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Goenka PK, Hall M, Shah SS, Florin TA, Leone N, Narayanan S, Ishman S, Gill P, Liewehr S, Palumbo N, McGeechan S, Mestre M, Parikh K. Corticosteroids in the Treatment of Pediatric Retropharyngeal and Parapharyngeal Abscesses. Pediatrics 2021; 148:peds.2020-037010. [PMID: 34697219 DOI: 10.1542/peds.2020-037010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) includes antibiotics, with possible surgical drainage. Although corticosteroids may decrease inflammation, their role in the management of RPAs and PPAs is unclear. We evaluated the association of corticosteroid administration as part of initial medical management on drainage rates and length of stay for children admitted with RPAs and PPAs. METHODS We conducted a retrospective study using administrative data of children aged 2 months to 8 years discharged with RPAs and PPAs from 2016 to 2019. Exposure was defined as systemic corticosteroids administered as part of initial management. Primary outcome was surgical drainage. Bivariate comparisons were made between patients in the corticosteroid and noncorticosteroid groups by using Wilcoxon rank or χ2 tests. Outcomes were modeled by using generalized linear mixed-effects models. RESULTS Of the 2259 patients with RPAs and PPAs, 1677 (74.2%) were in the noncorticosteroid group and 582 (25.8%) were in the corticosteroid group. There were no significant differences in age, sex, or insurance status. There was a lower rate of drainage in the corticosteroid cohort (odds ratio: 0.28; confidence interval: 0.22-0.36). Patients in this group were more likely to have repeat computed tomography imaging performed, had lower hospital costs, and were less likely to have opioid medications administered. The corticosteroid cohort had a higher 7-day emergency department revisit rate, but there was no difference in length of stay (rate ratio 0.97; confidence interval: 0.92-1.02). CONCLUSIONS Corticosteroids were associated with lower odds of surgical drainage among children with RPAs and PPAs.
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Affiliation(s)
- Pratichi K Goenka
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Matthew Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Samir S Shah
- Division of Hospital Medicine and Department of Pediatrics
| | - Todd A Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nicole Leone
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Sridaran Narayanan
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and School of Medicine, George Washington University, Washington, District of Columbia
| | - Stacey Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Peter Gill
- Division of Paediatric Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Sheila Liewehr
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Nancy Palumbo
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Stacy McGeechan
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Marcos Mestre
- Division of Pediatric Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida
| | - Kavita Parikh
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and School of Medicine, George Washington University, Washington, District of Columbia
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Torretta S, Ibba T, Guastella C, Gaini L, Di Cicco M, Folino F, Marchisio P, Bosis S, Pinzani R, D'Amico M, Pignataro L. Management of upper retropharyngeal abscesses in children: Two case reports of a troublesome situation. Clin Case Rep 2021; 9:e04598. [PMID: 34631059 PMCID: PMC8489505 DOI: 10.1002/ccr3.4598] [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: 02/09/2021] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Management of upper retropharyngeal abscesses in children is challenging. In surgical cases, ultrasound-assisted intra-operative procedures may be helpful to reach peculiar locations, thus reducing surgical morbidity and complications rate.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Tullio Ibba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Claudio Guastella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Lorenzo Gaini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Maurizio Di Cicco
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Francesco Folino
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Raffaella Pinzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Mario D'Amico
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
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Abstract
The last 3 decades have seen a shift in the epidemiology of epiglottitis. Epiglottitis was once most commonly associated with Haemophilus influenzae type B. However, with the implementation of the H. influenzae type B vaccine in 1985, the incidence has drastically declined. There are now new emerging pathogens-bacteria, viruses, and fungi-causing epiglottitis. Here, we report the first case of epiglottitis secondary to influenza A in a former full-term, vaccinated infant who presented with cough, fever, stridor, pursed lip breathing, and progressive respiratory distress and eventual respiratory failure. This case highlights the presentation and clinical course of epiglottitis and describes a rare clinical feature, pursed lip breathing, in an infant.
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Ali NES, Alyono JC, Koltai PJ. Neonatal retropharyngeal abscess with complications: Apnea and cervical osteomyelitis. Int J Pediatr Otorhinolaryngol 2019; 126:109613. [PMID: 31382216 DOI: 10.1016/j.ijporl.2019.109613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the clinical presentation and management strategies for neonatal retropharyngeal abscess (RPA). METHODS Retrospective chart review was performed, and literature reviewed. RESULTS We report two cases of neonatal RPA, with one complicated by cervical osteomyelitis, and the other presenting with apparent life-threatening events (ALTEs). A 6-week-old female underwent transoral drainage of an RPA, which grew methicillin sensitive Staphylococcus aureus. She had a prolonged recovery course and was found to have developed osteomyelitis of the dens and atlas. She was treated with 14 weeks of IV antibiotics and rigid collar fixation for spinal cord instability. A 2-month-old female was admitted after multiple ALTEs with episodes of apnea and pallor. Direct laryngoscopy revealed a bulging RPA, which was drained transorally. This grew multiple organisms including methicillin resistant Staphylococcus aureus, Streptococcal oralis and Prevotella species. CONCLUSIONS Uncommon in neonates, RPA can present in this age group without fever, and are is likely to have airway complications than in older children. In cases with prolonged recovery, additional diagnostic intervention is recommended to rule out rare complications such as osteomyelitis. Emphasis in such complex cases is placed on a multidisciplinary approach to patient care, coordinating neonatologists, infectious disease specialists, neurosurgeons, and otolaryngologists.
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Affiliation(s)
- Noor-E-Seher Ali
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer C Alyono
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Koltai
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Balfour-Lynn IM, Wright M. Acute Infections That Produce Upper Airway Obstruction. KENDIG'S DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2019. [PMCID: PMC7152287 DOI: 10.1016/b978-0-323-44887-1.00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This chapter discusses the common and potentially serious infective causes of acute upper airway obstruction in children. The laryngeal anatomy of young children makes them particularly susceptible to upper airway obstruction, and during acute infections this is exacerbated by inflammation and edema of the airway mucosa. The most common cause of infective upper airway obstruction in children is viral laryngotracheobronchitis, or croup, which is usually a mild and self-limiting illness, but management with corticosteroids may still be necessary. Bacterial causes of upper airway obstruction have fortunately become rare since the introduction of the Haemophilus influenzae B (HiB) immunization, but a few cases of epiglottitis do still occur due to nonimmunization, vaccine failure, and infection with non-HiB organisms. These cases constitute a medical emergency due to the risk of rapid progression to complete airway obstruction. Other rare conditions are discussed including bacterial tracheitis, diphtheria, retropharyngeal, and peritonsillar abscesses. Key learning points in this chapter include the main discriminating factors of the various causes of infective upper airway obstruction, the importance of a calm and minimally distressing approach to the child presenting with stridor, and the need for early anesthetic team involvement in cases with a suspected bacterial etiology or signs of impending airway obstruction.
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Infections of the Upper and Middle Airways. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152082 DOI: 10.1016/b978-0-323-40181-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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Khudan A, Jugmohansingh G, Islam S, Medford S, Naraynsingh V. The effectiveness of conservative management for retropharyngeal abscesses greater than 2 cm. Ann Med Surg (Lond) 2016; 11:62-65. [PMID: 27761237 PMCID: PMC5065001 DOI: 10.1016/j.amsu.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/02/2016] [Accepted: 10/02/2016] [Indexed: 11/06/2022] Open
Abstract
Objectives Conservative management for retropharyngeal abscesses <2 cm is now a first line option. It is unclear if conservative management can be used to manage larger abscesses without increased morbidity and mortality. Study design A prospective case series was performed from 2012 to 2015 by the Otolaryngology department of the San Fernando General Hospital involving pediatric patients who presented with retropharyngeal abscesses. All patients were initially treated with antibiotics alone. Methods Patients with clinical features and CT scan confirmation of a retropharyngeal abscess were included in the study. Those who improved clinically and biochemically within 48 h continued to be treated conservatively and those who deteriorated had surgical intervention. Results Sixteen patients fulfilled the inclusion criteria. Most patients were Afro Trinidadian males between the ages of two and five who were also found to be iron deficient. Drooling was a sensitive predictor for the presence of an abscess but did not indicate the need for drainage. Hoarseness was the clinical feature that prompted surgical intervention. Sixty three percent of patients had an abscess >2 cm of which 90% improved within 48 h. One patient required surgical drainage with no increase in morbidity or mortality. Conclusion Conservative management of retropharyngeal abscesses >2 cm can be offered to patients during the first 48 h. If the patient demonstrates clinical and biochemical improvement, antibiotics alone can be continued. If the patient deteriorates, surgical drainage can be subsequently performed with no increase in morbidity and mortality. The retropharyngeal abscess is a deep neck space infection commonly seen in the pediatric population. Drainage of these abscesses is associated with multiple complications. Patient presenting with hoarseness requires surgical intervention. Conservative management can be successfully performed in patients who have abscesses that are greater than 2 cm. Patients treated with antibiotic alone need to be closely followed up for lack of improvement or deterioration.
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Affiliation(s)
- A Khudan
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - G Jugmohansingh
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - S Islam
- Department of General Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - S Medford
- Otorhinolaryngology-Head and Neck Surgery, San Fernando General Hospital, Trinidad and Tobago
| | - V Naraynsingh
- Department of Clinical Surgical Sciences, University of West Indies, St. Augustine, Trinidad and Tobago
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Martin C, Gabrillargues J, Louvrier C, Saroul N, Mom T, Gilain L. Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:277-82. [DOI: 10.1016/j.anorl.2013.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 03/16/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022]
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Antibiothérapie des infections ORL sévères du nourrisson et de l’enfant : Infections péripharyngées. Arch Pediatr 2013; 20 Suppl 3:e1-4. [DOI: 10.1016/s0929-693x(13)71419-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Balfour-Lynn IM, Davies JC. Acute Infections that Produce Upper Airway Obstruction. KENDIG & CHERNICKÂS DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2012. [PMCID: PMC7151954 DOI: 10.1016/b978-1-4377-1984-0.00025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Respiratory Tract Symptom Complexes. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7152091 DOI: 10.1016/b978-1-4377-2702-9.00021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grisaru-Soen G, Komisar O, Aizenstein O, Soudack M, Schwartz D, Paret G. Retropharyngeal and parapharyngeal abscess in children--epidemiology, clinical features and treatment. Int J Pediatr Otorhinolaryngol 2010; 74:1016-20. [PMID: 20598378 DOI: 10.1016/j.ijporl.2010.05.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 05/23/2010] [Accepted: 05/25/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the clinical presentation, diagnosis, management and complications of children with retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs). METHODS A retrospective chart review was conducted at two tertiary care, pediatric hospitals in Israel. The medical records of all children <18 years who had been admitted with a diagnosis of RPA or PPA during an 11-year period (January 1997 to February 2008) were reviewed. Data on demographics, presenting symptoms, physical examination findings, imaging studies and interpretation, laboratory results, hospital course, medical treatment and surgical interventions were retrieved. RESULTS A total of 39 children were diagnosed as having RPA (n=26, 67%) or PPA (n=13, 33%). There was a predominance of boys (61.5%). The mean age of all the children at diagnosis was 4 years. The annual incidence increased over the 11-year period. The most common symptoms at presentation included fever (n=27, 70%) and neck pain (n=24, 62%). The physical examination revealed cervical lymphadenopathy in 30 children (77%), limitation of neck movements in 25 (64%), torticollis in 21 (54%), drooling in three (8%), and stridor in two (5%). Computerized tomographic (CT) scanning with contrast was performed in 37 patients (95%), of whom 17 underwent surgical drainage. Thirteen children were positively diagnosed as having an abscess by the finding of pus at surgery, of whom 12 had been found to have an abscess on their CT scan. All the patients received intravenous antibiotics. There was no significant difference in the duration of hospital stay between those who underwent surgery and those who were treated with antibiotics alone. There were no treatment failures and no complications in either of the two groups. CONCLUSION Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Many patients with RPA and PPA can be treated successfully without surgery. CT scans are helpful in diagnosing and assessing the extent of the infection, but they are not always accurate.
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Affiliation(s)
- Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Infections rétro- et parapharyngées : vers une harmonisation des pratiques. Arch Pediatr 2009; 16:1225-32. [DOI: 10.1016/j.arcped.2009.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 01/26/2009] [Accepted: 05/30/2009] [Indexed: 11/23/2022]
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Abcès rétro- et parapharyngés de l’enfant : facteurs prédictifs d’échec du traitement médical. ACTA ACUST UNITED AC 2009; 126:112-9. [DOI: 10.1016/j.aorl.2009.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 03/24/2009] [Indexed: 11/15/2022]
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Pediatric retropharyngeal abscesses: a national perspective. Int J Pediatr Otorhinolaryngol 2008; 72:1837-43. [PMID: 18926577 DOI: 10.1016/j.ijporl.2008.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 08/28/2008] [Accepted: 09/02/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the resource utilization and national variation in the management of pediatric retropharyngeal abscesses. METHODS The Kids' Inpatient Database (KID) 2003 was analyzed. International Classification of Diseases, Ninth Revision code 478.24 was the inclusion criteria. RESULTS One thousand three hundred and twenty-one admissions with retropharyngeal abscess were sampled from the KID in 2003; there were no deaths. The mean age of patients was 5.1 years (S.D. 4.4 years); 63% were male. Of all admissions, 563 (43%) patients underwent surgical drainage of their infection; surgical patients had longer length of stays and total charges than patients managed medically. The average state spending per admission varied from $5126 (Utah) to $27,776 (California). There was seasonal variation in admissions with the highest percentage of admissions occurring in March (10.7%) and lowest in August (3.8%). Indicators of increased resource utilization included age (older patients), increased length of stay, non-elective admission, discharge quarter, and number of other diagnoses on record. There is a statistically significant decrease in the length of stay and total charges in patients admitted in the Midwest compared to other regions of the country. CONCLUSIONS This study demonstrates national demographics and normative data on a commonly treated pediatric disease process, retropharyngeal space infections. The average demographic of such a patient is a 5-year-old male from an urban location admitted in a non-elective fashion via the emergency department. The mean total charges were $16,377; 90% of admissions had total charges less than $28,511. Patients who underwent surgical procedures had mean total charges of $22,013. There exists significant national variation in resource utilization for this commonly treated disease process.
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Long SS. Respiratory Tract Symptom Complexes. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASE 2008. [PMCID: PMC7310934 DOI: 10.1016/b978-0-7020-3468-8.50029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Abstract
The clinical spectrum of infectious causes of upper airway obstruction has changed dramatically in the last few decades, especially after the introduction of vaccines against diphtheria and Haemophilus influenzae. Nevertheless, infectious causes of upper airway obstruction remain an important source of morbidity and potential mortality in the pediatric age group. Physicians caring for children need to be cognizant of the clinical presentation of this group of disorders because prompt recognition and early appropriate treatment are lifesaving. Epiglottitis, or supraglottitis as some authors prefer, is a potentially life-threatening bacterial infection of the epiglottis and surrounding tissues, including the aryepiglottic folds, the arytenoids, and the supraglottic larynx. Despite the virtual elimination of invasive H. influenzae type B infection, it is important for physicians caring for children to understand the management issues surrounding patients with supraglottitis to avoid disastrous outcomes. As illustrated in the following case, these children may not always present with classic features of supraglottitis.
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Methicillin-resistant Staphylococcus aureus as a cause of extensive retropharyngeal abscess in two infants. Pediatr Infect Dis J 2007; 26:1161-3. [PMID: 18043461 DOI: 10.1097/inf.0b013e3181461b3a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report 2 cases of extensive methicillin-resistant Staphylococcus aureus (MRSA) retropharyngeal abscesses in young infants. In 1 case, the abscess was associated with a reactive thrombosis of the jugular vein. Based on the existing literature and the rapid emergence of MRSA skin and soft tissue infections, it is possible that similar severe infections will occur with increasing frequency in young infants.
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Courtney MJ, Mahadevan M, Miteff A. MANAGEMENT OF PAEDIATRIC RETROPHARYNGEAL INFECTIONS: NON-SURGICAL VERSUS SURGICAL. ANZ J Surg 2007; 77:985-7. [DOI: 10.1111/j.1445-2197.2007.04295.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Breysem L, Smet MH. Thoracic Emergencies. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_31] [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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23
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Cheffer N, Sluder J. Deep neck infections in children: A case study and review of the literature. J Nurse Pract 2006. [DOI: 10.1016/j.nurpra.2006.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Weil-Olivier C, Sterkers G, François M, Garnier JM, Reinert P, Cohen R. [Tonsillectomy in 2005]. Arch Pediatr 2005; 13:168-74. [PMID: 16386410 DOI: 10.1016/j.arcped.2005.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 10/18/2005] [Indexed: 11/28/2022]
Abstract
During the past years, the number of tonsillectomies (only palatine tonsils are taken off) has decreased, indications for surgery have changed. A multi-disciplinal group of paediatricians tried to elaborate the state of the art in the field. Tonsils are the first line defense of high respiratory tract. The immune functions of their lymphoid tissue are multiple: mucosal antigens capture, presentation to lymphocytes, antigens specific proliferation of lymphocytes T and B, differentiation of lymphocytes in effectors lymphocytes and immune lymphocytes. Epithelial cells on the tonsils' surface express non-specific defense. These facts explain partly tonsils' hypertrophy. Tonsillectomy has no general immune consequences. In 2002, in France, 75,000 tonsillectomies were realized, of which 90% were in children. Tonsil's hypertrophy is the major indication, mandatory when sleep apnoeas exist. The main historical tonsillectomy indication for recurrent tonsillitis should decrease due to a more precise diagnostic (rapid test at bed site), an efficient antibiotics therapy and better care for pain. Other indications are scarce. Surgery, feasible from 9 months of age, requires a brief general anaesthesia and has very few contra-indications. The technique, operator dependent, relies on his experience. The only potentially severe complication is an haemorrhage due to scab fall between the eighth and twelfth days. It requires explanation and a written note given to parents. The possibility of lack of feeding and voice modification, usually transitory, should be known. Multiple consequences of tonsillectomy especially allergy have been alleged. Since the years 1980, it is well established that pre-existing allergy or asthma are not a contraindication. More, its deleterious impact on allergic children has not been demonstrated. Last, a gain of weight post-tonsillectomy is possible and could become a risk if excessive.
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Affiliation(s)
- C Weil-Olivier
- Service de Pédiatrie Générale, Hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 178, rue des Renouillers, 92700 Colombes, France.
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Luu TM, Chevalier I, Gauthier M, Carceller AM, Bensoussan A, Tapiero B. Acute adenitis in children: clinical course and factors predictive of surgical drainage. J Paediatr Child Health 2005; 41:273-7. [PMID: 15953328 DOI: 10.1111/j.1440-1754.2005.00610.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe clinical course of children hospitalized for a first episode of acute unilateral infectious adenitis and to identify factors predictive of surgical lymph node drainage. METHODS We reviewed medical records of children from 0 to 17 years of age discharged from a tertiary care pediatric center with a diagnosis of adenitis between 1 April 1996 and 31 March 2001. Patients were included if they had acute (< or = 10 days) unilateral lymph node swelling greater or equal to 2.5 cm on initial physical examination. Exclusion criteria were: bilateral adenitis or adenitis at more than one site; prior adenitis; underlying chronic disease. RESULTS Two hundred and eighty-four patients were included in this study. The mean age was 4.0 years (3.1 SD). Twenty-three per cent of infected nodes were > 5 cm in size and 92.6% were cervical. Thirteen of 252 blood cultures were positive (5.2%), of which one showed Streptococcus pneumoniae and 12 contaminants. Mean length of stay was 4.2 days (2.2 SD). Surgical node drainage was performed in 60 (21.1%) patients. Factors significantly associated with increased risk of surgical drainage were age < 1 year (adjusted OR: 14.5; 95% CI: 5.0-42.2) and node involvement > 48 h (adjusted OR: 2.9; 95% CI: 1.2-7.2). There were no major complications. Follow-up was documented in 183 patients, of whom 92.3% achieved complete healing. CONCLUSIONS Children hospitalized for a first episode of acute unilateral infectious adenitis generally do well. Younger patients and those with longer duration of node involvement before admission have an increased risk of surgical node drainage.
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Affiliation(s)
- Thuy Mai Luu
- Department of Pediatrics, Hôpital Sainte-Justine, Montreal, Québec, Canada
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Tuerlinckx D, Bodart E, Lawson G, De Wispelaere JF, De Bilderling G. Retropharyngeal and mediastinal abscess following adenoidectomy. Pediatr Pulmonol 2003; 36:257-8. [PMID: 12910589 DOI: 10.1002/ppul.10319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adenoidectomy is one of the most common surgical procedures in children. On rare occasions it can be complicated by a retropharyngeal abscess (RA). We report the case of a 9-year-old girl with an RA extending to the mediastinum following adenoidectomy. The mediastinal collection was successfully treated with computed tomography-guided percutaneous drainage to avoid extensive surgical procedure. Surgeons should be aware of these dramatic complications and should avoid overzealous surgery in the removal of the adenoid tissue.
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Affiliation(s)
- David Tuerlinckx
- Department of Pediatrics, Université Catholique de Louvain, Mont-Godinne, Yvoir, Belgium.
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Ishimine P. A young boy with stridor. PEDIATRIC CASE REVIEWS (PRINT) 2003; 3:141-9. [PMID: 12865707 DOI: 10.1097/01.pca.0000074024.71816.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paul Ishimine
- Children's Hospital and Health Center, San Diego, CA, USA
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Craig FW, Schunk JE. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. Pediatrics 2003; 111:1394-8. [PMID: 12777558 DOI: 10.1542/peds.111.6.1394] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to describe the clinical presentation of patients with retropharyngeal abscess (RPA), utility of imaging studies, and implications on management. METHODS A retrospective chart review was performed at a tertiary-care, pediatric hospital with cases identified by a discharge diagnosis of RPA; posttraumatic RPA cases were excluded. Patients without confirmatory radiographic findings, fluoroscopy, or computed tomography (CT) were excluded. RESULTS Sixty-four cases involving 64 patients were studied. The median age of the patients was 36 months; 48 (75%) of the 64 patients were younger than 5 years. The most common chief complaints were neck pain (38%), fever (17%), sore throat (17%), neck mass (16%), and respiratory distress or stridor (5%). In 29 children (45%), it was noted that there was limitation of neck extension, in 23 (36.5%) torticollis, and in 8 (12.5%) limitation of neck flexion. The physical examination revealed stridor with wheezing in only 1 patient (1.5%) and wheezing in 1 other (1.5%). Twenty-seven patients (42%) underwent surgery; 37 (58%) were treated with antibiotics only. Performance of a surgical procedure was significantly associated with CT scan findings. Ten (37%) of 27 patients with defined abscess on CT scan were treated with antibiotics alone. There were no treatment failures in either the antibiotic-only group or the antibiotics-plus-surgery group. CONCLUSIONS Children with RPA present with limitation of neck movement, especially difficulty extending their neck to look up. They rarely present with respiratory distress or stridor. CT scan is useful to distinguish patients with RPA from those with retropharyngeal cellulitis. Most patients with retropharyngeal cellulitis and some with RPA can be treated successfully without surgery.
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Affiliation(s)
- Frances W Craig
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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Husson A, Brasse-Lagnel C, Fairand A, Renouf S, Lavoinne A. Argininosuccinate synthetase from the urea cycle to the citrulline-NO cycle. EUROPEAN JOURNAL OF BIOCHEMISTRY 2003; 270:1887-99. [PMID: 12709047 DOI: 10.1046/j.1432-1033.2003.03559.x] [Citation(s) in RCA: 231] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Argininosuccinate synthetase (ASS, EC 6.3.4.5) catalyses the condensation of citrulline and aspartate to form argininosuccinate, the immediate precursor of arginine. First identified in the liver as the limiting enzyme of the urea cycle, ASS is now recognized as a ubiquitous enzyme in mammalian tissues. Indeed, discovery of the citrulline-NO cycle has increased interest in this enzyme that was found to represent a potential limiting step in NO synthesis. Depending on arginine utilization, location and regulation of ASS are quite different. In the liver, where arginine is hydrolyzed to form urea and ornithine, the ASS gene is highly expressed, and hormones and nutrients constitute the major regulating factors: (a) glucocorticoids, glucagon and insulin, particularly, control the expression of this gene both during development and adult life; (b) dietary protein intake stimulates ASS gene expression, with a particular efficiency of specific amino acids like glutamine. In contrast, in NO-producing cells, where arginine is the direct substrate in the NO synthesis, ASS gene is expressed at a low level and in this way, proinflammatory signals constitute the main factors of regulation of the gene expression. In most cases, regulation of ASS gene expression is exerted at a transcriptional level, but molecular mechanisms are still poorly understood.
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Affiliation(s)
- Annie Husson
- ADEN, Institut Fédératif de Recherches Multidisciplinaires sur les Peptides no. 23 (IFRMP 23), Rouen, France.
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Doyle DJ, Arellano R. Upper airway diseases and airway management: a synopsis. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2002; 20:767-87, vi. [PMID: 12512262 DOI: 10.1016/s0889-8537(02)00019-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article summarizes some of the more important upper airway conditions likely to affect airway management. A number of upper airway conditions may present difficult challenges to the anesthesiologist. For instance, infected airway structures may lead to partial airway obstruction, stridor, or even complete airway obstruction. Partial airway obstruction may be mild, as in snoring or nasal congestion, or may be more severe, perhaps requiring the use of airway adjuncts, such as a nasopharyngeal airway. Complete airway obstruction is usually managed by prompt intubation, but surgical airways are sometimes needed as a last resort.
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Affiliation(s)
- D John Doyle
- Department of General Anesthesiology E31, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Stevenson MD, Gonzalez del Rey JA. Upper airway obstruction: Infectious cases. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2002. [DOI: 10.1053/epem.2002.128768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kobayashi KI, Haruta T, Kubota M, Nishio T. A case of retropharyngeal abscess caused by penicillin-resistant Streptococcus pneumoniae. J Infect 2002; 44:267-9. [PMID: 12099737 DOI: 10.1053/jinf.2002.0991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report here a case of a 1-year-old girl with retropharyngeal abscess caused by penicillin-resistant Streptococcus pneumoniae (PRSP). Computed tomography disclosed a retropharyngeal mass lesion (4 cm x 3 cm in diameter), and the diagnosis was confirmed by needle aspiration of the retropharyngeal space, which yielded PRSP. To our knowledge, this is the first report of a young subject in whom retropharyngeal abscess was caused by this organism. Retropharyngeal abscess is most common in children younger than 3 or 4 years of age, during which period a high carriage rate of PRSP is also shown. This patient was successfully treated with panipenem/betamipron.
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Affiliation(s)
- K-I Kobayashi
- Department of Pediatrics, Kobe City General Hospital, Japan.
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Abstract
An infant who presents with acute, unexplained crying requires a thorough examination to identify the source of distress. We report the case of a 5-week-old infant who had sudden irritability and was found to have retropharyngeal cellulitis caused by group B Streptococcus.
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Affiliation(s)
- Florence T Bourgeois
- Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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McCarthy PL. Fever without apparent source on clinical examination. Curr Opin Pediatr 2002; 14:103-11. [PMID: 11880744 DOI: 10.1097/00008480-200202000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paul L McCarthy
- Yale Univerisity, School of Medicine, Department of Pediatrics, New Haven, Connecticut 06520-8064, USA.
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