Tonsillar origin of deep neck infection as a negative prognostic factor for developing complications.

<b>Aim:</b> The aim of this study was to compare the odontogenic and tonsillar origins of deep neck infection (DNI) as a negative prognostic factor for developing complications. </br></br> <b>Methods:</b> This was a retrospective study of 544 patients with tonsillar and odontogenic origins of DNI treated between 2006 and 2015 at 6 ENT Departments and Departments of Oral and Maxillofacial Surgery. Complications from DNI (descending mediastinitis, sepsis, thrombosis of the internal jugular vein, pneumonia, and pleuritis) were evaluated in both groups and compared. Associated comorbidities (cardiovascular involvement, hepatopathy, diabetes mellitus respiratory involvement, gastroduodenal involvement) were reviewed. </br></br> <b>Results:</b> Five hundred and forty-four patients were analyzed; 350/544 males (64.3%) and 19/544 females (35.7%). There were 505/544 cases (92.8%) with an odontogenic origin and 39/544 cases (7.2%) with a tonsillar origin of DNI. Complications occurred more frequently in the group with tonsillar origin of DNI (P < 0.001). There was no difference in diabetes mellitus between the two groups. </br></br> <b>Conclusions:</b> Currently, the tonsillar origin of DNI occurs much less frequently; nevertheless, it carries a much higher risk of developing complications than cases with an odontogenic origin. We recommend that these potentially high-risk patients with a tonsillar origin of deep neck infections should be more closely monitored.

Chronic purulent pericarditis: case report.

Purulent pericarditis is an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on the tissue microscopy. In this case report, we will discuss a 31-year-old male who presented with a chief complaint of low-grade fevers, dry cough and difficulty breathing for about two weeks which preceded after removing of dental also two weeks prior. He was admitted and treated as COVID-19 in the isolation ward, he later developed cardiac tamponade and during pericardiocentesis thick pus was discharged. Pus culture and Gene Xpert tests were all negative. After his condition improved, the patient was transferred to the general ward with the pericardial window still discharging pus. Pericardiectomy was chosen as definitive management. The key takeaway in this report is that Empirical treatment with RHZE (rifampin, isoniazid, pyrazinamide, and ethambutol) in resource-limited settings is recommended due to difficulty in identifying the exact cause at a required moment.

Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine.

To present five patients with DNM, who were treated during the first quarantine for Coronavirus disease 2019 (Covid-19). Five patients with DNM were treated in our department during the first lockdown. The mean age of the patients was 42,2 years and four were male. Two patients were immunocompromised. Repeated surgical drainage was performed in all patients, whereas four were also subjected to elective tracheostomy during their first operation. The mean hospitalization duration was 55,4 days and mortality was 40%. During the first lockdown for the Covid-19, a rise in the ratio of DNM cases to the overall incidence of cervicofacial infections was observed in our department. All patients with DNM were operated on an emergency basis and were subsequently admitted to the ICU. We consider the effect of the quarantine as a decisive factor for this escalation, because according to the department archives, there had not been any cases of DNM originating from a dental infection, for the past 5 years. Additionally, past studies from the same department reported no more than 6 cases over a 10 year period.

[Treatment of postoperative anterior mediastinitis, sternal osteomyelitis in a patient with a novel coronavirus infection]. / Lechenie posleoperatsionnogo perednego mediastinita, osteomielita grudiny u patsientki s novoi koronavirusnoi infektsiei (COVID-19).

The incidence of mediastinitis after median sternotomy makes up 1-3%. This complication results prolonged hospital-stay, significant increase in treatment cost and high mortality (up to 75%). Severe COVID-19 pneumonia is often manifested by coughing, that impairs sternum stability after osteosynthesis. Moreover, concomitant leukopenia increases the risk of mediastinitis. Viral pneumonia and mediastinitis are complicated by respiratory failure and mutually potentiate the negative effect. Negative pressure wound therapy (NPWT) with combined antibiotic therapy ensures a favorable outcome even in patients with postoperative mediastinitis and osteomyelitis combined with viral pneumonia.

Severe parapharyngeal abscess that developed significant complications: management during the COVID-19 pandemic.

A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.

Observation of Retropharyngeal Fluid Collection in 2 COVID-19 Positive Patients.

Our understanding of the novel coronavirus, COVID-19, is growing; yet, there remains much we do not understand, and unique presentations are abundant. One potential presentation is retropharyngeal edema, defined as fluid in the retropharyngeal space. Multiplanar imaging with computed tomography or magnetic resonance imaging is ideal for characterizing and diagnosing these fluid collections rapidly as possible life-threatening complications may develop (eg, airway obstruction and mediastinitis). Here, we discuss the presentation, imaging identification, treatment, and recovery of retropharyngeal fluid collection in 2 COVID-19 cases. The significance of this article is to suggest conservative management as a viable treatment option for retropharyngeal fluid collection, as opposed to incision and drainage, in the setting of COVID-19.

Analysis of 4 imaging features in patients with COVID-19 (preprint)

Background: The aim of this was to analyze 4 chest CT imaging features of patients with coronavirus disease 2019 (COVID-19) in Shenzhen, China so as to improve the diagnosis of COVID-19. Methods: Chest CT of 34 patients with COVID-19 confirmed by the nucleic acid test (NAT) were retrospectively analyzed. Analyses were performed to investigate the pathological basis of four imaging features(“feather sign”,“dandelion sign”,“pomegranate sign”, and “rime sign”) and to summarize the follow-up results. Results: There were 22 patients (65.2 %) with typical “feather sign”and 18 (52.9%) with “dandelion sign”, while few patients had “pomegranate sign” and “rime sign”. The “feather sign” and “dandelion sign” were composed of stripe or round ground-glass opacity(GGO), thickened blood vessels, and small-thickened interlobular septa. The “pomegranate sign” was characterized as follows: the increased range of GGO, the significant thickening of the interlobular septum, complicated with a small amount of punctate alveolar hemorrhage. The “rime sign” was characterized by numerous alveolar edemas. Microscopically, the wall thickening, small vascular proliferation, luminal stenosis, and occlusion, accompanied by interstitial infiltration of inflammatory cells, as well as numerous pulmonary interstitial fibrosis and partial hyaline degeneration were observed. Repeated chest CT revealed the mediastinal lymphadenectasis in one patient. Re-examination of the NAT showed another positive anal swab in two patients. Conclusion: “Feather sign” and “dandelion sign” were typical chest CT features in patients with COVID-19; “pomegranate sign” was an atypical feature, and “rime sign” was a severe feature. In clinical work, accurate identification of various chest CT signs can help to improve the diagnostic accuracy of COVID-19 and reduce the misdiagnosis or missed diagnosis rate.

Radiological manifestations from 101 patients with 2019 Novel Coronavirus Disease (COVID-19) in Hamadan, West of Iran: Typical and atypical findings (preprint)

Background Coronavirus disease 2019 (COVID-19) has spread widely throughout the world and become a pandemic disease. In this study we decided to investigate the chest computed tomography (CT) findings in COVID-19 patients in Hamadan, west of Iran.Methods This cross-sectional study was conducted on 101 patients with confirmed COVID-19 infection from February to March 2020. Demographic, clinical, laboratory and chest CT information of identified COVID-19 patients were assessed.Results Totally, 101 patients diagnosed with COVID-19 were included. The mean age of the patients was 55.21 ± 14.08 years and 54% (53.47%) of them were male. With regards to clinical manifestations, 82.18%, 72.28% and 54.46% of COVID-19 patients had dry cough, dyspnea and fever, respectively and 44.5% had lymphopenia. The right lower lobe was the most common (69%) and severe involved lobe followed by left lower lobe, right middle lobe, and lingual; however, anterior segment of upper lobes showed least involvement with abnormality in the late course of disease. The most common pattern is ground glass opacity, but atypical patterns such as round pneumonia, moderate to severe plural effusion and segmental lobar collapse consolidation was seen without evidence of mediastinal adenopathy, cavitation or nodule. Chest X ray (CXR) was not sensitive method as a first line imaging because 34.65% of them were normal.Conclusion CXR is not sensitive method as first line imaging too (34.65% normal first CXR), but Chest CT is very sensitive and nonspecific modality for diagnosis of COVID – 19. Lower lobe and posterior basal predominance involvements were seen in most cases. About 12% showed atypical chest CT features.