Veillonella atypica causing retropharyngeal abscess: A rare case presentation.

Veillonella species are obligate anaerobes which are part of the human oral, gut and vaginal microbiota. The genus Veillonella consists of 16 characterized species. Very few infections due to Veillonella atypica have been reported till date. Here we present a case of retropharyngeal abscess due to this organism in a 55-year-old lady.

Role of steroids in conservative treatment of parapharyngeal and retropharyngeal abscess in children.

PURPOSE: To characterize the clinical features and outcomes of pediatric patients with retropharyngeal (RPA) or parapharyngeal abscesses (PPA) managed only with medical treatment and showing the importance of early symptoms and imaging studies in the diagnosis of deep neck space infections (DNIs) in children. METHODS: A retrospective analysis of all patients diagnosed with RPA and PPA between 2007 and 2017 was performed in Hospital Universitario Central de Asturias. RESULTS: 30 children were identified, with 11 RPA and 19 PPA. 23 children (76.7%) were under 5 years old, and all were treated with intravenous amoxicillin/clavulanic acid and corticosteroids. Torticollis and fever were present in all patients. The mean length of hospital stay was 7.5 days. There were no complications associated. CONCLUSION: DNIs can be treated in a conservative way, reserving the surgical drainage for cases with a complication associated (airway compromise, lack of response to antibiotic therapy, immunocompromised patients). Treatment with intravenous antibiotics and corticosteroids is a safe option, reducing the duration of symptoms and the length of hospital stay.

A study of Deep Neck Space Infections at Kathmandu University Dhulikhel Hospital.

Background Deep neck infections are severe infections in potential spaces and fascial planes of the neck. Despite antibiotic therapy, these infections continue to cause significant morbidity and mortality. Objective To determine the clinical features, predisposing factors, socio demographic factors and complications associated with deep neck infections. Method Prospective study conducted in the Department of Otorhinolaryngology, Kathmandu University Dhulikhel Hospital between March 2018 and June 2020. Seventy-five patients with deep neck infections were enrolled. Result Submandibular abscess was most frequently observed (41.3%), followed by submental abscess (25.3%), parotid abscess(9.3%), ludwig's angina (6.7%), posterior triangle of neck abscess (4%), retropharyngeal abscess (2.7%), parapharyngeal space abscess (2.7%), and multiple space infections (8%). Staphylococcus aureus was the most common organism (53.3%), followed by Beta hemolytic Streptococcus (12%) and methicillin-resistant Staphylococcus aureus (12%). A negative culture was seen in 22.7%. Sixty-eight percent of patients underwent incision and drainage. Incision and drainage with dental extraction was done in 26.7%, four percent underwent incision and drainage with debridement and dental extraction, whereas 1.3% underwent incision and drainage with tracheostomy. Eight percent patients required Intensive care unit admission. Seven patients had descending mediastinitis, four out of which developed sepsis. When age and duration of hospital stay were correlated by using Pearson correlation coefficient, a remarkable correlation was observed (p=.020). Noteworthy relationship was not observed between different locations of deep neck infections and duration of hospital stay (p=.202). Conclusion Early identification of deep neck infections is often challenging. Proper knowledge and extreme vigilance is necessary when dealing with these complex entities to avoid life-threatening complications.

Corticosteroids in the Treatment of Pediatric Retropharyngeal and Parapharyngeal Abscesses.

BACKGROUND AND OBJECTIVES: Treatment of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) includes antibiotics, with possible surgical drainage. Although corticosteroids may decrease inflammation, their role in the management of RPAs and PPAs is unclear. We evaluated the association of corticosteroid administration as part of initial medical management on drainage rates and length of stay for children admitted with RPAs and PPAs. METHODS: We conducted a retrospective study using administrative data of children aged 2 months to 8 years discharged with RPAs and PPAs from 2016 to 2019. Exposure was defined as systemic corticosteroids administered as part of initial management. Primary outcome was surgical drainage. Bivariate comparisons were made between patients in the corticosteroid and noncorticosteroid groups by using Wilcoxon rank or χ2 tests. Outcomes were modeled by using generalized linear mixed-effects models. RESULTS: Of the 2259 patients with RPAs and PPAs, 1677 (74.2%) were in the noncorticosteroid group and 582 (25.8%) were in the corticosteroid group. There were no significant differences in age, sex, or insurance status. There was a lower rate of drainage in the corticosteroid cohort (odds ratio: 0.28; confidence interval: 0.22-0.36). Patients in this group were more likely to have repeat computed tomography imaging performed, had lower hospital costs, and were less likely to have opioid medications administered. The corticosteroid cohort had a higher 7-day emergency department revisit rate, but there was no difference in length of stay (rate ratio 0.97; confidence interval: 0.92-1.02). CONCLUSIONS: Corticosteroids were associated with lower odds of surgical drainage among children with RPAs and PPAs.

Absceso retrofaríngeo por fístula congénita del seno piriforme en una adolescente / Retropharyngeal abscess due to a congenital pyriform sinus fistula in a teenager

Arch Argent Pediatr 2020;118(1):e81-e84 / e81Presentación de casos clínicosRESUMENLas fístulas del seno piriforme son anomalías poco frecuentes de los arcos branquiales. La forma de presentación más común en los niños y los adolescentes es la tiroiditis aguda supurada y/o los abscesos cervicales laterales recurrentes. Sin embargo, las fístulas se pueden manifestar de forma atípica. La rareza de esta patología y la presentación clínica atípica pueden demorar el diagnóstico, lo que aumenta el riesgo de infecciones recurrentes y complicaciones.Se presenta el caso inusual de una adolescente de 13 años con absceso retrofaríngeo debido a una fístula congénita del seno piriforme, tratada de forma exitosa mediante electrocauterización endoscópica.

Pyriform sinus fistulas are rare anomalies of the branchial arches. The most common form of presentation in children and adolescents is acute suppurative thyroiditis and/or recurrent lateral cervical abscesses. However, fistulas can manifest atypically. The rarity of this pathology and the atypical clinical presentation can delay the diagnosis increasing the risk of recurrent infections and complications.We present the unusual case of a 13-year-old teenager with retropharyngeal abscess due to a congenital pyriform sinus fistula successfully treated by endoscopic electrocautery

Kicking off a Retropharyngeal Abscess

Aim Retropharyngeal abscesses (RPA) are deep neck space infections that can pose an immediate life-threatening emergency, such as airway obstruction. [1] Methods We describe an atypical presentation of RPA in a three year old girl who attended with a history of post-traumatic Neck pain. Results MB presented to the Emergency department with neck pain and reduced range of motion following a kick to the neck by a sibling. Examination was unremarkable. Cervical spine x-ray showed psuedosubluxation of C2/C3 with a concern regarding facet joint injury. Ultimately, MRI revealed a RPA, which was incised and drained, and the patient treated with antibiotics. MB did not have any classic symptoms and signs of RPA. The history was misleading the treating physicians, and hence a delay in diagnosis. Conclusion This case highlights an unusual presentation of a retropharyngeal abscess and reminds us that trauma can often be a red herring in a patient's presentation.

Abscesos profundos de cuello en pediatría: experiencia del Hospital Dr. Sótero del Río entre los años 2011 y 2018 / Pediatric deep neck abscesses: Dr. Sótero del Río Hospital 2011-2018 experience

RESUMEN Introducción: Los abscesos profundos de cuello son colecciones de pus alojadas en los espacios profundos cervicales. En la población pediátrica son poco frecuentes, sin embargo, pueden presentar complicaciones potencialmente mortales. Objetivo: Caracterizar a los pacientes que consultan por abscesos profundos del cuello en el Servicio de Urgencia Pediátrico del Hospital Dr. Sótero del Rio. Material y método: Estudio de tipo descriptivo retrospectivo con datos obtenidos de fichas clínicas de pacientes. Se realizó una revisión de fichas clínicas de los pacientes diagnosticados con abscesos profundos de cuello en el Servicio de Urgencia Pediátrica del Hospital Sótero del Río entre los años 2011 y 2018. Se analizaron variables clínicas (anamnesis, examen físico, exámenes de laboratorio generales y específicos y su manejo) y demográficas. Los resultados se analizaron mediante estadística descriptiva con medidas de tendencia central y rango, utilizando Statistical Package for the Social Science (SPSS). Resultados: Se incluyeron 41 pacientes entre 0 y 15 años, con un promedio de edad de 7,2 años. Sesenta y tres por ciento de los pacientes fueron de sexo masculino. Se presentaron 23 (56%) pacientes con abscesos periamigdalinos (PA), 12 (29,2%) con abscesos retrofaríngeos (RF), 5 (12,1%) con abscesos parafaríngeos (PF) y 1 (2,4%) con absceso de tipo mixto (RF- PF). El 60% de los pacientes recibió algún tratamiento médico previo. Se realizó estudio imagenológico en 83% de los pacientes. Todos los pacientes presentaron parámetros inflamatorios elevados. En el 80% de los pacientes se realizó tratamiento médico y algún tipo de drenaje. Conclusiones: Los abscesos profundos del cuello son una entidad relativamente poco frecuente en pediatría, pero potencialmente peligrosa si no se detecta a tiempo, por lo que debemos tener un alto índice de sospecha para evitar las complicaciones.

ABSTRACT Introduction: Deep neck abscesses are pus collections lodged in the deep cervical spaces. They are rare in the pediatric population, however, they can present life-threatening complications. Objective: To characterize the patients who consult for deep neck abscesses in the pediatric emergency department of Dr. Sótero del Rio Hospital. Material and method: Descriptive retrospective study. A review of clinical records of patients diagnosed with deep neck abscesses in the pediatric emergency department of Dr. Sótero del Rio Hospital between 2011 and 2018 was made. The clinical (anamnesis, physical exam, general and specific laboratory exams and management) and demographic characteristics were evaluated. The results were analyzed by descriptive statistics with measures of central tendency and range, using Statistical Package for the Social Science (SPSS). Results: Forty-one patients between 0 and 15 years of age were included, with an average age of 7.2 years. 63% of the patients were male. There were 23 (56%) patients with peritonsillar abscesses (PA), 12 (29.2%) with retropharyngeal abscesses (RF), 5 (12.1%) with parapharyngeal abscesses (PF) and 1 (2.4%) with abscess of mixed type (RF-PF). 60% of the patients received some previous medical treatment. An imaging study was performed in 83% of the patients. All the patients presented high inflammatory parameters. In 80% of patients, medical treatment and some type of drainage were performed. Conclusions: Deep abscesses of the neck are a relatively rare entity in pediatrics, but potentially dangerous if not detected in time, so we must have a high index of suspicion to avoid complications.

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.

Peritonsillar and deep neck infections: a review of 330 cases / Infecções peritonsilares e cervicais profundas: revisão de 330 casos

Abstract Introduction: Deep neck infections are defined as suppurative infectious processes of deep visceral spaces of the neck. Objective: The aim of this study is to review different factors that may influence peritonsillar and deep neck infections and may play a role as bad prognosis predictors. Methods: We present a retrospective study of 330 patients with deep neck infections and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS. Results: There has been an increase in incidence of peritonsilar and deep neck infections. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%). Conclusion: Systemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.

Resumo Introdução: Infecções cervicais profundas são definidas como processos infecciosos supurativos dos espaços viscerais profundos do pescoço. Objetivo: Analisar diferentes fatores que podem influenciar as infecções peritonsilares e cervicais profundas que podem desempenhar um papel como preditores de mau prognóstico. Método: Apresentamos um estudo retrospectivo de 330 pacientes portadores de infecções cervicais profundas e de infecções peritonsilares admitidos entre janeiro de 2005 e dezembro de 2015 em um hospital terciário de referência. A análise estatística de comorbidades, aspectos diagnósticos e terapêuticos foi realizada utilizando-se os programas Excel e o SPSS. Resultados: Houve um aumento na incidência de infecções peritonsilares e infecções cervicais profundas. Comorbidades sistêmicas como diabetes ou doença hepática são fatores de mau prognóstico. O patógeno mais comum foi S. viridans (32,1% das culturas positivas). 100% dos pacientes receberam antibióticos e corticosteroides, e 74,24% necessitaram de tratamento cirúrgico. As complicações mais comuns foram mediastinite (1,2%) e obstrução das vias aéreas (0,9%). Conclusão: Comorbidades sistêmicas são preditores de mau prognóstico. Atualmente, a mortalidade diminuiu graças ao cuidado multidisciplinar e melhorias no diagnóstico e tratamento.

Deep head and neck infections: outcome following empirical therapy with early generation antibiotics.

In order to study the bacteriological profile, antibiotic sensitivity and outcome following empirical therapy with early generation antibiotics in patients with deep head and neck infection, a retrospective review of 42 patients admitted for drainage and intravenous antibiotic therapy was performed. Ludwig's angina was the commonest infection, with the most common organisms isolated being Group F ß-haemolytic (15%) and non-haemolytic (12.5%) streptococcus. All streptococci and anaerobic gram-positive cocci were susceptible to penicillin. S. aureus isolates were oxacillin-sensitive and enterococcus isolates were ampicillin-sensitive. All 42 patients received empirical therapy with either intravenous penicillin or its derivatives. In only three patients was a change of antibiotic required based on culture and sensitivity results. Early generation antibiotics appear ideal as empirical therapy for deep head and neck infection.

Peritonsillar and deep neck infections: a review of 330 cases.

INTRODUCTION: Deep neck infections are defined as suppurative infectious processes of deep visceral spaces of the neck. OBJECTIVE: The aim of this study is to review different factors that may influence peritonsillar and deep neck infections and may play a role as bad prognosis predictors. METHODS: We present a retrospective study of 330 patients with deep neck infections and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS. RESULTS: There has been an increase in incidence of peritonsilar and deep neck infections. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%). CONCLUSION: Systemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.

Kicked to touch: Hoodwinked by torticollis.

A 2-year-old girl presented to the emergency department with a 3-day history of a painful stiff neck after getting a kick to her head from her older brother. Her general practitioner had recently started her on oral antibiotics for otitis media. Plain film imaging of her cervical spine on admission revealed anterior subluxation of C2 on C3 suggestive of bifacetal dislocation. Subsequent CT imaging confirmed malalignment of the upper cervical spine. The patient was admitted and worked up with MRI of the cervical spine which unexpectedly revealed a large 4×2 cm retropharyngeal abscess extending from C1 to C4. No associated structural abnormality of the spine was detected. This case report highlights the life-threatening causes of torticollis (retropharyngeal abscess and cervical spine injury), and summarises the anatomy and normal variants that one should expect on interpretation of cervical spine imagery.

[A Pediatric Case of Retropharyngeal Abscess Causing Multiple Instances of Cranial Nerve Palsy].

Deep neck abscesses are relatively rare in children compared with adults. Diagnosis can be difficult in pediatric patients because of the various clinical symptoms, therefore, it is important to correctly understand the pathology. We report herein on a rare pediatric case of a deep neck abscess that caused multiple instances of cranial nerve palsy. The patient was a 7-year-old boy who, despite treatment by a local physician for fever, swelling of the left neck and neck pain, developed torticollis, dysarthria, dysphagia and hoarseness and consequently consulted our department. We observed palsy associated with the IX, X, and XII left cranial nerves and a retropharyngeal abscess was diagnosed based on the computed tomography findings. The patient was hospitalized and underwent conservative treatment, and on day 21 of hospitalization, the patient was discharged after his symptoms had eased and the size of the abscess had reduced. We believe that palsy of the cranial nerves in the present case occurred as a result of pressure being applied to the cranial nerves in the carotid space due to an abscess in the retropharyngeal space.