Assessment of Bacteriological Pattern and Antimicrobial Susceptibility in Deep Neck Space Abscess

Background: Deep neck abscess is a common clinical entity in developing countries like ours. Despite the widespread use of antibiotics, deep neck infections do not disappear and remain one of the most difficult emergencies encountered in daily clinical practice. The extent and severity of the illness could become life-threatening. Therefore, coping with deep neck abscess remain a challenge to otolaryngologists. This study aimed to analyze the bacteriological pattern and antimicrobial susceptibility in deep neck space abscesses. Material & Methods: It was a cross-sectional observational study. 50 patients with deep neck space abscesses fulfilling the inclusion and exclusion criteria admitted to the department of ENT & Head Neck Surgery, Rangpur Medical College Hospital, Rangpur, from 1st July 2017 to 30th December 2017 were enrolled in this study. Pus from deep neck space abscess was collected by either aspiration or incision and drainage with proper aseptic measure and sent by sterile test tube to microbiology department immediately. Data were collected by detailed history taking and clinical examination & investigations with informed written consent and analyzed by SPSS (version 20). Results: In this study most commonly involved deep neck spaces were Submandibular (38%), Peritonsillar (32%), Retropharyngeal (14%), and parapharyngeal (8%) spaces. Streptococcus viridans was the most prominent organism 14 (28%) followed by Klebsiella pneumonia 9(18%) and Staph. aureus 4 (8%). The most effective antibiotic was Ceftriaxone 34(79%) followed by Cefuroxime 30 (70%) and Erythromycin 23(54%). Aerobic organisms were highly sensitive to Cefuroxime (83%) and Ceftriaxone (83%) followed by Erythromycin (48%). Anaerobic organisms were sensitive to Clindamycin (100%), Metronidazole (100%), and Erythromycin (100%) followed by Ceftriaxone (75%). Conclusion: The most frequently isolated organism in deep neck space abscesses were Streptococcus viridans and Staphylococcus aureus and sensitivity results showed the majority of isolates are susceptible to Ceftriaxone and Cefuroxime

Complicaciones ORL severas por mononucleosis infecciosa en adolescentes sanos: 2 casos clínicos y revisión de la literatura / ENT severe complications of infectious mononucleosis in healthy adolescents: report of two cases and literature review

Resumen La mononucleosis infecciosa (MI) es un cuadro clínico generalmente benigno y autolimitado en la infancia y adolescencia debido a la primoinfección del virus de Epstein-Barr caracterizado por la triada de faringitis, fiebre y adenopatías. El riesgo de complicaciones aumenta con la edad y la inmunosupresión, siendo las complicaciones letales más frecuentes las asociadas a rotura esplénica, alteraciones neurológicas y obstrucción de la vía aérea por el aumento del tamaño amigdalar. Los abscesos cervicales asociados a MI son poco frecuentes, siendo mayoritariamente periamigdalinos e intraamigdalares. Presentamos dos casos quirúrgicos de abscesos cervicales profundos de gran tamaño con afectación retrofaríngea y parafaríngea en adolescentes sanos de corta edad (14 y 15 años), sin ningún tipo de inmunosupresión o factores de riesgo, uno de ellos asociado además, a una relevante hemorragia amigdalar espontanea, condición no descrita previamente en la literatura en relación a MI en un paciente tan joven.

Abstract Infectious mononucleosis (MI) is a generally benign and self-limited condition in childhood and adolescence due to the primary EBV infection characterized by the triad of pharyngitis, fever, and lymphadenopathies. The risk of complications increases with age and immunosuppression. The most frequent fatal complications are those associated with splenic rupture, neurological alterations, and airway obstruction due to increased tonsillar size. Cervical abscesses associated with MI are rare, being mostly peritonsillar and intra-tonsil. We present two surgical cases of big deep cervical abscesses with retropharyngeal and parapharyngeal involvement in healthy very young adolescents (14 and 15 years old), without any type of immunosuppression or risk factors, one of them associated with a clinically relevant spontaneous tonsillar bleeding, which had not been described in the literature associated with MI in such young patient.

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children / Diagnóstico e tratamento de abscesso cervical profundo por fístula congênita do seio piriforme em crianças

Abstract Introduction: Congenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it. Objectives: This study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children. Methods: We performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis. Results: Children from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1 year after the surgery. No recurrence occurred in any patient. Conclusion: Congenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.

Resumo Introdução: A fístula congênita do seio piriforme é uma doença relativamente rara na prática clínica; a maioria se manifesta na infância; entretanto, os médicos geralmente têm conhecimento insuficiente sobre essa condição clínica e seu diagnóstico é facilmente feito de forma errônea. Objetivo: Identificar as características do abscesso cervical profundo devido à fístula congênita de seio piriforme em crianças. Método: Estudo retrospectivo de 21 casos de janeiro de 2016 a agosto de 2018 em nosso hospital. Idade de início, características clínicas, exames auxiliares e tratamento clínico dos pacientes foram resumidos para analisar o diagnóstico, as características do tratamento e o prognóstico. Resultados: Foram incluídas crianças de 11 dias a 12 anos, com média de 3,5 anos. Vinte pacientes tinham fístula congênita de seio piriforme no lado esquerdo e um no lado direito; a tomografia computadorizada cervical com contraste mostrava distribuição líquido-gasosa ou sombra aérea nos abscessos em 18 casos. O ultrassom cervical demonstrou eco gasoso na região da tireoide em 10 casos. Todos os pacientes foram submetidos a plasma de baixa temperatura para queimar a fístula interna e retornaram ao hospital para exame com laringoscópio eletrônico e ultrassonografia cervical aos 3 meses, 6 meses e um ano após a cirurgia. Não houve recorrências. Conclusão: A fístula congênita de seio piriforme é uma causa importante de abscesso cervical profundo em crianças. A presença de conteúdo líquido-gasoso purulento ou sombra gasosa na tomografia computadorizada ou no ultrassom cervical sugere uma alta possibilidade da presença de uma fístula interna e a ablação endoscópica a baixa temperatura pode ser feita ao mesmo tempo que a endoscopia diagnóstica.

Factors influencing paediatric neck abscess and treatment at Hospital Tuanku Jaafar, Seremban

@#Background: This is a descriptive study of in-patient paediatric population with the diagnosis of neck abscess. The objective of this study was to calculate the number of children who require conservative (antibiotic) management compared to surgery for neck abscess. A second objective was to identify the factors influencing the choice of the treatments selected. Methods: A retrospective review was performed on a group of paediatric population aged 0 till 12 years of age, with a history of admission to paediatric ENT ward from the year 2010 till 2015 in HTJS. Initially, 69 children with the diagnoses of various neck infections were identified. Then, the sample amount was narrowed to 30 patients with neck abscesses only. Results: The data analysis was performed using descriptive statistics, Chi-squared test and Fisher’s exact test. Twentyfive out of the 30 patients required operative drainage of abscess (83.3%). In this group, children aged ≤2 years old were the largest group to have undergone surgical drainage. Only five patients were successfully treated with antibiotic therapy alone. Nineteen children came only after developing neck swelling for more than a week, in which 18 of them required surgery. Conclusion: Younger group of children are more likely to undergo surgical drainage than older children for neck abscess. Also, children who came in after two weeks of symptoms have a higher probablity of requiring surgery than antbiotic alone. Nonetheless, every child who comes in with neck abscess should be evaluated and treated early to avoid any sinister complications.

Deep neck abscesses: study of 101 cases / Abscessos cervicais profundos: estudo de 101 casos

Abstract Introduction: Although the incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. Objective: This study aimed to present our clinical-surgical experience with deep neck abscesses. Methods: A retrospective study analyzed 101 patients diagnosed with deep neck abscesses caused by multiple etiologies, assisted at a medical school hospital during 6 years. One hundred one patients were included and 27 (26.7%) were younger than 18 years old (the children group), 74 patients (73.3%) were older than 18 years old (the adults group). The following clinical features were analyzed and compared: age, gender, clinical symptoms, leukocyte count, the affected cervical area, lifestyle habits, antibiotic therapy, comorbidities, etiology, bacterial culture, time of hospitalization, the need of tracheostomy and complications. Results: There was predominance in the male gender (55.5%) and young people (mean age 28.1 years). All of the 51 patients with associated disease comorbidity were adults. The most frequent etiologies were bacterial tonsillitis (31.68%) and odontogenic infections (23.7%). The most common cervical areas affected were the peritonsillar (26.7%), submandibular/mouth floor (22.7%) and parapharyngeal spaces (18.8%). In children group, the site most commonly involved was the peritonsillar space (10 patients, 37%). In adults group, the site most commonly involved was multispace (31 patients, 41.8%). Streptococcus pyogenes (23.3%) was the most common microorganism present. Amoxicillin associated with clavulanate (82.1%) was the more used antibiotic. The main complications of abscesses were septic shock (16.8%), pneumonia (10.8%) and mediastinitis (1.98%). Tracheostomy was necessary in 16.8% of patients. The mortality rate was 1.98%. Conclusion: The clinical features and severity of DCA varied according to different age groups, perhaps due to the location of the infection and a higher incidence of comorbidity in adults. Thus, DCA in adults is more facile to have multispace involvement and lead to complications and seems to be more serious than that in children.

Resumo Introdução: Embora a incidência dos abscessos cervicais profundos (ACP) tenha diminuído, principalmente pela disponibilidade dos antibióticos, essa infecção ainda ocorre com frequência considerável e pode estar associada a alta morbidade e mortalidade. Objetivo: Este estudo teve como objetivo apresentar nossa experiência clínico-cirúrgica com os abcessos cervicais profundos. Método: Um estudo retrospectivo realizado em um hospital universitário analisou 101 pacientes, durante seis anos, diagnosticados com abscessos cervicais profundos causados por múltiplas etiologias. Foram incluídos 101 pacientes, sendo que 27 (26,7%) tinham menos de 18 anos (grupo das crianças) e 74 (73,3%) tinham mais de 18 anos (grupo dos adultos). As seguintes características clínicas foram analisadas e comparadas: idade, sexo, sintomas clínicos, área cervical acometida, hábitos de vida, antibioticoterapia, comorbidades, etiologia, cultura bacteriana, tempo de internação, necessidade de traqueotomia e complicações. Resultados: Houve predominância do sexo masculino (55,5%) e de jovens (idade média de 28,1 anos). Todos os 51 pacientes com comorbidade associada eram adultos. As etiologias mais frequentes foram tonsilite bacteriana (31,68%) e infecções odontogênicas (23,7%). As áreas cervicais acometidas mais comuns foram a peritonsilar (26,7%), submandibular/assoalho da boca (22,7%) e os espaços parafaríngeos (18,8%). No grupo das crianças, o local mais comumente envolvido foi o espaço peritonsilar (10 pacientes, 37%). No grupo dos adultos, houve predomínio de acometimento de múltiplos espaços cervicais (31 pacientes, 41,8%). Streptococcus pyogenes foi o microrganismo presente mais comum (23,3%). A amoxicilina associada ao clavulanato foi o antibiótico mais usado (82,1%). As principais complicações dos abscessos foram choque séptico (16,8%), pneumonia (10,8%) e mediastinite (1,98%). A traqueostomia foi necessária em 16,8% dos pacientes. A taxa de mortalidade foi de 1,98%. Conclusão: As características clínicas e a gravidade dos ACP variam de acordo com as diferentes faixas etárias, possivelmente devido à localização da infecção e à maior incidência de comorbidades em adultos. Assim, o ACP em adultos acomete mais facilmente múltiplos espaços, apresenta mais complicações e parece ser também mais grave do que em crianças.

Acute Fascial Space Abscess upon Dental Implantation to Patients with Diabetes Mellitus

As popularity of dental implantation is increasing, the number of cases associated with complications also increase. Evaluation on diabetes mellitus is often neglected due to the disease's irrelevance to implantability. However, patients with diabetes mellitus are susceptible to infection due to impaired bactericidal ability of neutrophils, cellular immunity and activity of complements. Due to this established connection between diabetes mellitus and infection, a couple of cases were selected to present patients with diabetes mellitus with glycemic incontrollability, suffering from post-implantation dentigerous inter-fascial space abscess.

Septicemic Melioidosis Presenting as Head and Neck Abscesses / 감염과화학요법

Melioidosis is a life-threatening disease caused by Burkholderia pseudomallei , which is endemic in Southeast Asia and Northern Australia. It may manifest as a pulmonary lesion, osteomyelitis, septicemia, or abscesses of soft tissue or various organs. However, soft tissue abscess associated with bacteremia, especially those found in the head and neck, are rarely reported. We report a case of disseminated septicemia due to Burkholderia pseudomallei presenting as head and neck abscesses in a 55-year-old Korean man with a history of working in Malaysia. This is the first report of fatal melioidosis presenting as a complicated skin and soft tissue infection, in Korea.

Submasseteric abscess: A rare head and neck abscess.

The objective of the article is to highlight and make people aware of a rare abscess which is often missed or misdiagnosed. As only a few cases have been reported, the authors feel that reporting such a case would help in proper management of the disease. We are presenting a 6.5-year-old male child with 3 weeks history of right facial swelling in the parotid region, with low-grade fever and trismus. Submasseteric abscess is a rare abscess which is often misdiagnosed as a parotid abscess or parotitis. Only a few cases have been reported. The cause is mostly dental in origin. Intravenous antibiotics often fail to alleviate the symptoms as this is a closed space and needs prompt drainage. Therefore, awareness of this complication of dental infections is vital for proper diagnosis and timely management.

Treatment of Tuberculous Cervical Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tuberculous cervical lymphadenitis is not an uncommon inflammatory disorder in Korea. It often does not respond to the antituberculous medication, but grows up gradually making the cervical abscess. Authors aimed to find out the clinical features and the treatment modalities of tuberculous cervical abscess. SUBJECTS AND METHOD: From Jan. 2001 through Dec. 2005, 52 cases of the tuberculous cervical abscess (16 males, 36 females : age range 18-63 years, mean 30.4 years) were diagnosed and managed at the Department of Otolaryngology, Asan Medical Center. We reviewed medical records of patients to find out their presentations, diagnostic considerations, therapeutic options, and outcomes. Patients were followed up for sixteen months on the average after treatment. RESULTS: There was no difference in the duration of antituberculous chemotherapy according to the surgical methods. However, in the cases of mass excision (91.7%), cure rate (remnant mass size <5 mm) was higher, compared to incision and drainage (80.0%). Compared to excision (3/15, 25%, 39 days), incision and drainage needed more days for dressing for healing (4/5, 80%, 90 days). CONCLUSION: Therefore, we recommend, if possible, complete excision as a therapeutic modality in cases of tuberculous cervical abscess.

Delayed Rupture of the Transverse Atlantal Ligament Complicated after the Treatment of Posterior Neck Abscess: A case report / 대한척추외과학회지

Atlantoaxial instability with rupture of transverse atlantal ligament is mostly caused by trauma, and this can be combined with myelopathy. Although it gives rise to no neurologic deficit, it has a high possibility to quadriplegia or death by minor trauma. We experienced a rare case about atlantoaxial instability with delayed rupture of transverse atlantal ligament that was complicated after the treatment of posterior neck abscess. A 44-year-old male patient had complained of posterior neck pain for 1 month. Based on a clinical examination, simple radiography, CT and MRI, his diagnosis was posterior neck abscess. He underwent an emergency operation with open drainage. One year later, he again had posterior neck pain. Atlantoaxial instability with rupture of the transverse atlantal ligament was confirmed. Skeletal traction was applied and then C1-2 posterior fusion without wiring was performed. After the operation, antibiotics were injected for 4 weeks and a halo-vest was put on for 6 months. Complete fusion of C1-2 was obtained without posterior neck pain at the 1 year follow-up.

A Case of Neonatal Suppurative Submandibular Sialadenitis: Complicated with Multiple Deep Neck Abscess

Isolated submandibular suppurative sialadenitis occurring in the neonatal period is extremely rare. At present, only 15 cases of isolated submandibular sialadenitis in the neonatal period have been reported in the literature. We report a rare case of multiple deep neck abscess in association with both submandibular suppurative sialadenitis in a term neonate.

A Case of Methimazole Induced Agranulocytosis Complicated with Deep Neck Abscess / 대한내분비학회지

The thiourea derivatives, propylthiouracil and methimazole are in widespread use for the treatment of hyperthyroidism. The untoward side effects of these drugs are not infrequent and agranulocytosis is the most serious side effect them. We observed one case of methimazole induced agranulocytosis complicated by deep neck abscess. A 54-year-old woman was admitted because of fever, chilling and sore throat for 1 week. The symptom was developed after receiving methimazole 30mg daily day due to hyperthyroidism during last 3 months. Physical examination revealed hyperemic, enlarged tonsils and tender swelling of the right lower neck The peripheral blood total leukoeyte count was 1,500/mm' (absolute neutrophil count, ANC 9) and a peripheral blood smear revealed few neutrophil. The patient was administered G-CSF 2 mg/kg daily, and on the fifth day of hospitalization, fever subsided and ANC increased to 3,431. On the 11th day, fever developed again and the tenderness and swelling in both lower neck area were aggrevated. Computed tomography of the neck was performed, and revealed a large deep neck abscess. After pus aspiration and antibiotics therapy, the neck abscess was disappeared.