Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 250
Filtrar
1.
Cochrane Database Syst Rev ; 12: CD008669, 2019 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-31886897

RESUMO

BACKGROUND: Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a rare clinical syndrome of unknown cause usually identified in children. Tonsillectomy is considered a potential treatment option for this syndrome. This is an update of a Cochrane Review first published in 2010 and previously updated in 2014. OBJECTIVES: To assess the effectiveness and safety of tonsillectomy (with or without adenoidectomy) compared with non-surgical treatment in the management of children with PFAPA. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2019, Issue 4); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 15 October 2019. SELECTION CRITERIA: Randomised controlled trials comparing tonsillectomy (with or without adenoidectomy) with non-surgical treatment in children with PFAPA. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcomes were the proportion of children whose symptoms have completely resolved and complications of surgery (haemorrhage and number of days of postoperative pain). Secondary outcomes were: number of episodes of fever and the associated symptoms; severity of episodes; use of corticosteroids; absence or time off school; quality of life. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: Two trials were included with a total of 67 children randomised (65 analysed); we judged both to be at low risk of bias. One trial of 39 participants recruited children with PFAPA syndrome diagnosed according to rigid, standard criteria. The trial compared adenotonsillectomy to watchful waiting and followed up patients for 18 months. A smaller trial of 28 children applied less stringent criteria for diagnosing PFAPA and probably also included participants with alternative types of recurrent pharyngitis. This trial compared tonsillectomy alone to no treatment and followed up patients for six months. Combining the trial results suggests that patients with PFAPA likely experience less fever and less severe episodes after surgery compared to those receiving no surgery. The risk ratio (RR) for immediate resolution of symptoms after surgery that persisted until the end of follow-up was 4.38 (95% confidence interval (CI) 0.64 to 30.11); number needed to treat to benefit (NNTB) = 2, calculated based on an estimate that 156 in 1000 untreated children have a resolution) (moderate-certainty evidence). Both trials reported that there were no complications of surgery. However, the numbers of patients randomly allocated to surgery (19 and 14 patients respectively) were too small to detect potentially important complications such as haemorrhage. Surgery probably results in a large overall reduction in the average number of episodes over the total length of follow-up (rate ratio 0.08, 95% CI 0.05 to 0.13), reducing the average frequency of PFAPA episodes from one every two months to slightly less than one every two years (moderate-certainty evidence). Surgery also likely reduces severity, as indicated by the length of PFAPA symptoms during these episodes. One study reported that the average number of days per PFAPA episode was 1.7 days after receiving surgery, compared to 3.5 days in the control group (moderate-certainty evidence). The evidence suggests that the proportion of patients requiring corticosteroids was also lower in the surgery group compared to those receiving no surgery (RR 0.58, 95% CI 0.37 to 0.92) (low-certainty evidence). Other outcomes such as absence from school and quality of life were not measured or reported. AUTHORS' CONCLUSIONS: The evidence for the effectiveness of tonsillectomy in children with PFAPA syndrome is derived from two small randomised controlled trials. These trials reported significant beneficial effects of surgery compared to no surgery on immediate and complete symptom resolution (NNTB = 2) and a substantial reduction in the frequency and severity (length of episode) of any further symptoms experienced. However, the evidence is of moderate certainty (further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate) due to the relatively small sample sizes of the studies and some concerns about the applicability of the results. Therefore, the parents and carers of children with PFAPA syndrome must weigh the risks and consequences of surgery against the alternative of using medications. It is well established that children with PFAPA syndrome recover spontaneously and medication can be administered to try and reduce the severity of individual episodes. It is uncertain whether adenoidectomy combined with tonsillectomy adds any additional benefit to tonsillectomy alone.


Assuntos
Linfadenite/cirurgia , Faringite/cirurgia , Estomatite Aftosa/cirurgia , Tonsilectomia/métodos , Adenoidectomia/métodos , Criança , Pré-Escolar , Febre/cirurgia , Humanos , Lactente , Periodicidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome
2.
BMJ Case Rep ; 12(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31494583

RESUMO

Tularaemia is a rare infectious disease endemic in most European countries caused by the bacterium Francisella tularensis 1 Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.


Assuntos
Francisella tularensis/isolamento & purificação , Linfonodos/patologia , Linfadenite/cirurgia , Doenças Faríngeas/cirurgia , Tularemia/microbiologia , Abscesso , Antibacterianos/uso terapêutico , Pré-Escolar , Drenagem , Febre/microbiologia , Gentamicinas/uso terapêutico , Humanos , Linfadenite/microbiologia , Masculino , Doenças Faríngeas/microbiologia , Faringite/microbiologia , Resultado do Tratamento , Tularemia/fisiopatologia , Tularemia/terapia
3.
Int J Pediatr Otorhinolaryngol ; 125: 182-186, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31344608

RESUMO

OBJECTIVES: To present cases of pediatric periparotid nontuberculous mycobacterial lymphadenitis excised through a facelift incision in order to review the advantages of this approach to parotidectomy. We also aim to discuss scenarios in which to forgo the facelift incision in favor of a traditional modified Blair incision. METHODS: Retrospective series of seven consecutive patients who underwent parotidectomy for nontuberculous mycobacterial lymphadenitis between 2013 and 2018. RESULTS: The series included three uses of the facelift incision and four uses of the modified Blair incision, which was specifically selected for cases of bulky lymphadenopathy anterior to the masseter muscle. All cases of Modified Blair incision involved circumferential dissection of the marginal mandibular branch of the facial nerve. The facelift incision permitted complete removal of disease in cases located posterior to the masseter as well as neck dissection as inferiorly as level III. Post-operatively, temporary marginal mandibular nerve weakness was seen in all cases of Modified Blair incision. Scar widening was most notable in patients who required skin excision or dermal curettage. CONCLUSION: The facelift incision offers a more hidden scar. This may serve as an alternative approach to parotid surgery in young children with nontuberculous mycobacterial lymphadenitis, except in cases of bulky disease anterior to the masseter muscle for which optimal exposure of the marginal mandibular nerve via a modified Blair incision is warranted.


Assuntos
Linfadenite/microbiologia , Linfadenite/cirurgia , Infecções por Mycobacterium não Tuberculosas/cirurgia , Esvaziamento Cervical/métodos , Complicações Pós-Operatórias/prevenção & controle , Ritidoplastia/métodos , Criança , Pré-Escolar , Cicatriz/prevenção & controle , Dissecação , Nervo Facial , Feminino , Humanos , Lactente , Masculino , Glândula Parótida/cirurgia , Estudos Retrospectivos , Ferida Cirúrgica
4.
Int J Pediatr Otorhinolaryngol ; 122: 196-202, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31039497

RESUMO

OBJECTIVES: Nontuberculous mycobacterial (NTM) lymphadenitis is a rare disease of children under 5 years. Its treatment is not standardized, even a "wait-and-see" approach is shown to be effective in the literature. Here, we discuss the diagnostic and therapeutic strategies employed in our departments. METHODS: Records of pediatric patients treated for NTM cervical lymphadenitis from 2010 to 2015 in our tertiary center were retrospectively reviewed. Patients underwent cervical echotomography and/or CT scan. Every patient but one had microbiological explorations (NTM polymerase chain reaction [PCR] and culture) on fine needle aspiration of pus and/or adenitis biopsy. Differential diagnoses (tuberculosis, cat scratch disease) were excluded with serologies, chest X-Ray, and PCR on adenitis samples. Patients were classified as "proven diagnosis" (NTM detected), "highly probable" (suggestive clinical and anatomopathological aspect) or "possible" infection (suggestive adenitis alone). Treatments, follow-up and adverse events were reviewed. RESULTS: Thirty-one patients were treated for NTM, median age 2.40 years (Interquartile Range IQR = [1.85-3.16]). Twenty-nine patients (96.77%) had an isolated cervico-facial localization. Median follow-up was 8.00 months (IQR = [4.20-13.43]). We found 17 "proven diagnosis" (58.62%), 5 "highly probable" (17.24%) and 7 "possible" infections (24.14%). "Proven" infections were due to: Mycobacterium avium (n = 12, 66.67%) and M. intracellulare (n = 5, 27.78%). All 29 patients received antibiotics, which were effective for 10 (34.48%, group 1); 10 underwent surgical excision for a poor outcome with antibiotics (34.48%, group 2); spontaneous or surgical drainage occurred in 9 on antibiotics (31.03%, group 3). The median times to resolution for group 1, 2 and 3 were respectively 6.33 months, 6.22 months and 9.53 months. Antibiotics treatment was mostly clarithromycin (n = 27, 93.10%) and/or rifampicin (n = 19, 65.52%); 18 patients (62.07%) received both. Median antibiotics duration was 6.23 months (IQR = [5.17-7.46]), with good compliance (79.31%). The observed adverse effects were 3 (13.04%) isolated transient transaminase elevations, 1 case (4.35%) of minor creatinine elevation, and 1 case (4.35%) of transient diarrhea. Surgical drainage caused 1 transient marginal mandibular nerve palsy, resolutive after 1 month. CONCLUSION: Antibiotics in NTM adenitis lead to resolution in 7 months, with good tolerance and compliance. The efficacy of "wait-and-see" attitude in the literature make excision surgery a second line treatment.


Assuntos
Antibacterianos/uso terapêutico , Linfadenite/tratamento farmacológico , Linfadenite/microbiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Antibacterianos/efeitos adversos , Antibióticos Antituberculose/uso terapêutico , Pré-Escolar , Claritromicina/uso terapêutico , Drenagem/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Lactente , Linfadenite/cirurgia , Masculino , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium avium , Complexo Mycobacterium avium , Pescoço , Estudos Retrospectivos , Rifampina/uso terapêutico
5.
Br J Gen Pract ; 69(678): e33-e41, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30397014

RESUMO

BACKGROUND: Neither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based is known. AIM: To determine the incidence of indications for tonsillectomy in UK children, and the proportion of tonsillectomies meeting evidence-based criteria. DESIGN AND SETTING: A retrospective cohort study of electronic medical records of children aged 0-15 years registered with 739 UK general practices contributing to a research database. METHOD: Children with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy was then identified. The numbers with evidence-based and non-evidence-based indications for surgery among children who had undergone tonsillectomy were determined. RESULTS: The authors included 1 630 807 children followed up for 7 200 159 person-years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years; 13.6% (2144/15 760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years; 11.7% (2144/18 281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: five to six sore throats (12.4%) in 1 year, two to four sore throats (44.6%) in 1 year, sleep disordered breathing (12.3%), or obstructive sleep apnoea (3.9%). CONCLUSION: In the UK, few children with evidence-based indications undergo tonsillectomy and seven in eight of those who do (32 500 of 37 000 annually) are unlikely to benefit.


Assuntos
Medicina Baseada em Evidências/estatística & dados numéricos , Atenção Primária à Saúde , Tonsilectomia/estatística & dados numéricos , Tonsilite/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Febre/epidemiologia , Febre/cirurgia , Humanos , Incidência , Lactente , Recém-Nascido , Linfadenite/epidemiologia , Linfadenite/cirurgia , Masculino , Faringite/epidemiologia , Faringite/cirurgia , Recidiva , Estudos Retrospectivos , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/cirurgia , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Estomatite Aftosa/epidemiologia , Estomatite Aftosa/cirurgia , Síndrome , Neoplasias Tonsilares/epidemiologia , Neoplasias Tonsilares/cirurgia , Tonsilite/cirurgia , Reino Unido/epidemiologia
6.
Braz J Otorhinolaryngol ; 85(1): 78-82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29203159

RESUMO

INTRODUCTION: The role of tonsillectomy in the periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome, is controversial. Although some studies reported high success rates with tonsillectomy, further investigations are needed with larger numbers of patients. OBJECTIVE: To seek the long-term outcomes of tonsillectomy in periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. METHODS: Case series; multi-center study. The study comprised 23 patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome who underwent surgery (tonsillectomy with or without adenoidectomy) between January 2009 and November 2014. RESULTS: 21 (91%) of 23 patients had complete resolution immediately after surgery. One patient had an attack 24h after surgery, but has had no further attacks. One patient had three attacks with various intervals, and complete remission was observed after 3 months. CONCLUSIONS: Tonsillectomy is a good option for the treatment of periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome.


Assuntos
Febre/cirurgia , Linfadenite/cirurgia , Faringite/cirurgia , Estomatite Aftosa/cirurgia , Tonsilectomia/métodos , Adenoidectomia/métodos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Reprodutibilidade dos Testes , Síndrome , Resultado do Tratamento
7.
Cir Pediatr ; 31(4): 171-175, 2018 Oct 17.
Artigo em Espanhol | MEDLINE | ID: mdl-30371028

RESUMO

AIM OF STUDY: To describe our experience in the management of non-tuberculosis mycobacterial lymphadenitits (NTML). METHODS: Retrospective analysis of patients who underwent surgery for NTML in our centre during the period between 2010-2017. Demographic data, diagnostic tests, treatment and follow up information were recovered from medical records. RESULTS: 65 patients (26 male/39 female) with a mean age of 31 months (range 7 months-12 years) were intervened during the period of study. As diagnostic tests, chest X-ray was performed in 92.3% of patients with normal result in all cases, Mantoux test was positive in 20.3%, inconclusive in 12.5% and negative in 67.1%. Preoperative fine needle aspiration was positive for NTML (granulomatous necrotizing lymphadenitis) in 93.7% whereas culture for mycobacteria was only positive in 23.4% of cases, being Mycobacterium lentiflavum the most frequent agent found. Mean preoperative waiting time was 2.5 months with 7.7% of fistulization previous to surgery. Mean hospital stay was 1,1 days and there were no intraoperative complications. Mean follow up time was 5.5 months (range 1-24 months) during which 19 cases of temporal facial paralysis were noted, among which only 2 persisted after one year. CONCLUSIONS: NTML is a disease with a growing incidence in our country. It is important to make an early diagnosis and surgical treatment in order to avoid complications, as surgery has demonstrated to be safe and effective, with a low rate of complications. We believe the actual protocols should be revised/checked due to low effectiveness of diagnostic tests.


Assuntos
Linfadenite/cirurgia , Infecções por Mycobacterium não Tuberculosas/cirurgia , Micobactérias não Tuberculosas/isolamento & purificação , Biópsia por Agulha Fina/métodos , Criança , Pré-Escolar , Paralisia Facial/epidemiologia , Paralisia Facial/etiologia , Feminino , Seguimentos , Humanos , Lactente , Tempo de Internação , Linfadenite/diagnóstico , Linfadenite/microbiologia , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Estudos Retrospectivos , Fatores de Tempo
8.
J Pak Med Assoc ; 68(7): 1120-1123, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30317317

RESUMO

The aim was to determine the role of needle aspiration and surgical excision in the management of suppurative Bacillus Calmette Guerin (BCG) lymphadenitis. This prospective study was done in Rafha Central Hospital, over 1.5 years. Thirty two patients were enrolled after informed consent. Needle aspiration was done if size of lymphadenitis was up to 3cm. Surgical excision was done primarily for size more than 3cm or in cases of failed aspiration. Eighteen were males and 14 were females. Median age was 3.75 months (IQR 2-7). All were full term with normal birth weight and vaccinated in first 2 days of life. Predominantly single region of lymphadenitis was involved in 75% cases; with left axilla being mainly affected (56.3% cases). Needle aspiration was done in 18 cases and surgical excision was carried out in 14 cases. Resolution of lymphadenopathy was 7 days in cases of surgical excision, while within 60 days in cases of aspiration. Failure of aspiration was noted in cases of multiple, matted suppurative lymph nodes.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Vacina BCG/efeitos adversos , Biópsia por Agulha , Excisão de Linfonodo , Linfonodos/cirurgia , Linfadenite/cirurgia , Feminino , Humanos , Lactente , Linfonodos/patologia , Linfadenite/induzido quimicamente , Masculino , Estudos Prospectivos , Supuração , Fatores de Tempo , Falha de Tratamento
9.
Int J Immunopathol Pharmacol ; 32: 2058738418806413, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30354841

RESUMO

Non-tuberculous mycobacterial lymphadenitis (NTML) accounts for about 95% of the cases of head-and-neck mycobacterial lymphadenitis, and its prevalence has been increasing in the Western world. The diagnostic work-up can be challenging, and differential diagnoses such as tuberculous and suppurative lymphadenitis need to be considered. It may, therefore, not be diagnosed until the disease is in a late stage, by which time it becomes locally destructive and is characterized by a chronically discharging sinus. The treatment options include a medical approach, a wait-and-see policy, and surgery, with the last being considered the treatment of choice despite the high risk of iatrogenic nerve lesions. The aim of this article is to provide an overview of pediatric, head-and-neck NTML based on the literature and our own experience, with particular emphasis on the impact and limitations of surgery.


Assuntos
Linfadenite/cirurgia , Infecções por Mycobacterium não Tuberculosas/cirurgia , Criança , Diagnóstico Diferencial , Cabeça/cirurgia , Humanos , Linfadenite/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Pescoço/cirurgia , Micobactérias não Tuberculosas/patogenicidade
10.
Cir. pediátr ; 31(4): 171-175, oct. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-172930

RESUMO

Objetivos: Describir nuestra experiencia en el manejo de la linfadenitis por micobacterias no tuberculosas (LMNT). Material y métodos: Análisis retrospectivo de 65 pacientes (26 varones/ 39 mujeres) intervenidos en nuestro centro de LMNT durante los años 2010-2017. Se analizaron datos demográficos, pruebas complementarias realizadas y datos de seguimiento. Resultados: La edad media fue de 31 meses (rango 7 meses-12 años). Para el diagnóstico la radiografía de tórax se realizó al 92,3% de pacientes, siendo en todos normal. El Mantoux fue positivo en 20,3%, dudoso en 12,5% y negativo en 67,1%. La PAAF preoperatoria fue diagnóstica (linfadenitis granulomatosa necrotizante) en 93,7% mientras que el cultivo para micobacterias fue positivo solo en 23,4%, siendo el Mycobacterium lentiflavum el patógeno más frecuentemente encontrado. El tiempo de espera preoperatorio fue de 2,5 meses con un porcentaje de fistulización previo a la cirugía de 7,7%. La estancia hospitalaria media fue 1,1 días y no hubo complicaciones perioperatorias. El tiempo medio de seguimiento fue 5,5 meses (rango 1-24 meses) observándose 19 casos de parálisis facial temporal, de los cuales 2 persistieron al cabo de 1 año. Conclusiones: La LMNT es una enfermedad cada vez más frecuente en nuestro medio. Es importante realizar un diagnóstico y tratamiento precoz, puesto que el tratamiento quirúrgico ha demostrado ser seguro y eficaz asociando baja tasa de complicaciones. Creemos que los protocolos actuales se deben revisar, debido a la escasa rentabilidad de algunas pruebas complementarias


Aim of study: to describe our experience in the management of non-tuberculosis mycobacterial lymphadenitits (NTML). Methods: Retrospective analysis of patients who underwent surgery for NTML in our centre during the period between 2010-2017. Demographic data, diagnostic tests, treatment and follow up information were recovered from medical records. Results: 65 patients (26 male/39 female) with a mean age of 31 months (range 7 months-12 years) were intervened during the period of study. As diagnostic tests, chest X-ray was performed in 92.3% of patients with normal result in all cases, Mantoux test was positive in 20.3%, inconclusive in 12.5% and negative in 67.1%. Preoperative fine needle aspiration was positive for NTML (granulomatous necrotizing lymphadenitis) in 93.7% whereas culture for mycobacteria was only positive in 23.4% of cases, being Mycobacterium lentiflavum the most frequent agent found. Mean preoperative waiting time was 2.5 months with 7.7% of fistulization previous to surgery. Mean hospital stay was 1,1 days and there were no intraoperative complications. Mean follow up time was 5.5 months (range 1-24 months) during which 19 cases of temporal facial paralysis were noted, among which only 2 persisted after one year. Conclusions: NTML is a disease with a growing incidence in our country. It is important to make an early diagnosis and surgical treatment in order to avoid complications, as surgery has demonstrated to be safe and effective, with a low rate of complications. We believe the actual protocols should be revised/checked due to low effectiveness of diagnostic tests


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Linfadenite/complicações , Linfadenite/diagnóstico , Linfadenite/cirurgia , Micobactérias não Tuberculosas/isolamento & purificação , Micobactérias não Tuberculosas/patogenicidade , Linfadenite/etiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Radiografia Torácica/métodos , Estudos Retrospectivos , Espanha/epidemiologia , Biópsia por Agulha Fina/métodos
11.
Int J Pediatr Otorhinolaryngol ; 109: 149-153, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29728170

RESUMO

OBJECTIVE: Review the evaluation of children with a deep lateral neck infection and define the impact of initial imaging modality on outcomes and costs. METHOD: Case series, pediatric patients <18 years of age admitted to a tertiary care hospital with lateral neck infection between 01/01/14-05/31/16 as identified by ICD-9 and ICD-10 codes: 289.3 (lymphadenitis, unspecified), 682.1 (cellulitis and abscess of neck), 683 (acute lymphadenitis), I88.9 (nonspecific lymphadenitis, unspecified), L02.11 (cutaneous abscess of neck), L03.221 (cellulitis of neck), and L03.222 (acute lymphangitis of neck). Patients were divided into two groups based on initial imaging modality: primary ultrasound or primary computed tomography. Differences in length of stay, type and total number of imaging studies obtained, number of procedures, hospital readmission, and hospital cost were compared between cohorts. RESULTS: There were 40 (31%) primary ultrasound and 88 (69%) primary computed tomography patients (128 total). Median length of stay was 46 (IQR: 25,90) hours (1.9 days) for primary ultrasound and 63 (IQR: 39,88) hours (2.6 days) for primary computed tomography patients (p = 0.33). Drainage was performed in 48% of both groups. Additional imaging occurred in 17 (43%) primary ultrasound and 18 (20%) primary computed tomography patients (p = 0.02). Readmission occurred in 8 patients (6.3%). Retropharyngeal infection was encountered in 13 patients (10%); this was only discovered in patients who had a computed tomography performed. Median cost per primary ultrasound patients was $5363 (IQR: 3011, 7920) and $5992 (IQR: 3450, 8060) for primary computed tomography patients. CONCLUSIONS: The primary imaging modality (ultrasound or computed tomography) used to work-up children with a lateral neck infection did not impact length of stay or hospital cost. However, a significant subset had a coexisting retropharyngeal infection that was only identified on computed tomography. Future studies are needed to identify appropriate criteria for imaging in the work-up of lateral neck infections.


Assuntos
Abscesso/diagnóstico por imagem , Celulite (Flegmão)/diagnóstico por imagem , Linfadenite/diagnóstico por imagem , Pescoço/patologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Abscesso/economia , Abscesso/cirurgia , Adolescente , Celulite (Flegmão)/economia , Celulite (Flegmão)/cirurgia , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Linfadenite/economia , Linfadenite/cirurgia , Masculino , Pescoço/diagnóstico por imagem , Estudos Retrospectivos
12.
Int J Pediatr Otorhinolaryngol ; 108: 137-142, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29605343

RESUMO

OBJECTIVES: Non-tuberculous mycobacteria are the most frequent cause of chronic lymphadenitis in children. We reviewed treatment and outcomes of paediatric patients with chronic cervical lymphadenitis, to better understand their differential diagnosis, surgical indication, complication and recover. METHODS: A retrospective study was carried out on children who underwent surgery from 2013 to 2016 at Meyer Children's University Hospital, Florence, Italy. Time to cure, type of surgery, and complications rate were determined and etiologic agents were identified and correlated to their clinical presentation. RESULTS: 275 children were evaluated. Nearly 98% of the patients were cured regardless of which therapeutic option was used and surgery was necessary in 38.2% of children. Complete excisional biopsy ensured recover in 97.7% of patients compared with the non-excisional surgical group 88.2% (p = 0.06). Re-interventions were needed in the 2.3% of complete excision group and in two cases of the incision and drainage group; all of them developed fistula and were caused by Mycobacterium avium complex. Excision followed by adjunctive antibiotic therapy was favoured in the majority of the patients (80.1%, n = 71). CONCLUSION: In cases of non-tuberculous mycobacteria lymphadenitis, surgery is the treatment of choice and it is closely related to a favourable prognosis.


Assuntos
Antibacterianos/uso terapêutico , Linfadenite/cirurgia , Infecções por Mycobacterium não Tuberculosas/cirurgia , Micobactérias não Tuberculosas , Complicações Pós-Operatórias/epidemiologia , Adolescente , Biópsia , Criança , Pré-Escolar , Doença Crônica , Drenagem/estatística & dados numéricos , Feminino , Humanos , Lactente , Itália , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/microbiologia , Linfonodos/cirurgia , Linfadenite/tratamento farmacológico , Linfadenite/microbiologia , Imagem por Ressonância Magnética , Masculino , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Estudos Retrospectivos , Centros de Atenção Terciária
13.
Clin Exp Rheumatol ; 36(6 Suppl 115): 129-134, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29533751

RESUMO

OBJECTIVES: To compare the long-term morbidity of patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome treated by tonsillectomy (TE) in childhood to that of matched controls. METHODS: We identified 132 PFAPA patients from the medical records treated by TE in 1987-2007 in Oulu University Hospital, Finland. Altogether 119 patients participated the follow-up study and 94 were clinically examined on average 9.0 years after TE. The controls consisted of 230 randomly selected age-, sex-, and birth place-matched individuals from the Population Register Center of Finland. The patients and controls completed a detailed questionnaire about their current health and the data were compared. RESULTS: Self-estimated general health was good and growth was normal among PFAPA patients and controls at long-term follow-up. There were no between-group differences in the occurrence of autoimmune or other chronic diseases. Thirty percent of the PFAPA patients and 13% of the controls reported infections as causes of hospital visits during their lifetime (p<0.001). Usage of antibiotics during lifetime was reported by 99% of the PFAPA patients and by 88% of the controls (p= 0.009). Twelve percent of PFAPA patients and 0.4% of the controls reported oral thrush in their history (p=0.003). CONCLUSIONS: The health of the PFAPA patients was as good as that of healthy matched controls. Autoimmune or other chronic diseases were not more prevalent among PFAPA patients treated with TE in childhood than among controls. Respiratory infections and oral thrush were more common among the PFAPA patients than controls.


Assuntos
Febre/epidemiologia , Linfadenite/epidemiologia , Faringite/epidemiologia , Estomatite Aftosa/epidemiologia , Idade de Início , Estudos de Casos e Controles , Pré-Escolar , Comorbidade , Feminino , Febre/diagnóstico , Febre/cirurgia , Finlândia/epidemiologia , Nível de Saúde , Humanos , Linfadenite/diagnóstico , Linfadenite/cirurgia , Masculino , Faringite/diagnóstico , Faringite/cirurgia , Prevalência , Fatores de Risco , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/cirurgia , Síndrome , Fatores de Tempo , Tonsilectomia , Resultado do Tratamento
18.
J Craniofac Surg ; 28(8): 1960-1965, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28938329

RESUMO

BACKGROUND: Mycobacterium abscessus has been implicated as the cause of various infections in the setting of healthcare-related "outbreaks." Mandibular osteomyelitis caused by M abscessus is exceedingly rare, with only 1 patient reported in the literature. The authors describe the surgical management of 12 pediatric patients with M abscessus-related mandibular osteomyelitis and cervical lymphadenitis caused by exposure to contaminated water at a regional dental clinic. METHODS: Following institutional review board approval, new suspected patients were reviewed and followed prospectively. A multidisciplinary team coordinated the surgical approach, antibiotic regimen, and follow-up for each patient. RESULTS: Twelve patients (median age 7.5 years) received treatment of M abscessus infection. Eleven had mandibular osteomyelitis and underwent debridement along with extraction of affected teeth. Eight had lymphadenitis and underwent excision of involved nodes. Four patients (in whom surgical debridement was considered inadequate) received antibiotic therapy with a regimen of amikacin, cefoxitin, and azithromycin for 4 months. Nine of 12 patients have been followed for a median of 5 months (range 1-11 months); no patient has evidence of persistent clinical infection. Three of 4 patients treated with amikacin have high-frequency hearing loss. CONCLUSIONS: The authors describe a pediatric cohort with mandibular osteomyelitis and cervical lymphadenitis due to M abscessus following pulpotomy at a single dental clinic. Diagnosis required a high index of suspicion. Patients in our series had resolution of infection even without antibiotic therapy, suggesting that early complete surgical debridement and removal of affected lymph nodes can be sufficient as a sole treatment modality.


Assuntos
Antibacterianos , Desbridamento/métodos , Linfadenite , Doenças Mandibulares , Mycobacterium abscessus/isolamento & purificação , Osteomielite , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Criança , Estudos de Coortes , Feminino , Humanos , Linfadenite/diagnóstico , Linfadenite/microbiologia , Linfadenite/cirurgia , Masculino , Doenças Mandibulares/diagnóstico , Doenças Mandibulares/tratamento farmacológico , Doenças Mandibulares/microbiologia , Doenças Mandibulares/cirurgia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/cirurgia , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Osteomielite/cirurgia
19.
An. pediatr. (2003. Ed. impr.) ; 86(3): 115-121, mar. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-160628

RESUMO

Objetivo. Estudiar la epidemiología, las manifestaciones clínicas, el manejo diagnóstico-terapéutico y la evolución de las linfadenitis por micobacterias no tuberculosas en la población pediátrica de Aragón. Material y métodos. Estudio retrospectivo de pacientes menores de 15 años diagnosticados de linfadenitis por micobacteria no tuberculosa entre 2000 y 2015. Criterios de inclusión: pacientes con linfadenitis y cultivo positivo. Los resultados se expresan como medias, rango y desviación típica para las variables cuantitativas, y porcentajes para las cualitativas. Resultados. Se detectan 27 casos, edad media de presentación 39,9 meses (rango 10 meses-8 años). El tiempo desde inicio de los síntomas hasta la primera consulta especializada es 1,7±1,1 meses. La localización más frecuente es submaxilar en 17/27 casos (63%), lado derecho en el 59,3%, con tamaño de 2,96±1,26cm. Solo 16/27 presentan fistulización. Prueba de tuberculina superior a 10mm en 7/24 (29,1%). El cultivo es positivo para Mycobacterium avium en 14/27 (51,9%), Mycobacterium intracellulare 3/27 (11,1%), Mycobacterium lentiflavum 3/27 (11,1%). El 92,6% (23/27) es tratado inicialmente con amoxicilina-clavulánico. La combinación de antibióticos y cirugía se aplica en 16/27 casos (59,3%), solo antibioterapia 7/27 (25,9%) y únicamente exéresis 4/27 (14,8%). Dos pacientes precisan reintervención y un caso desarrolla neutropenia grave secundaria a rifabutina. Solo un caso (3,7%) presenta parálisis facial transitoria como secuela. Conclusiones. La combinación de antibioterapia y cirugía es el tratamiento más frecuente. El retraso en el diagnóstico hace que la exéresis como primera opción terapéutica se realice únicamente en uno de cada 7 pacientes (AU)


Objective. To study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragón (Spain). Material and methods. A retrospective study was conducted on patients under 15 years-old diagnosed with non-tuberculous mycobacterial lymphadenitis between the years 2000 and 2015. Inclusion criteria: patients with lymphadenitis and positive culture. Quantitative values are shown as mean, rank, and standard deviation, and qualitative data as frequencies. Results. Twenty-seven cases were registered, with a mean age of presentation of 39.9 months (range 10 months-8 years). The mean time between the symptoms onset and first consultation was 1.7±1.1 months. The most frequent location was sub-maxilar in 17/27 cases (63%), on the right side in 59.3%, and size 2.96±1.26cm. Fistulae were observed in 16/27 cases. Tuberculin test was greater than 10mm in 7/24 (29.1%). Microbiological cultures were positive for Mycobacterium avium in 14/27 (51.9%), Mycobacterium intracellulare 3/27 (11.1%), and Mycobacterium lentiflavum 3/27 (11.1%). Combined treatment of antibiotics and surgery was given in 16/27 cases (59.8%), medical treatment only in7/27 (25.9%), and surgical exeresis alone in 4/27 (14.8%). Two patients required a new surgery, and one showed severe neutropenia secondary to rifabutin. Only one case (3.7%) suffered from temporary facial palsy as sequel. Conclusions. The most frequent treatment was the combination of antibiotics and surgery. Delay in diagnosis seemed to be responsible for the limited number of exeresis as first option, only one for every seven patients (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Linfadenite/diagnóstico , Linfadenite/tratamento farmacológico , Linfadenite/cirurgia , Tuberculina/análise , Teste Tuberculínico/métodos , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Diagnóstico Precoce , Micobactérias não Tuberculosas , Micobactérias não Tuberculosas/isolamento & purificação , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Estudos Retrospectivos , Radiografia Torácica/métodos
20.
J Pediatr Surg ; 52(4): 593-597, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27614809

RESUMO

PURPOSE: Nontuberculous mycobacteria are uncommon cause of chronic cervicofacial lymphadenitis in healthy children. We describe clinical features and management strategies of cervicofacial nontuberculous mycobacterium lymphadenitis in a tertiary pediatric hospital. METHODS: Retrospective analysis of medical records of children discharged from 1992 to 2014 with a diagnosis of cervicofacial nontuberculous mycobacterium was made. Diagnosis certainty was based on microhistological investigations. Clinical stage was evaluated according to lymph node size and presence of fistulas. Successful therapy was defined by the regression of the lymph node enlargement (>75%) or complete surgical excision without relapse. RESULTS: Cervicofacial nontuberculous mycobacterium was diagnosed in 33 patients. Complete excision was performed in 73% of cases primarily observed in our hospital, while 83% of those referred from other hospitals required further surgical treatment. No case of relapse was observed after one year of follow-up. CONCLUSIONS: We recommend surgical approach as the first therapeutic option in the management of cervicofacial nontuberculous mycobacterium lymphadenitis. LEVELS OF EVIDENCE: Prognosis and Retrospective Study - Level II.


Assuntos
Excisão de Linfonodo , Linfadenite/cirurgia , Infecções por Mycobacterium não Tuberculosas/cirurgia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Lactente , Linfadenite/diagnóstico , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Pescoço , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA