Infecciones profundas del cuello / Deep neck infections

Deep neck infections (DNIs) are special entities among infectious diseases for their versatility and potential for severe complications. Complex head and neck anatomy often makes early recognition of DNIs challenging, and a high index of suspicion is necessary to avoid any delay in treatment. The diagnosis is made by clinical history, physical examination findings and imaging studies. The treatment consists in securing the airway, intravenous antibiotics and surgical drainage, when needed. To make decisions the surgeon must understand the anatomy of the region, the etiology of infection, appropriate diagnostic tools, and medical and surgical management. This article provides a review of these pertinent topics. (AU)

Absceso de espacios profundos de cuello: a propósito de un caso en un niño / Infections of the deep neck spaces: a report of a case in a child

Infections of the deep neck spaces are low-frequency entities. They can be classified according to the anatomical space committed to peritonsillar, parapharyngeal, retropharyngeal, etc. They are clinically similar to other upper respiratory infection with symptoms like: fever, sore throat, dysphagia, dysphonia, cervical lymphadenitis. The diagnosis is made by clinical history, physical examination findings and imaging studies. The treatment consists in securing the airway, intravenous antibiotics and surgical drainage. We report the case of a ten months years old child who consulted at the Hospital Clínico Universidad de Chile by an upper respiratory infection associated with right cervical enlargement. The neck CT scan showed extensive soft tissue inflammatory changes of right lateral cervical region, supra and infrahyoid. The diagnosis of right deep neck space abscess was made. We began treatment with Cefotaxime / Clindamycin, and surgical drainage, showing favorable results.

A Case of Neck Abscess Caused by Salmonella Serotype D in a Patient with Liver Cirrhosis

Non-typhoidal salmonellosis, which is increasing nowadays in Korea as well as in the developed countries, is manifested as enteritis in most cases, but it also encompasses bacteremia, intraabdominal infections, and bone, joint and soft tissue infections. These rare diseases are known to result from primary gastrointestinal infection and subsequent bacteremia with or without symptoms. We experienced a case of neck abscess caused by Salmonella serotype D, which is a rare but important differential diagnosis of neck abscess. We herein report it.

Infecções bacterianas da cabeça e pescoço: estudo retrospectivo / Head and neck bacterial infections: retrospective study

Objetivos: avaliar retrospectivamente as características das infecções de origem odontogênica ou não, acometendo a região da cabeça e pescoço. Material e Métodos: por meio de uma análise retrospectiva de 50 prontuários de pacientes com diagnóstico de infecções bacterianas da cabeça e pescoço (IBCP) tratados no âmbito hospitalar pela disciplina de Cirurgia e Traumatologia Buco-Maxilo-Facial da Faculdade de Odontologia de Araraquara – UNESP, no período de 1998 a 2006, analisou-se aspectos como gênero, idade, etiologia, tempo de permanência hospitalar, sinais e sintomas, espaços fasciais envolvidos e protocolo de tratamento. Resultados: nesta pesquisa observou-se que as IBCP geralmente têm origem odontogênica (94%), do quadrante póstero-inferior (49%), por meio de lesões de cárie (66%), acometendo preferencialmente sujeitos do gênero masculino (1.6:1), acima dos 18 anos de idade. Geralmente, os pacientes apresentam-se com edema, eritema, dor, odinofagia, trismo e disfagia, permanecendo internados durante cinco dias em média. Estas infecções acometem com freqüência mais de um espaço fascial (74%), sendo o submandibular o mais envolvido (80%). São infecções de natureza polimicrobiana, com predomínio de aeróbios. O protocolo de tratamento mais empregado para estes pacientes incluiu exodontia, drenagem e antibioticoterapia, correspondendo a 94% da amostra. Optou-se pelas cefalosporinas como antibiótico para terapia empírica em 94% dos casos, utilizando associações de antimicrobianos na maior parte dos pacientes (94%). Conclusão: a maior parte das IBCP é de origem odontogênica, advinda do quadrante póstero-inferior, acometendo mais frequentemente o espaço submandibular de homens com mais de 18 anos, caracterizando-se usualmente por edema, eritema, trismo, odinofagia, disfagia e dor. O protocolo de tratamento padrão incluiu exodontia, drenagem e antibioticoterapia.

Purpose: retrospective analyze of head and neck bacterial infections by odontogenic and non-odontogenic source. Materials and Methods: a retrospective analyze of 50 records of patients with diagnosis of HNBI treated in hospital room by Department of Maxillofacial Surgery and Traumatology of Araraquara Dentistry Faculty – UNESP, between 1998 and 2006, was made analyzing issues as gender, age, etiology, length of hospital stay, symptoms and signals, fascial spaces and treatment. Results: It could be established that infections are usually originated from odontogenic causes (94%), from postero-inferior quadrant (49%) by carious lesions (66%), affecting usually males (1.6:1), above 18 years old. Patients are encountered most commonly with swelling, erythema, pain, odynophagia, trismus and dysphagia, staying in the hospital for five days in median. This infections affect most commonly multiples fascial spaces (74%), being submandibular the most affected (80%). Infections usually have both aerobic and anaerobic organisms, being aerobic the most frequent. The treatment plan most utilized for this patients are extractions, drainage and antibiotic therapy (94%). The cefalosporines were the choice for the empiric therapy (94%), utilizing antibiotic associations for the most patients (94%). Conclusion: the most of HNBI were by odontogenic source, from postero-inferior quadrant, affecting usually submandibular space of men above 18 years, characterizing usually by swelling, erythema, trismus, odynophagia, dysphagia and pain. Standard treatment was extractions, drainage and antibiotic therapy.

Fasceíte necrotizante cervical em lactente: relato de caso / Cervical necrotizing fasciitis in infant: case report

Introdução: A Fasceíte Necrotizante é uma infecção bacteriana caracterizada por extensa necrose dos tecidos, que pode envolver desde a pele até a musculatura. É mais prevalente na população adulta do que pediátrica e os principais locais de acometimento são o tronco e extremidades, sendo a região da cabeça e pescoço menos comumente atingida. Os patógenos mais freqüentemente isolados são Streptococcus pyogenes (grupo A) e Staphilococcus aureus. O exame anatomopatológico é o melhor método diagnóstico identificando precocemente a doença. O suporte clínico, o debridamento cirúrgico, além de antibioticoterapia endovenosa são fundamentais para o tratamento. Objetivo: Relatar o caso de um lactente que apresentou Fasceíte Necrotizante na região cervical. Relato do caso: Lactente, sexo masculino, branco, 2 meses de idade, previamente hígido, com quadro de Fasceíte Necrotizante em região cervical anterior e lateral direita. Com tratamento adequado o paciente obteve excelente recuperação sem apresentar importantes alterações estéticas ou funcionais. Conclusão: A Fasceíte Necrotizante cervicofacial é rara em crianças. O debridamento cirúrgico precoce é necessário para controlar a infecção mesmo que possa resultar em ferimentos grandes e profundos. A antibioticoterapia de amplo espectro e o suporte hemodinâmico também são fundamentais para o sucesso terapêutico.

Introduction: Necrotizing fasciitis is a bacterial infection characterized by extensive necrosis of tissues, and may include skin and muscles. It's more frequent in adults than in children and generally involves the trunk and extremities. Head and neck area is less commonly affected. The most frequently isolated pathogens are the Streptococcus pyogenes (group A) and Staphylococcus aureus. The anatomopathological exam is the best diagnostic method, which early identifies the disease. The clinical support, surgical debridement, and the intravenous antibiotic therapy, are fundamental for the treatment. Objective: To report a case of an infant who suffered from Cervical Necrotizing Fasciitis. Case Report: Infant, male sex, white, 2 months old, previously healthy, with Necrotizing Fasciitis involving the frontal and right lateral cervical regions. After adequate treatment the patient obtained excellent recovery without presenting important aesthetic or functional alterations. Conclusion: The Cervical Necrotizing Fasciitis is uncommon in children. The early surgical debridement is necessary to control the infection, even if it may result in great and deep injuries. The wide spectrum antibiotic therapy and hemodynamic support are also basic for the therapeutic success.

Adenoflegmón cervical por Streptococcus intermedius en una niña de 3 años: caso clínico / Cervical lymphadenitis due to Streptococcus intermedius in a 3 years-old girl: case report

Objetivo: Comunicar el caso de un adenoflegmón cervical por Streptococcus intermedius y caracterizar aspectos clínicos y microbiológicos de la infección por esta bacteria. Caso: Niña de 3 años, con historia de fiebre y aumento de volumen cervical anterior y supraclavicular izquierdo de 5 días de evolución, diagnosticándose adenoflegmón cervical; la punción revela Streptococcus intermedius. Se trató con cloxacilina y luego penicilina EV y completó tratamiento de 10 días con cotrimoxazol. Discusión: Streptococcus intermedius corresponde a una de las tres especies del grupo “anginosus” o “milleri”, integrante a su vez del grupo viridans. Forma parte de la flora bacteriana habitual orofaringea, de tubo digestivo y vagina. Tiene capacidad de migrar a otros parénquimas, produciendo infecciones abscedantes, a veces polimicrobianas y de difícil erradicación. Estudios nacionales de susceptibilidad antimicrobiana reportan sensibilidades cercanas al 100 por ciento a Penicilina y Cefotaxima. Diversos protocolos microbiológicos de identificación rápida permiten su diferenciación bacteriológica, ayudando a establecer alternativas terapéuticas más adecuadas.

Absceso parafaríngeo: revisión bibliográfica y exposición de un caso clínico / Parapharyngeal abscess: bibliographic revision and presentation of a clinical case

El absceso parafaríngeo es la segunda localización más frecuente de los abscesos profundos del cuello. Presentamos el caso de un varón de 37 años a quien se le diagnosticó un absceso parafaríngeo izquierdo, sin puerta aparente de entrada del foco séptico. Se logró el control y la curación del enfermo con tratamiento antibiótico, no requiriendo cirugía. Se revisa el tema en lo referente a la etiología, cuadro clínico, fisiopatología, diagnóstico, tratamiento y complicaciones.

Cervical mycobacterial lymphadenitis

Cervical lymphadenopathy may arise from infections with mycobacteria other than mycobacterial tuberculosis. These infections are being diagnosed more frequently, and reported to be an important cause of cervicofacial lymphadenitis in Western countries and United states. These infections resemble mycobacterial tuberculosis in its clinical picture, but it is important to make a distinction between them, for their clinical courses and treatments, are different. This work discussed the differential diagnosis of mycobacterial lymphadenitis and illusterated five cases of non tuberculous mycobacteria out of forty three cases examined, and showed that tuberculosis still having a higher incidence among our patients

Abscesos profundos de cuello / Deep abscess of the neck

Se presenta un análisis sobre los mecanismos de las infecciones profundas del cuello y las bases para su tratamiento. Los autores en un período de cuatro años diagnosticaron 36 casos con abscesso profundo del cuello, de los cuales pudieron hacer un seguimiento adecuado a 14, sobre los cuales hacen el presente trabajo. Lograron controlar la infección a 13 casos mediante la debridación tamprana y un adecuado esquema antimicrobiano. Hacen notar la frecuencia con la que se presentan estos abscesos en pacientes con padecimientos que modifican la respuesta inmunológica