - M Puechmaille
- Service d'ORL et chirurgie cervico-faciale, CRNH, unité de nutrition humaine, université de Clermont-Auvergne, CHU de Clermont-Ferrand, 28, rue Montalembert, 63000 Clermont-Ferrand, France
| | - L Gibold
- Service de bactériologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - N Saroul
- Service d'ORL et chirurgie cervico-faciale, CRNH, unité de nutrition humaine, université de Clermont-Auvergne, CHU de Clermont-Ferrand, 28, rue Montalembert, 63000 Clermont-Ferrand, France; Inra, CRNH, unité de nutrition humaine, université Clermont Auvergne, Auvergne, Clermont-Ferrand, France
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Koç RH, ABakay MA, Sayın İ. Determining the prognostic value of CRP and neutrophil lymphocyte ratio in patients hospitalized for deep neck infection. Braz J Otorhinolaryngol 2024; 90:101492. [PMID: 39205364 PMCID: PMC11399593 DOI: 10.1016/j.bjorl.2024.101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/25/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES This study aims to assess the impact of the Neutrophil/Lymphocyte Ratio (NLR) and C-Reactive Protein (CRP), both markers of systemic inflammation, on the duration of hospitalization for Deep Neck Infections (DNIs). METHODS The research encompassed patients of all age groups admitted between January 2016 and January 2021 due to DNIs. Patient data, including demographic details, etiology, comorbidities, radiological findings, treatment specifics, laboratory results (CRP values, leukocyte counts, neutrophil counts, lymphocyte counts, NLR), culture outcomes, length of stay, complications, mortalities were retrospectively evaluated. Patients were categorized into two groups based on their hospitalization duration: less than 7-days and 7-days or more. Univariate and multivariate analyses were conducted to examine the association between age, NLR, CRP, and hospital stay length. RESULTS The study encompassed 275 patients, with a mean age of 36 ± 20.2 years. The mean hospital stay was 9.6 ± 6.6 days. Tonsillopharyngeal infections were the most common etiology (34%). Notably, in both univariate and multivariate analyses, age, NLR, and CRP values demonstrated significant (p < 0.05) predictive influence on hospitalization duration. CONCLUSION Age emerges as a determinant that affects hospital stay duration in DNIs. Moreover, NLR is proven to be comparable to CRP in predicting hospitalization length for these patients. NLR's feasibility as a cost-effective predictive marker, being conveniently derived from routine complete blood count assessments, adds to its clinical significance. This study underscores the potential value of NLR and CRP in informing patient management and care strategies for DNIs.
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Affiliation(s)
- Recep Haydar Koç
- Sultangazi Haseki Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey.
| | - Mehmet Akif ABakay
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey
| | - İbrahim Sayın
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey
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Mejias CD, Hubbard D, Jeong E, Reddy A. CT-guided transcutaneous drainage of peritonsillar abscess after failed ultrasound-guided drainage: A case report. Radiol Case Rep 2024; 19:654-660. [PMID: 38111556 PMCID: PMC10726339 DOI: 10.1016/j.radcr.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 12/20/2023] Open
Abstract
Peritonsillar abscess (PTA) is the most common deep neck infection in the United States. Timely treatment of PTA with antibiotics and aspiration or drainage is paramount, as delay in management may lead to further complications. The oral approach is the preferred route of drainage however may not always be accessible, warranting consideration of other routes of drainage. To the best of our knowledge, CT guidance for aspiration or drainage of a PTA has not been previously described. We present a 50-year-old patient with a PTA who initially presented with throat pain and dysphagia, rapidly developed upper airway obstruction, and required intubation. After the failure of clinical improvement and unsuccessful PTA aspiration via the conventional oral route, successful CT-guided percutaneous needle aspiration was performed by neuroradiology. Shortly thereafter, the patient clinically improved and was discharged with an oral course of antibiotics and follow-up on an as-needed basis. Total hospital length of stay was seven days. The complex patient may not allow for simple incision and drainage or needle aspiration of a suspected PTA. Assistance with ultrasound guidance is often utilized, however, challenges may persist depending on the anatomical location of the PTA and patient comorbidities. In cases where external drainage is considered and conventional ultrasound imaging is particularly challenging, CT-guided percutaneous aspiration may provide a useful alternative. PTAs are common with the possibility of complication. Although the usual route of drainage is oral, there are instances in which this cannot be performed. This case exhibits an uncommon approach to PTA aspiration via an external CT-guided percutaneous approach with rapid subsequent clinical improvement, exhibiting the utility of CT guidance.
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Affiliation(s)
| | - Daniel Hubbard
- Department of Radiology, Medical College of Georgia at Augusta University, Augusta GA, USA
| | - Eun Jeong
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Ambur Reddy
- Department of Radiology, Neuroradiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Mehmed M, Walters B, Keys H, Hnynn Si PE, Athavale N, Abdelhafiz AH. Spontaneous retropharyngeal abscess presenting as delirium in a frail older woman: a case-based review. Hosp Pract (1995) 2024; 52:39-45. [PMID: 38466020 DOI: 10.1080/21548331.2024.2329043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Retropharyngeal abscess (RPA) is an uncommon infection in older people, which usually presents with localized upper airway symptoms. CASE PRESENTATION We present a case of RPA in a 69-year-old frail woman with co-morbidities, who presented atypically with delirium. She initially complained of general symptoms of malaise, body aches and general decline. Her symptoms progressed to hypoactive delirium before she started to localize her complaints to the upper airway. The delirium presentation of RPA is not commonly reported in the literature. Co-morbidities and frailty are likely to be the underlying risk factors for delirium presentation in this case. Most of the RPA cases reported in older people in the literature presented typically with localized symptoms, however these cases had lower burden of morbidities and reported no frailty. In our case report, poor mouth hygiene and dental caries were thought to be the source of infection. Early intervention with antibiotic treatment for total of four weeks resulted in a full recovery. CONCLUSION RPA may present with delirium in older people with frailty and co-morbidities. Poor oral hygiene and dental caries, if left untreated, may progress into serious deep space neck infection.
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Affiliation(s)
- Melisa Mehmed
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Ben Walters
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Heather Keys
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Pann Ei Hnynn Si
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | | | - Ahmed H Abdelhafiz
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
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Tao X, Hua H, Liu Y. A novel model for predicting mortality in the management of deep neck infections. EAR, NOSE & THROAT JOURNAL 2022:1455613221133245. [PMID: 36318220 DOI: 10.1177/01455613221133245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Deep neck infections (DNIs) are a common and intractable disease encountered in ENT clinics that impose a significant medical and financial burden on affected individuals and their families. However, insufficient data are currently available for predicting outcomes in cases of DNI. The present study thus sought to develop a novel model capable of predicting treatment outcomes of DNI patients just using indicators at the visit. METHODS Patients with DNIs treated from 2010 to 2022 were included in the present study. Patient data were retrospectively collected from medical records. Risk factors associated with mortality were identified using logistic regression models. A predictive model was constructed based on odds ratios for factors calculated using a multivariate regression model. RESULTS In total, 153 patients were enrolled in the present study. Risk factors associated with mortality included age >50 years, residence in a rural area, dyspnea at visit, the involvement of multiple infected sites, serum albumin<34 g/L, renal insufficiency, mediastinitis, pulmonary infection, and septic shock. A multivariate regression model revealed that mediastinitis (OR: 7.308, P < 0.001), serum creatinine>95 μmol/L (OR: 23.363, P < 0.05), and serum albumin<34 g/L (OR: 13.837, P < 0.05) were independent predictors of mortality in deep neck infection patients, with serum creatinine>95 μmol/L being particularly critical to the outcomes. Diabetes was not the predictor of mortality but was associated with long-term hospitalization (P < 0.001). CONCLUSIONS In summary, the model constructed in the present study was capable of estimating the potential for poor outcomes in DNI patients before the initiation of treatment. These findings may help improve doctor-patient communication, especially for those struggling financially.
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Affiliation(s)
- Xiaoyao Tao
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongting Hua
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yehai Liu
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Tailor BV, Devakumar H, Myuran T, Ioannidis D. Parapharyngeal and floor-of-mouth abscess secondary to tonsillar phlegmon: A rare and unusual cause of Ludwig's angina. Clin Case Rep 2022; 10:e6325. [PMID: 36172328 PMCID: PMC9468653 DOI: 10.1002/ccr3.6325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
We present an unusual case of Ludwig's angina secondary to a left tonsillar phlegmon in a previously fit and well 50-year-old woman. This tonsillar phlegmon spread along the peritonsillar/parapharyngeal plane to cause a diffuse cellulitis and collection in the submental, sublingual, and submandibular spaces despite empirical intravenous antibiotic therapy.
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Affiliation(s)
- Bhavesh V. Tailor
- Department of Otolaryngology, Colchester General HospitalEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - Haran Devakumar
- Department of Otolaryngology, Colchester General HospitalEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - Tharsika Myuran
- Department of Otolaryngology, Colchester General HospitalEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - Dimitrios Ioannidis
- Department of Otolaryngology, Colchester General HospitalEast Suffolk and North Essex NHS Foundation TrustColchesterUK
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Kamiński B, Błochowiak K, Kołomański K, Sikora M, Karwan S, Chlubek D. Oral and Maxillofacial Infections—A Bacterial and Clinical Cross-Section. J Clin Med 2022; 11:jcm11102731. [PMID: 35628858 PMCID: PMC9145374 DOI: 10.3390/jcm11102731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
The treatment of oral and maxillofacial infections is based on a recognized algorithm that may require modification under the influence of various local and systemic factors. The aim of this study was to present a comprehensive and microbiological profile of oral and maxillofacial infections, and explore possible correlations between the course of an infection and selected systemic factors based on the medical records of 329 patients affected by the disease. We identified most common clinical, demographic, bacterial, and laboratory parameters specific for these infections. There were statistically significant differences in Erythrocyte Sedimentation Rate, number of accompanying diseases, otalgia, dyspnea, and speech difficulties occurrence and neck space involvement between diabetic and non-diabetic patients. The duration of hospitalization and accompanying diseases correlated positively with the patient age and white blood cell count, and C-reactive protein value negatively correlated with age. The primary cause of infections, age, and comorbid diseases can modify the infection course and increase the risk of developing serious complications. It confirms the need for effective and targeted bacterial treatment in the early stages of infections. Age and general diseases are the most important systemic factors determining the infection symptoms and laboratory parameters assessing the severity of the inflammatory process.
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Affiliation(s)
- Bartłomiej Kamiński
- Department of Otolaryngology, Maria Skłodowska-Curie District Hospital, 26-110 Skarżysko-Kamienna, Poland;
| | - Katarzyna Błochowiak
- Department of Oral Surgery and Periodontology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Konrad Kołomański
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, 25-375 Kielce, Poland; (K.K.); (M.S.)
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, 25-375 Kielce, Poland; (K.K.); (M.S.)
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sławomir Karwan
- Department of Maxillofacial Surgery, Regional Specialized Children’s Hospital, 10-561 Olsztyn, Poland;
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
- Correspondence:
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Baša M, Sovtić A. Treatment of the most common respiratory infections in children. ARHIV ZA FARMACIJU 2022. [DOI: 10.5937/arhfarm72-37857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Acute respiratory infections are the most common group of infective diseases in the pediatric population. Although the improvement of health care and vaccination program has led to a significant reduction in the incidence of certain respiratory infections, the combination of a high prevalence in vulnerable pediatric categories and uncritical prescription of antibiotics, due to the inability to adequately distinguish between viruses and bacterial etiology, still represents a significant challenge for the public health system. In order to promote rational antibiotic therapy with an overall improvement of both diagnostic and therapeutic principles, acute respiratory diseases have been the subject of consideration in numerous publications and national guidelines. Nonspecific clinical manifestations with pathogen heterogeneity and both anatomical and physiological characteristics of the child's respiratory system during growth and development have created the need for individualized therapy. Since the guidelines emphasize the undoubtful and crucial benefits of symptomatic therapy (e.g. analgesics in acute otitis media, supplemental oxygen in lower respiratory tract infections with hypoxemia), the use of antibiotics and corticosteroids is indicated in selected cases with a severe clinical picture. The choice of antibiotic depends on the clinical condition, presumed causative agent, and local epidemiologic circumstances. Respiratory support (oxygen therapy and/or artificial ventilation) is reserved for inpatient treatment of cases with a particularly severe clinical picture and associated complications.
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Sideris G, Malamas V, Tyrellis G, Maragkoudakis P, Delides A, Nikolopoulos T. Ubi pus, ibi evacua: a review of 601 peritonsillar abscess adult cases. Ir J Med Sci 2021; 191:1849-1853. [PMID: 34617243 PMCID: PMC8494509 DOI: 10.1007/s11845-021-02796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
Background Peritonsillar abscess (PTA) is the most common deep neck infection, occurring as a consequence of bacterial acute tonsillitis or as a result of infection of the Weber glands, with frequent and life-threatening complications. Aim To investigate several factors associated with complications and worse prognosis, such as defining the method of surgical drainage and treatment of a PTA which remains an area of controversy in the literature Methods The purpose of this retrospective study is to examine the epidemiological, clinical, and laboratory findings of 601 adult patients and to discuss them along with their treatment plan. Results Pharyngalgia was the most common reported symptom, followed by trismus, odynophagia, fever, hot potato voice, malaise, and cervical lymphadenopathy. Sixty-eight patients developed complications. Streptococcus species were the most common pathogens. A statistically significant difference was found in days of hospitalization, WBC and CRP levels, age, and the pre-existing systemic diseases between patients with and without complications. A comparison of patients treated with intravenous and oral antibiotics revealed no statistically significant difference. Conclusion Οver 10% of PTA cases may develop complications, the most common of which is extension into deep neck spaces. Comorbid conditions increase the risk of complications. Despite the wide range of treatment strategies, incision and drainage remain the cornerstone of surgical treatment. In patients with no comorbidities, intravenous antibiotics appear to have no advantage over oral antibiotics.
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Affiliation(s)
- Giorgos Sideris
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece.
| | - Vangelis Malamas
- Department of Infomatics, University of Peiraeus, Peiraeus, Greece
| | - George Tyrellis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Pavlos Maragkoudakis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Alexander Delides
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
| | - Thomas Nikolopoulos
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Rimini 1 Chaidari, 124 62, Athens, Greece
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Tiefel NL, Lorenz M, Bartlett TR. Adult Patients With Peritonsillar Abscess: What Nurse Practitioners in Primary Care Need to Know. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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A Nationwide Population-Based Study on the Incidence of Parapharyngeal and Retropharyngeal Abscess-A 10-Year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031049. [PMID: 33504039 PMCID: PMC7908373 DOI: 10.3390/ijerph18031049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan’s citizens. During 2007–2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20–44, 45–64, and >64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 per 100,000 people. The gender-specific incidence rates per 100,000 people were 3.34 for males and 1.94 for females with a male:female gender ratio of 1.72. A slight increase in incidence rates among both genders over the study period was noted. Age-specific rates were lowest in the 20–44 age group with a mean annual incidence of 2.00 per 100,000 people, and the highest rates were noted in the age groups of 45–64 and >64 years with mean annual incidences of 3.21 and 3.20, respectively. We found that PRPA is common in Taiwan, males and older individuals are more susceptible to it, and incidence has increased in recent years.
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Bal KK, Unal M, Delialioglu N, Oztornaci RO, Ismi O, Vayisoglu Y. Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients. Braz J Otorhinolaryngol 2020; 88:511-522. [PMID: 32868223 PMCID: PMC9422577 DOI: 10.1016/j.bjorl.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/20/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
Introductıon Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. Objectives Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. Methods A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. Results According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). Conclusions Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.
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Affiliation(s)
- Kemal Koray Bal
- University of Health Sciences Adana City Hospital, Department of Otorhinolaryngology & Head and Neck Surgery, Adana, Turkey.
| | - Murat Unal
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Nuran Delialioglu
- University of Mersin, Faculty of Medicine, Department of Microbiology, Mersin, Turkey
| | - Ragip Onur Oztornaci
- University of Mersin, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin, Turkey
| | - Onur Ismi
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Yusuf Vayisoglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
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Watanabe Y, Nagao Y, Endo H, Yamane I, Hirata M, Hatakeyama K. An intubated 7-month-old infant with a retropharyngeal abscess and multidrug-resistant Streptococcus mitis. Clin Case Rep 2019; 7:2443-2448. [PMID: 31893077 PMCID: PMC6935668 DOI: 10.1002/ccr3.2528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/19/2019] [Accepted: 10/09/2019] [Indexed: 12/23/2022] Open
Abstract
The profile of antimicrobial resistance (ie, antibiogram) may be disparate between children and adults. An infant developed severe deep neck infection with a multidrug-resistant microbe. The microbe was more drug-resistant in children than in adults, in our hospital. Treatment of a child should be guided by the antibiogram obtained from children.
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Affiliation(s)
| | - Yoshiro Nagao
- Department of PediatricsFukuoka Tokushukai HospitalKasugaJapan
| | - Hisashi Endo
- Department of PediatricsFukuoka Tokushukai HospitalKasugaJapan
| | - Ichiro Yamane
- Department of PediatricsFukuoka Tokushukai HospitalKasugaJapan
| | - Masaaki Hirata
- Department of PediatricsFukuoka Tokushukai HospitalKasugaJapan
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Kimura A, Miyamoto S, Yamashita T. Clinical predictors of descending necrotizing mediastinitis after deep neck infections. Laryngoscope 2019; 130:E567-E572. [PMID: 31747058 DOI: 10.1002/lary.28406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/02/2019] [Accepted: 10/21/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify the clinical predictors of descending necrotizing mediastinitis (DNM) secondary to deep neck infections (DNIs) before treatment. STUDY DESIGN Retrospective case series. METHODS We reviewed 73 patients with DNIs who had been treated with external drainage at our institute between April 2009 and March 2019. We divided these patients into either a DNI group without mediastinitis (n = 55) or a DNM group secondary to DNI (n = 18). We collected clinical data and compared them between the groups, conducting univariate and multiple logistic regression analysis to identify the predictors of DNM. RESULTS We identified age, C-reactive protein (CRP), neutrophil percentage, lymphocyte percentage, neutrophil to lymphocyte ratio (NLR), presence of comorbidities, presence of gas, and abscess extension below the hyoid bone as statistically significant by univariate analysis. Moreover, multiple logistic regression analysis showed that age ≥55 years, NLR ≥13, and CRP ≥30 mg/dL were statistically significant. CONCLUSIONS We identified age ≥55, NLR ≥13, and CRP ≥30 before DNI treatment as clinical predictors of a DNM complication. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E567-E572, 2020.
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Affiliation(s)
- Akari Kimura
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shunsuke Miyamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Taku Yamashita
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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Beka D, Lachanas VA, Doumas S, Xytsas S, Kanatas A, Petinaki E, Skoulakis C. Microorganisms involved in deep neck infection (DNIs) in Greece: detection, identification and susceptibility to antimicrobials. BMC Infect Dis 2019; 19:850. [PMID: 31615449 PMCID: PMC6794762 DOI: 10.1186/s12879-019-4476-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background To determine, from October 2010 to October 2018, the epidemiology of Deep Neck Infections (DNIs), regarding the detection, the identification and the susceptibility to antimicrobials of causative microorganisms, in Thessaly-Central Greece. Methods An analysis of data from a prospective database was conducted on 610 consecutive patients with DNIs treated in the Otolaryngology / Head & Neck Surgery Department of University Hospital of Larissa. Demographics, clinical features and microbiological data were analyzed. Results Among the 610 patients (1,9/1 male to female ratio, mean age: 39,24 ± 17,25) with DNIs, 579 had a single space (94,9%), while the remaining 31 had a multi-space (5,1%) DNI. The most common areas affected were the peritonsillar space (84,6%) followed by the submandibular space (6,5%). Clinical samples were obtained from 462 patients, and were tested by culture and by the application of 16S rRNA PCR. Two hundred fifty-five samples (55,2%) gave positive cultures, in which Streptococcus pyogenes and Staphylococcus aureus were predominant. The application of the 16S rRNA PCR revealed that 183 samples (39,6%) were positive for bacterial DNA; 22 of them, culture negative, were found to be positive for anaerobic (Fusobacterium necrophorum, Actinomyces israellii etc) and for fastidious microorganisms (Brucella mellitensis, Mycobacterium avium). Conclusion DNIs represent a medical and surgical emergency and evidence-guided empirical treatment with intravenous infusion of antibiotics at the time of diagnosis is mandatory, highlighting the importance of epidemiological studies regarding the causative microorganisms. Although, in our study, the predominant pathogens were S. pyogenes and S. aureus, the combination of culture and molecular assay revealed that anaerobic bacteria play also a significant role in the pathogenesis of DNIs. Based on the local epidemiology, we propose as empirical therapy the intravenous use of a beta-lactam /beta-lactamase inhibitor; metronidazole or clindamycin can be added only in specific cases such as in immunocompromised patients.
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Affiliation(s)
- Despoina Beka
- Department of Otorhinolaryngology, University Hospital of Larissa, Larissa, Greece
| | - Vasileios A Lachanas
- Department of Otorhinolaryngology, University Hospital of Larissa, Larissa, Greece
| | - Stergios Doumas
- OMFS Department, Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Stelios Xytsas
- Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece
| | - Anastasios Kanatas
- OMFS Department, Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Efi Petinaki
- Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece.
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Nasir SB, Shuaibu IY, Labaran SA, Inusa A. Management of Deep Neck Space Infections in a Tertiary Center in North West Nigeria. Niger J Surg 2019; 25:183-187. [PMID: 31579374 PMCID: PMC6771174 DOI: 10.4103/njs.njs_19_19] [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: 11/04/2022] Open
Abstract
Background Deep neck space infection (DNSI) is a potentially fatal condition that more commonly results from dental and tonsillar infections. Timely intervention is, therefore, crucial when such patients present to the managing physician. Objective The objective of this study is to review the etiology, clinical presentation, and treatment outcome of patients managed for DNSIs over a period of 7 years at National Ear Care Centre, Kaduna. Methodology The record of patients managed for DNSIs over a 7-year period between January 2010 and December 2016 was reviewed. Data obtained included demographic characteristics such as age, sex, occupation, level of education, main presenting symptoms, duration of symptoms, etiology of the DNSI, location of the infection, comorbidity, bacteriology, duration of hospital stay, and type of treatment given. The data were analyzed using the Statistical Package of the Social Sciences version 23.0. Results A total of 55 patients presented with DNSIs, and there were 34 (61.8%) females and 21 (38.2%) males, with a sex ratio of 1.6:1. The age range of the patients was 1-71 years, with a mean age of 30.7 years (standard deviation of 18.1). The most common etiologic factor among these patients was tonsillar-related infection which accounted for 24 (43.6%). The most common symptom at presentation was fever (96.4%), followed by odynophagia (60%). Peritonsillar space infection as seen in 25 (45.5%) patients was the most common region affected, followed by submandibular space infection. Of the 35 (64%) patients who had incision and drainage, Staphylococcus aureus was the most common organism isolated in 16 (45.7%), followed by Streptococcus pneumoniae (11, 31.4%). Majority (38, 69.1%) of the patients spent <5 days on admission. Conclusion This study shows that oropharyngeal and orodental infections are the most common causes of DNSIs. Educating the populace about orodental health may help in reducing cases of DNSIs in Nigeria.
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Affiliation(s)
| | - Iliyasu Yunusa Shuaibu
- Department of Surgery, Division of Otorhinolaryngology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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