Demographics of Pediatric Head and Neck Infections in a Tertiary Care Hospital

Effects of temperature and humidity on peritonsillar abscess volume of emergency patients

Climate and temperature have long been considered in relation to human diseases and mortality. In this study, we investigated whether daily temperature and humidity and patients' personal history affect the volume of peritonsillar abscesses (PTAs). We included 52 patients with PTAs who were admitted to the emergency department of the study hospital; their computed tomography data were analyzed, and PTA volume was measured. We investigated the possible correlation between PTA volume and mean/minimum/maximum temperature and humidity. Furthermore, we obtained personal history data, including information on drinking status, smoking status, dental problems, and patients' treatment experiences at local clinics before visiting the emergency department. The mean PTA volume was 3.93 mL, which was significantly correlated with temperature differences between 1 and 2 days before hospitalization and the day of hospitalization (P < .05) and also with a lack of treatment experience at local clinics (P < .001). However, no significant correlation was noted between PTA volume and the mean/minimum/maximum temperature and humidity on the day of hospitalization (P > .05). Similar findings were obtained for drinking status, smoking status, and dental problems (P > .1). PTA volume appears to be strongly associated with temperature differences between 1 and 2 days before hospitalization and the day of hospitalization. Patients with treatment experience at local clinics exhibited substantial increases in PTA volume. Thus, an increased PTA volume may be observed in patients who visit the emergency department without any treatment experience at local clinics or from environments that differ considerably from their current environment in terms of temperature.

Lymph node abscess caused by Francisella tularensis - a rare differential diagnosis for cervical lymph node swelling: a case report

BACKGROUND

Cervical lymph node swelling is quite a common symptom mainly caused by infections in the face or as metastasis of a malignant tumor. In infection cases in particular, rare diseases should never be overlooked. With an incidence of 120 cases in the United States of America (USA) and approximately 25 cases in Germany per year, infection with the pathogen Francisella tularensis is one of these rare diseases that can cause massive lymph node swellings and might even be fatal.

CASE PRESENTATION

The example of a healthy 67-year-old German woman who was treated at our university hospital presents a typical progression of a localized form of tularemia. The pathogen could be identified in a universal 16S ribosomal deoxyribonucleic acid (DNA) polymerase chain reaction. Pathogen-specific treatment with lymph node abscess incision, daily rinsing of the abscess cavity, and orally administered antibiotic therapy with doxycycline could cure our patient completely without any remaining complications.

CONCLUSION

In patients with cervical lymph node swelling caused by infection it is indispensable to perform specific identification of the pathogen for further local and specific antibiotic treatment. Possible infections with atypical bacteria like Francisella tularensis should never be ignored. Universal polymerase chain reactions are a suitable method for early detection of such rare pathogens.

Confluent Retropharyngeal, Lateral Pharyngeal, and Peritonsilar MRSA Abscess in an Infant

Neck abscesses such as retropharyngeal, peritonsilar, and lateral pharyngeal are well described, typically cause a characteristic illness, and have a known epidemiology. We present a rare occurrence of case of confluent, mixed retropharyngeal, lateral pharyngeal, and peritonsilar abscess in a 9-month-old female infant. The symptoms at presentation were very mild and not expected in association with this extensive an abscess. The causative organism was methicillin-resistant Staphylococcus aureus.

Bilateral Peritonsillar Abscess in an Infant: An Unusual Presentation of Sore Throat

Introduction

Peritonsillar abscess is considered a suppurative complication of acute tonsillitis. It is usually unilateral and clinically evident bilateral presentation is uncommon. The condition affects mainly children older than 10 years and young adults. Herein we present a rare case of bilateral peritonsillar abscess in an infant.

Presentation of Case

A 1-year-old boy presented with a two-day history of worsening sore throat, loss of appetite, vomiting, and fever. Examination of the oral cavity and oropharynx revealed enlarged and inflamed tonsils and a bilaterally congested and bulging soft palate. CT scan confirmed the hypothesis of bilateral peritonsillar abscess. Antibiotic therapy was instituted and after 5 days only slight regression of swelling of the soft palate was observed. He underwent a surgical procedure for draining the abscesses. After the procedure, he presented good clinical and laboratory evolution and was discharged home.

Discussion

Although peritonsillar abscesses are considered common complications of acute tonsillitis bilateral cases are extremely rare, especially in early childhood. The diagnosis is based on history and physical examination and the treatment remains controversial among otolaryngologists.

Conclusion

Bilateral peritonsillar abscess should be diagnosed and treated promptly and adequately to prevent respiratory obstruction and to avoid dissemination into the deep neck spaces.

Zygomatic haematoma in an 11-month-old helps diagnose retropharyngeal abscess, with concurrent tonsillitis and subsequent infant tonsillectomy

An 11-month-old boy presented with a 2-day history of non-specific symptoms and a zygomatic haematoma. With aetiology uncertain after admission clerking and blood tests, a CT head scan was arranged for suspected traumatic injury and revealed a retropharyngeal abscess (RPA) with significant airway narrowing in the transverse plane. The patient received urgent intraoral abscess drainage and bilateral tonsillectomy in theatre. This case highlights the need for a high index of suspicion regarding RPAs. These abscesses have potentially fatal sequelae and are difficult to diagnose in the infant paediatric population.

Healthcare costs of acute and chronic tonsillar conditions in the pediatric population in the United States

OBJECTIVE

To determine the prevalence and healthcare costs associated with the diagnosis and treatment of acute and chronic tonsillar conditions (ACT) in children.

DESIGN

Cross-sectional analysis of the 2006, 2008, and 2010 Medical Expenditure Panel Surveys.

METHODS

Pediatric patients (age < 18 years) were examined from the above mentioned database. From the linked medical conditions file, cases with a diagnosis of ACT were extracted. Ambulatory visit rates, prescription refills, and ambulatory healthcare costs were then compared between children with and without a diagnosis of ACT and acute versus chronic tonsillitis, with multivariate adjustment for age, sex, ethnicity, region, insurance coverage and comorbid conditions (e.g., asthma and otitis media).

RESULTS

A total of 74.3 million children (mean age 8.55 years, 51% male) were sampled (raw N = 28,873). Of these, 804,229 children (1.1 ± 0.1%) were diagnosed with ACT annually (mean age 7.24 years, 49.1% male); 64.6 ± 2.0% had acute tonsillitis diagnoses and 35.4 ± 2.0% suffered from chronic tonsillitis. Children with ACT incurred an additional 2.3 office visits and 2.1 prescription fills (both p < 0.001) annually compared with those without ACT, adjusting for demographic variables and medical comorbidities, but did not have an increase in emergency department visits (p = 0.123). Children with acute tonsillar diagnoses carried total healthcare expenditures of $1303 ± 390 annually versus $2401 ± 618 for those with chronic tonsillitis (p = 0.193). ACT was associated with an incremental increase in total healthcare expense of $1685 per child, annually (p < 0.001).

CONCLUSION

The diagnosis of ACT confers a significant incremental healthcare utilization and healthcare cost burden on children, parents and the healthcare system. With its prevalence in the United States, pediatric tonsillitis accounts for approximately $1.355 billion in incremental healthcare expense and is a significant healthcare utilization concern.

LEVEL OF EVIDENCE

2C.

Changing trends of peritonsillar abscess

OBJECTIVE

This retrospective, cohort study aims to assess the changing characteristics of peritonsillar abscess (PTA).

METHOD

Data were obtained from PTA patient records admitted to a secondary hospital over a 10-year period.

RESULTS

A total of 427 patients, aged 31.6 +/- 15.2 years (range, 3-91), were treated for PTA, reflecting an incidence of 0.9/10 000/y. Forty-seven (11%) patients had more than one episode. There was no sex, seasonal, or side predominance. Thirteen (3%) patients developed complications. One hundred four (24.4%) patients were 40 years or older, had a longer hospital stay, and were prone to complications. One hundred two (23.8%) patients did not have an anteceding pharyngotonsillitis. Smoking was more common among patients with PTA as compared with the general population and was associated with more complications. A total of 283 (66.2%) patients developed PTA in spite of prior antibiotic therapy; 51.1% of smokers that received prior antibiotics had a higher incidence of Streptococcus viridans isolates.

CONCLUSION

Peritonsillar abscess may have changed its characteristics: affecting more older patients having a worse and longer course and PTA evolvement without anteceding tonsillitis or in spite of a prior adequate antibiotic therapy. Smoking may be a predisposing factor.

Peritonsillar abscess in children in the southern district of Israel

OBJECTIVE

Peritonsillar abscess is the most common deep neck infection and still provides a challenge to care givers in terms of diagnosis and treatment in the pediatric population. This study reviews our experience over the years 2004-2007 at the Soroka University Medical Center in the southern district of Israel in treating children with peritonsillar abscess. We compared our results with data regarding peritonsillar abscess in adults.

METHODS

We performed a retrospective chart review of 126 children diagnosed and proved to have a peritonsillar abscess. Data regarding: age, sex, ethnicity, number of patients per year, seasonality, prior history of tonsillar infection, prior antibiotic treatment, length of hospitalization, surgical treatment, bacterial results and in hospital antibiotic treatment was collected from the medical charts of the patients.

RESULTS

The average age of children with peritonsillar abscess was 12.8 years. 92 patients (73%) were above 10 years of age. We did not find an increase in the number of children with peritonsillar abscess per year over the time period of the study. The number of patients with peritonsillar abscess was significantly higher in the autumn and spring, 79 (62.6%) patients did not have prior history of tonsillar infections and 64 (67.4%) children were treated with antibiotics prior to the diagnosis of an abscess. In 95 (75.4%) patients the drainage method was needle aspiration, in 30 (28.3%) patients incision and drainage was performed and only one patient underwent bilateral quinsy tonsillectomy (0.8%). The bacterial culture was negative in 37 (36.7%) patients. In 29 patients (45% of positive cultures) the causative organism was Streptococcus group A. Mixed culture was present in 10 (15.6%) patients, nine cultures (14%) were positive for anaerobes, alone or in combination with other pathogens. Eighty-one patients (64.2%) were treated with amoxicillin-clavulanate potassium, 24 (19%) received cefuroxime and 17 (13.5%) were treated with cefuroxime+ metronidazole. The average hospital stay was 3 days.

CONCLUSION

Peritonsillar abscess, a potentially life threatening infection, is similar in presentation and bacteriology in the pediatric and the adult population. Based on our review we conclude that peritonsillar abscess in children can be effectively treated by the same methods used in the adult population.

Pediatric retropharyngeal abscesses: a national perspective

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.

Incidence of peritonsillar abscess and relationship to age and gender: retrospective study

The incidence of peritonsillitis is not very well known. A retrospective study was performed at the Ear, Nose and Throat clinic (ENT) at the University Hospital of Orebro Sweden. We studied every case from 2002 to 2004 and related it to a well-defined catchment area of 179,200 inhabitants. We identified 283 events of peritonsillitis, of which 85 were defined as peritonsillar cellulitis (PTC). Peritonsillar abscess (PTA) was found in 198 events in patients between 7 and 82 y of age. 13 patients had 2 episodes of PTA during the study period. The overall incidence was 37/100,000/y. The highest incidence was found between 14 and 21 y of age, with 124/100,000/y. The male: female ratio was 1: 1. Affected females were younger than males (p=0.04), and the peak incidence was earlier for females. This may be due to differences in immunological response, owing to hormonal maturation. The annual incidence of PTA was higher in this study than found in previous studies, which is probably attributable to the fact that our study identified almost all cases in the population.

Methicillin-resistant Staphylococcus aureus as a cause of extensive retropharyngeal abscess in two infants

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.