Complicated pneumonia with empyema caused by streptococcus anginosus in a child / Complicated pneumonia with empyema caused by streptococcus anginosus in a child

ABSTRACT Objective: To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy. Case description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Pleural fluid cultures grew Streptococcus anginosus. On day 11, the child had a clinical deterioration with recurrence of fever, hypoxia, and respiratory distress. At this point, considering the causative agent, he was submitted to video-assisted thoracoscopic decortication, with good progress thereafter. Comments: Streptococcus anginosus is a commensal bacterium of the human oral cavity capable of causing severe systemic infections. Although reports of complicated thoracic infections with this agent are rare in the pediatric population, they have been increasing in adults. Streptococcus anginosus has a high capacity to form abscess and empyema, requiring different therapeutic approaches when compared to complicated pneumonia caused by other agents.

RESUMO Objetivo: Alertar para a patogenicidade do Streptococcus anginosus que, apesar de raro em pediatria, pode causar infeções graves que necessitam de tratamento invasivo e antibioterapia de longo curso para obter um melhor prognóstico. Descrição do caso: Criança de seis anos, com atraso do desenvolvimento psicomotor, avaliado no serviço de urgência por febre e dificuldade respiratória. O exame físico, juntamente com os exames complementares, revelou uma pneumonia complicada com empiema no hemitórax esquerdo, tendo iniciado antibioterapia e sido submetido à drenagem do líquido pleural. Foi identificado Streptococcus anginosus nesse líquido. No 11º dia de doença, a criança agravou o seu estado clínico, com recidiva da febre, hipoxemia e dificuldade respiratória. Considerando-se o microrganismo identificado, o paciente foi submetido à decorticação pulmonar por videotoracoscopia, com boa evolução clínica posterior. Comentários: Streptococcus anginosus é uma bactéria comensal da cavidade oral humana, que pode causar infecções sistêmicas graves. Apesar de serem raros os casos descritos em pediatria, têm sido cada vez mais descritas infecções torácicas complicadas em adultos. Esse microrganismo também tem a capacidade de formar abcessos e empiemas, que precisam de intervenções terapêuticas diferentes, quando comparados a pneumonias complicadas causadas por outros agentes.

Absceso retrofaríngeo en lactante menor: reporte de caso y revisión de la literatura / Retropharyngeal abscess in a toddler: case report and literature review

El absceso retrofaríngeo corresponde a una complicación infrecuente de las infecciones de tracto respiratorio superior, asociada a una potencial pero significativa morbimortalidad. Posee mayor incidencia en la edad pediátrica, siendo la media de presentación los 3 años. En la literatura se le atribuyen diferentes factores de riesgo, destacando como factores endógenos enfermedades crónicas como diabetes mellitus y otros estados de inmunodeficiencia, y como factor exógeno las infecciones de vía aérea superior, dentarias y el traumatismo por cuerpo extraño. Si bien es difícil aislar un solo agente etiológico, se describe con mayor frecuencia la participación de Streptococcus pyogenes. El diagnóstico es eminentemente clínico, con confirmación imagenológica con tomografía computarizada como gold standard. El tratamiento es controversial, existiendo defensores de un tratamiento quirúrgico precoz versus un manejo expectante con antibióticos endovenosos. Se presenta a continuación el caso de una lactante menor de 1 año 4 meses hospitalizada en el Servicio de Pediatría en Hospital San Camilo en San Felipe por un cuadro febril agudo, catalogado inicialmente como meningitis, resultando en un absceso retrofaríngeo con extensión hacia mediastino superior, el cual fue resuelto de manera exitosa con tratamiento quirúrgico precoz asociado a antibióticos endovenosos de amplio espectro.

Retropharyngeal abscess corresponds to an uncommon complication of upper respiratory tract infections, associated with a potential but significant morbidity and mortality. It has a greater incidence in the pediatric age, being the average of presentation the 3 years. Different risk factors are attributed to the disease in the literature, standing out endogenous chronic diseases such as diabetes mellitus and other immunodeficiency states, and exogenous factors such as upper airway infections, dental infections and foreign body trauma. Although it is difficult to isolate a single etiologic agent, the involvement of Streptococcus pyogenes is more frequently described. The diagnosis is eminently clinical, with confirmed imaging with Tomography computed as gold standard. Treatment is controversial, with advocates of early surgical treatment versus expectant management with intravenous antibiotics. Is presented below the case of a toddler girl of 1 year and 4 months hospitalized in the Pediatrics service at San Camilo's Hospital in San Felipe by an acute febrile condition, initially classified as meningitis, resulting in a retropharyngeal abscess with extension towards the upper mediastinum, which was successfully solved with early surgical treatment associated with broad-spectrum intravenous antibiotics.

Infecciones por Streptococcus anginosusen otorrinolaringología: revisión de 9 casos clínicos / Infections caused by Streptococcus anginosusin otolaryngology: review of 9 clinical cases

Introducción: El Streptococcus anginosus (SA) es un habitante común de la cavidad oral y tracto gastrointestinal, y puede ser un patógeno agresivo causante de abscesos en varios sitios del cuerpo. Aparentemente, su rol en infecciones de cabeza y cuello está adquiriendo cierta notoriedad y no está claramente reportado en la literatura. Objetivo: El objetivo del presente estudio fue evaluar las implicancias clínicas de estas infecciones en otorrinolaringología. Material y método: Estudio retrospectivo de todos los pacientes diagnosticados microbiológicamente con infecciones causadas por Streptococcus anginosus, tratados en el Servicio de Otorrinolaringología del Hospital Barros Luco-Trudeau entre los años 2007 a 2012. Se describen las características clínicas, microbiológicas y el manejo de los pacientes. Resultados: La muestra estuvo constituida por 9 casos, 3 hombres y 6 mujeres, con una mediana de edad de 52 años (rango 6-70). Los sitios de infección fueron: absceso periamigdalino (2 casos), un absceso peritraqueostoma, un absceso submandibular, un absceso submentoniano, un absceso parafaríngeo con extensión retrofaríngea y mediastino, un caso de absceso cerebral frontal secundario a sinusitis frontal complicada, un caso de otitis media crónica activa, y un caso de sinusitis maxilar crónica. Discusión: El SA ha sido reportado como un agente causal de infecciones potencialmente graves en cabeza y cuello. Su identificación requiere de consideraciones especiales para el cultivo, y al ser un microorganismo común puede ser confundido e informado como S viridans o Streptococcus anaeróbico. Es importante reconocer al SA como un patógeno a considerar en infecciones de cabeza y cuello.

Introduction: Streptococcus anginosus (SA) is a common inhabitant of the oral cavity and gastrointestinal tract, and can be an aggressive pathogen causing abscesses in various body sites. Apparently, its role in head and neck infections is gaining some notoriety that it is not clearly reported in the literature. Aim: The aim of this study was to evaluate the clinical implications of this infections in otolaryngology. Material and method: A retrospective case series study of all patients diagnosed microbiologically with Streptococcus anginosus infections treated at the Department of Otolaryngology, HospitalBarros Luco-Trudeau from 2007 to 2012. We describe the clinical and microbiological features, and treatment of each patient. Results: The sample consisted of 9 patients, 3 men and 6 women, with a median age of 52 years (range 6-70). The sites of infection were: peritonsillar abscess (2 cases), peritracheostomy abscess, submandibular abscess, submental abscess, parapharyngeal abscess with retropharyngeal and mediastinal extension, a case of frontal brain abscess secondary to frontal sinusitis, a case of otitis chronic active half, and one case of chronic maxillary sinusitis. Discussion: SA has been reported as a causative agent ofpotentially serious infections in the head and neck region. Their identification requires special considerations for growing, and because of being a common microorganism may be confused and informed as Streptococcus viridans or anaerobic streptococcus. It is important to recognize SA as a relevant pathogen in head and neck infections.

Sialography: Report of 3 cases.

Salivary gland examination is an important part of oral examination, especially because of it's involvement in most of the systemic diseases. Patients most commonly seek medical attention when the major salivary glands like parotid and submandibular gland become enlarged or painful. The various imaging modalities practiced to check the salivary gland disorders include conventional radiography, sialography, ultrasonography, computerized tomography, radionuclide imaging and magnetic resonance imaging. Sialography is one of the oldest imaging procedures and still most commonly practiced, as it is a chair side procedure, simple to perform, and cost effective. We report the role of sialography as an adjuvant in the diagnosis of bacterial sialadenitis and sialadenosis and as a diagnostic and therapeutic aid in a case of juvenile recurrent parotitis.