Microbiological analysis and antibiotic selection strategy in neck abscesses among patients with diabetes mellitus.

PURPOSE: This study aimed to analyze the clinical characteristics, pathogen distribution, drug sensitivity, and antibiotic treatment strategies of patients with neck abscesses with or without diabetes. METHODS: A retrospective analysis was conducted on 2194 patients who underwent neck abscess surgery at our hospital over the past 13 years. Patients were grouped as NAwithDM (neck abscess with diabetes mellitus) or NAwithoutDM (neck abscess without diabetes mellitus). Clinical features, pathogen distribution, and antibiotic sensitivity were compared between the groups. Venn diagrams were used to illustrate the antibiotics effective against all three predominant pathogens. RESULTS: A total of 2194 patients with neck abscesses were included in this study, with 579 patients (26.43%) in the NAwithDM group and 1612 patients (73.51%) in the NAwithoutDM group. There were no significant differences in sex or age distribution between the two groups (all P > 0.05). However, there were significant differences in BMI, length of hospital stays, occurrence of laryngeal obstruction, hypertension, and hypoalbuminemia between the two groups (all P < 0.05). In the NAwithoutDM group, the top three pathogens were Streptococcus constellatus, Klebsiella pneumoniae, and Staphylococcus aureus. The antibiotics that were simultaneously effective against all three pathogens were ceftriaxone, moxifloxacin, and ampicillin/sulbactam. In the NAwithDM group, the top three pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus constellatus. The antibiotics that were simultaneously effective against all three pathogens were compound sulfamethoxazole, cefuroxime, levofloxacin, ciprofloxacin, vancomycin, and imipenem. CONCLUSION: Neck abscess patients with diabetes have distinct clinical features. Therefore, it is crucial to pay attention to these clinical features and manage them accordingly during the treatment process. Empirical antibiotic treatment should be tailored to individual patient groups. Sulfamethoxazole-methoxazole is recommended for neck abscess patients with diabetes, while ceftriaxone or moxifloxacin is recommended for those without diabetes.

Deep cervical abscesses in children: efficacy of the cefotaxime-rifampicin combination.

The objective is to determine whether a medical treatment, the combination of cefotaxime and rifampicin, is effective in avoiding surgery for managing deep cervical abscesses in children and to determine prognostic factors in the efficacy of this medical treatment. This is a retrospective analysis of all patients under 18 presenting with para- or retro-pharyngeal abscess over the period 2010-2020 in two hospitals' pediatric otorhinolaryngology departments. One hundred six records were included. Multivariate analyses were performed to study the relationship between the prescription of the Cefotaxime-rifampicin protocol at the onset of the management and the use of surgery and to evaluate the prognostic factors of its efficacy. The 53 patients who received the cefotaxime-rifampicin protocol as first-line treatment (vs. 53 patients receiving a different protocol) required surgery less frequently: 7.5% versus 32.1%, validated by a Kaplan-Meier survival curve and a Cox model analysis adjusted for age and abscess size (Hazard Ratio = 0.21). This good outcome of the cefotaxime-rifampicin protocol was not demonstrated when it was instituted as a second-line treatment after the failure of a different protocol. An abscess larger than 32 mm at hospitalization was significantly associated with more frequent use of surgery in multivariate analysis adjusted for age and sex (Hazard Ratio = 8.5).    Conclusions: The cefotaxime-rifampicin protocol appears to be an effective first-line treatment in managing non-complicated deep cervical abscesses in children. What is Known: • Nowadays, medical treatment is preferred for managing deep neck abscesses in children. There has yet to be a consensus on the antibiotic therapy to be proposed. • Staphylococcus aureus and streptococci are the most frequent causative organisms. What is New: • The cefotaxime-rifampicin protocol introduced at first intention is effective, with only 7.5% of patients requiring drainage surgery. • The only risk factor for failure of the medical treatment is the initial size of the abscess.

The first case of deep neck abscess due to Filifactor alocis co-infected with Eggerthia catenaformis, Parvimonas micra, and Streptococcusconstellatus.

Filifactor alocis, an anaerobic Gram-positive rod, has garnered interest from its association with periodontal disease. Extraoral infections by F. alocis are rare; only seven cases have been reported. We report the first case in which we identified F. alocis as one of the causative organisms of a deep neck abscess. A 71-year-old male on hemodialysis came to our hospital with a fever and left buccal pain. The patient's left neck was swollen, and contrast-enhanced computed tomography showed an abscess with gas extending from the left cheek to the deep neck. We diagnosed the patient with a deep neck abscess and performed an urgent neck drainage. We isolated F. alocis, Eggerthia catenaformis, Parvimonas micra, and Streptococcus constellatus in the abscess and identified them using matrix-assisted laser desorption ionization-time of flight mass spectrometry. Blood cultures were negative. We initiated treatment with piperacillin-tazobactam and vancomycin. The patient improved but developed a hemorrhagic duodenal ulcer on the third day of admission. We attempted endoscopic hemostasis, but the patient's bleeding continued. Ultimately, he died of the duodenal ulcer hemorrhage on the sixth day of admission. This is the first case of F. alocis detected in a deep neck abscess.

Perioperative factors influencing hospitalization duration for pediatric neck abscesses.

PURPOSE: Pediatric neck abscesses are a common pathology seen in an ambulatory setting. Although some pediatric neck abscesses are managed medically with antibiotics, surgical intervention is often required. Given the often non-emergent presentation of many abscesses, a variety of logistical and perioperative factors may delay time to care and subsequently prolong hospital stay. The objective of this study was to examine factors that influence the overall time to surgery (TTS) and hospital length of stay (LOS) in a pediatric population with neck abscesses who ultimately require surgical drainage. MATERIALS AND METHODS: 161 pediatric patients who underwent incision and drainage of a neck abscess over a ten-year period at a tertiary referral children's center were reviewed. Demographic information, radiographic studies, and surgical information were extracted from patient charts. Descriptive statistics, Mann-Whitney U tests, and multivariate analyses were performed. RESULTS: The most common subcategory location was deep neck abscesses (33.1 %). Computed tomography (CT) was the most common pre-operative imaging modality (54.1 %) followed by ultrasound (US) (49.1 %) and magnetic resonance imaging (2.6 %). US and a combination of multiple preoperative imaging modalities were associated with increased LOS and TTS. Repeat surgery was associated with increased LOS. Pre-admission antibiotic use was associated with increased LOS and TTS. Younger patients were more likely to have a longer LOS. CONCLUSIONS: A variety of factors can influence TTS, LOS, and time from surgery to discharge including patient age, abscess location, a non-optimized utilization of imaging modalities, the utilization of pre-admission antibiotics, and the need for repeat operations.

Hematologic and inflammatory parameters for determining severity of odontogenic infections at admission: a retrospective study.

BACKGROUND: Severe odontogenic infections in the head and neck region, especially necrotizing soft tissue infection (NSTI) and deep neck abscess, are potentially fatal due to their delayed diagnosis and treatment. Clinically, it is often difficult to distinguish NSTI and deep neck abscess in its early stage from cellulitis, and the decision to perform contrast-enhanced computed tomography imaging for detection is often a challenge. This retrospective case-control study aimed to examine the utility of routine blood tests as an adjunctive diagnostic tool for NSTI in the head and neck region and deep neck abscesses. METHODS: Patients with severe odontogenic infections in the head and neck region that required hospitalization were classified into four groups. At admission, hematologic and inflammatory parameters were calculated according to the blood test results. In addition, a decision tree analysis was performed to detect NSTI and deep neck abscesses. RESULTS: There were 271 patients, 45.4% in Group I (cellulitis), 22.5% in Group II (cellulitis with shallow abscess formation), 27.3% in Group III (deep neck abscess), and 4.8% in Group IV (NSTI). All hematologic and inflammatory parameters were higher in Groups III and IV. The Laboratory Risk Indicator for Necrotizing Fasciitis score, with a cut-off value of 6 and C-reactive protein (CRP) + the neutrophil-to-lymphocyte ratio (NLR), with a cut-off of 27, were remarkably useful for the exclusion diagnosis for Group IV. The decision tree analysis showed that the systemic immune-inflammation index (SII) of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 suggests Group III + IV and the classification accuracy was 89.3%. CONCLUSIONS: Hematologic and inflammatory parameters calculated using routine blood tests can be helpful as an adjunctive diagnostic tool in the early diagnosis of potentially fatal odontogenic infections. An SII of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 can be useful in the decision-making for performing contrast-enhanced computed tomography imaging.

A comparison of patients with neck abscesses caused by esophageal foreign body impaction vs. inflammatory disease: a retrospective study.

OBJECTIVES: During clinical practice, we have detected a few cases of neck abscesses in patients diagnosed with esophageal foreign body impaction (EFB) but without the primary inflammatory disease. However, we do not know if neck abscesses caused by an inflammatory source are more like to be associated with a more severe progression or poorer prognosis. In this study, we aimed to identify differences between these two groups of patients by comparing progression and prognosis. MATERIALS AND METHODS: We retrospectively reviewed all patients who underwent neck abscess incisions between January 2011 and March 2022 and divided these patients into two groups: an EFB group and an inflammation group. Data were described by percentages, means, and standard deviations (SDs). Fisher's precision probability test was used to compare differences between the EFB and inflammation groups. Categorical variables were analyzed by Pearson's Chi-squared test. In addition, three factors including hospital days, intensive care unit (ICU) stay, and drainage-tube removal time were used for multivariate analysis to identify independent correlations separately. RESULTS: We enrolled a total of 33 patients with neck abscesses who received surgical incisions; the EFB group included 14 (42%) cases, while the inflammatory group included 19 (58%) cases. No significant differences were identified between the two groups in terms of surgery type (with or without mediastinotomy) and postoperative management (negative pressure drainage or postoperative irrigation). There were no significant differences between the two groups in terms of hospital stay, the timing of drainage-tube removal, the risk of ICU admission, and the probability of receiving intubation and tracheotomy. The incidence rate of esophageal perforation differed significantly between the two groups (p < 0.001). However, there were no significant differences in terms of other preoperative or postoperative comorbidities. The multivariate analysis revealed that the application of mediastinotomy (HR = 0.216 [0.049, 0.963]; p = 0.044) was correlated with a longer stay in the hospital. The time from symptoms to surgery was associated with a longer drainage tube removal time (HR = 0.392 [0.159, 0.967]; P = 0.042) and longer ICU stay (OR = 79.754[1.513, 4203.182]; P = 0.03). CONCLUSION: Patients with neck abscesses associated with EFB and inflammation received the same therapeutic management, and there were no significant differences between these two groups in terms of prognosis. Furthermore, esophageal perforation was found to be irrelevant to the aggravation of neck abscesses, and there was no need for additional surgery to repair a perforated esophagus in patients with neck abscesses. LEVEL OF EVIDENCE: Retrospective cohort (2b).

Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes.

INTRODUCTION: Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality. METHODS: Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital. RESULTS: Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). Streptococcus spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (n = 5). Mean hospital stay was 9.13 days (±7.2). DM (p = 0.016), age (p = 0.001), BMI classification 3, 4, and 6 (p = 0.041), and intensive care unit (ICU) admission (p = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (p = 0.001) and masticator (p = 0.002) space involvement and DM (p = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (p = 0.001), ICU admission (p < 0.0001), Streptococcus spp. (p = 0.019), and low hemoglobin levels (p = 0.004) were associated with mortality. DISCUSSION/CONCLUSION: DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.

Risk Factors of Descending Necrotizing Mediastinitis in Deep Neck Abscesses.

Background and Objectives: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if untreated. The aim of this study was to identify risk factors for the progression of deep neck abscesses to descending necrotizing mediastinitis. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing surgical treatment of deep neck abscesses from August 2017 to July 2022. Computed tomography (CT) was performed in all patients. Before surgery, lab data including hemoglobulin (Hb), white blood cell count, neutrophil percentage, C-reactive protein (CRP) level, and blood glucose were recorded. Patients' characteristics including gender, age, etiology, and presenting symptoms were collected. Hospitalization duration and bacterial cultures from the wound were also analyzed. Results: The C-reactive protein (CRP) level was higher in patients with a mediastinal abscess than in patients without a mediastinal abscess (340.9 ± 33.0 mg/L vs. 190.1 ± 72.7 mg/L) (p = 0.000). The submandibular space was more commonly affected in patients without a mediastinal abscess (p = 0.048). The retropharyngeal (p = 0.003) and anterior visceral (p = 0.006) spaces were more commonly affected in patients with a mediastinal abscess. Conclusions: Descending necrtotizing mediastinitis results in mortality and longer hospitalization times. Early detection of a mediastinal abscess on CT is crucial for treatment. Excluding abscesses of the anterior superior mediastinum for which transcervical drainage is sufficient, other mediastinal abscesses require multimodal treatment including ENT and thoracic surgery to achieve a good outcome.

A case of neck abscess caused by rare hypervirulent Klebsiella pneumoniae, capsular type K20 and sequence type 420.

BACKGROUND: This case report describes a neck abscess caused by a strain of Hypervirulent Klebsiella pneumoniae in a middle aged man with diabetes without a history of travel to East and South East Asia. This case report is of notable significance as Hypervirulent Klebsiella pneumoniae neck abscesses are rarely seen in the UK and are very infrequently documented in individuals who have not first travelled to the high prevalence areas of East and South East Asia. CASE PRESENTATION: This case report describes a 53 year old diabetic man who contracted a Hypervirulent Klebsiella pneumoniae neck abscess which led to the development of sepsis. Klebsiella pneumoniae was cultured from blood cultures and fluid aspirated from the abscess grew the pathogen with same antimicrobial susceptibility. Hypervirulence was demonstrated after the samples were analysed, at the Antimicrobial Resistance and Healthcare Associated Infections Reference Unit Public Health England Colindale, and found to contain the K20 (rmp)A and rmpA2 virulence genes. DISCUSSION: Hypervirulent Klebsiella pneumoniae is a Gram-negative, encapsulated, non-motile bacillus notable for its ability to metastatically spread and cause potentially life threatening infections in otherwise healthy adults, but especially in those with diabetes. Genes responsible for the production of hyperviscous mucoid polysaccharide capsules and siderophores, such as those isolated in this case, enable the bacteria to more efficiently evade the hosts immune system and disseminate and invade surrounding and distant tissues. Data from Public Health England shows Hypervirulent Klebsiella pneumoniae are rare in the UK. A review of current literature also showed Hypervirulent Klebsiella pneumoniae almost exclusively occur in those who have traveled to East and South East Asia. CONCLUSIONS: This case reported a rare Hypervirulent Klebsiella pneumoniae neck abscess outside of, and without travel to, East and South East Asia. This raises concerns about future, potentially life threatening, Hypervirulent Klebsiella pneumoniae infections becoming more widespread without the need for endemic travel. This concern is further exacerbated by the growing global challenge of antimicrobial resistance.

Early detecting cervical necrotizing fasciitis from deep neck infections: a study of 550 patients.

PURPOSE: The aim of this retrospective review study is to evaluate Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score as an indicative parameter in early detecting cervical necrotizing fasciitis (CNF) from deep neck infections (DNI). METHODS: We reviewed 12 cases of CNF and 538 cases of non-necrotizing deep neck infection hospitalized in our hospital over the last decade. Cervical necrotizing fasciitis was histologically confirmed. RESULTS: Using an LRINEC score of 6 as a cutoff sensitivity was calculated at 100% (95% CI 99.9-100) and specificity 72.5% (95% CI 72.4-72.6). Negative predicted value (NPV) was 100% and positive predicted value (PPV) was 7.5%. C-reactive protein (CRP), white blood count (WBC), and glucose (Glu) levels have a higher correlation. Haemoglobin (Hb), sodium (Na), and creatinine (Cr) do not seem to have a big impact in our study. CONCLUSION: LRINEC score proves to be a useful "rule-out" tool that works on the safe side with high sensitivity and poor specificity. WBC, CRP, and Glu seem to be the most significant variables of the LRINEC score. Hb, Na, and Cr make the score safer. Decision for surgery must be based on medical history, clinical symptoms and signs, imaging findings, and laboratory tests and not according to the LRINEC score itself.

Translocation of intestinal bacteria as a cause of subcutaneous abscesses of the neck and head in American mink (Neovison vison) - a case report.

BACKGROUND: The problem of transmission of intestinal microorganisms to tissues occurs when intestinal epithelial cells do not adhere tightly (tight junction), which is caused by improper nutrition, usually associated with poor mucosal status. The impact on maintaining its proper condition in the case of animals also depends on the proper preparation and fragmentation of the ingredients of the feed. Intestinal microbiota disorders are increasingly indicated as one of the causes of many autoimmune, neurodevelopmental and metabolic diseases. However, there are no studies indicating damage to the intestinal barrier of animals resulting in the penetration of microorganisms from the gastrointestinal tract directly into the bloodstream which may result in the development of chronic inflammation. CASE PRESENTATION: On a mink (Neovison vison) farm with a foundation stock of 4,000 females, abscesses were observed in the head, followed by progressive deaths. Antibiotic treatment with amoxicillin and clavulanic acid added to the animals' feed was not successful. Macroscopic and microscopic changes indicated local suppurative inflammation of the skin and subcutaneous tissue with the presence of purulent fistulas. Microbiological analysis showed a significant increase in Escherichia coli in all samples taken from the abscesses. The results indicate the migration of intestinal bacteria through disturbance of the permeability of the intestinal barrier and their transfer to the blood. Symptoms were alleviated in all animals following changes in the feed components and in feed particle size. CONCLUSIONS: It is necessary to take into account the possibility of transmission of intestinal bacteria in the etiology of inflammatory diseases in animals. Conducting more research in this field will improve the understanding of the relationship between intestinal microbes and the health of the body as a whole.

Chronic neck sinus secondary to retained polyglactin 910 suture following sub-total thyroidectomy: a case study.

OBJECTIVE: Reaction to sutures is a rare cause of non-healing in clean wounds. Cases of severe reaction to silk sutures have been reported, causing chronic infection and failure of thyroidectomy wound healing. We report a case of retained polyglactin 910 suture presenting with a chronically discharging sinus of the neck after sub-total thyroidectomy. CASE: The patient, a 37-year old female, presented with a simple benign multinodular goitre. She had subtotal thyroidectomy and was discharged on day six postoperatively, after satisfactory primary wound healing. The patient observed swelling, pus/discharge and extrusion of the suture in the neck three weeks after surgery. Discharge did not stop after initial wound debridement under local anaesthesia. Computed tomography (CT) scan showed a small area of ring-enhancement soft tissue density, anterior to the right thyroid remnant. Subsequent wound exploration under general anaesthesia revealed a sinus tract extending to the thyroid bed with undegraded strands of thickened polyglactin 910 suture. Suture remnants were removed and the wound healed satisfactorily a week later. CONCLUSION: Non-healing post thyroidectomy wounds should raise suspicion of a retained suture. Early recognition and surgical intervention will shorten the period of morbidity.

Swallowing the Unexpected: A Case Report on an Unusual Presentation of Esophageal Malignancy.

Head and neck malignancies presenting with a neck abscess as the primary symptom are uncommon and may result in a misdiagnosis or delay in diagnosis and appropriate treatment. Here we report on a rare case where a young adult presented with signs and symptoms of a retropharyngeal abscess, which was later identified as an esophageal malignancy.

The COVID-19 period influence on pediatric deep neck abscess: Occurrences and clinical presentation.

OBJECTIVE: The purpose of the study was to investigate the influence of the COVID-19 pandemic on the incidence of deep neck infections (DNIs) in pediatric patients. In addition, it describes the clinical, laboratory, and microbiology presentation as well as the clinical outcomes. STUDY DESIGN: Retrospective cohort study. SETTINGS: A single tertiary medical center. METHODS: All patients ≤18 years with a diagnosis of DNI, between the years 2010-2022, were included in the study and the yearly incidence of DNI was calculated. Patients were divided according to their diagnosis of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs), and according to age; Group 1 (aged 0 to ≤4 years) and Group 2 (aged>4 to ≤18 years). RESULTS: A total of 46 cases of DNIs; 24 were RPAs and 22 were PPAs, age group 1 had 20 patients, and age group 2 had 26 patients. The overall DNI incidence during 2010 was 0.81 and declined in 2020 (COVID-19 pandemic period) to 0.33, followed by a surge in the incidence of 4.85 in 2022 (post-COVID-19 period). In age group 1 RPAs were more dominant (70 %) while PPAs were dominant (61.5 %) in group 2. (p = 0.034). A higher prevalence of positive cultures was seen in the RPA group compared to the PPA group (75 % vs 33 %, p = 0.025, respectively), and in age group 1 compared to age group 2 (77 % vs 30 %, p = 0.001, respectively). CONCLUSION: In conclusion, our study provides valuable insights about the disease and vulnerable communities. In addition, we showed a decrease during the COVID-19 pandemic followed by an increase in DNI incidence post-COVID-19 pandemic era. A larger comprehensive prospective study is warranted to gain a deeper understanding of these trends and their underlying causes.

Ingested Australasian Snapper (Chrysophrys auratus) Bone Migration to C5 Vertebral Body.

Fishbone ingestion has been reported multiple times previously as a cause of oesophageal perforation. This is a surgical emergency that needs to be identified early to ensure immediate medical attention. This report presents the case of a 70-year-old patient with laryngeal perforation and the migration of a Chrysophrys auratus (Australasian snapper) fishbone to the C5 vertebral body. It is hypothesized that the fishbone migrated from the larynx to the visceral fascia and prevertebral fascia before lodging in between the intramuscular substance of the longus coli muscle. Multiple imaging modalities were used to identify and locate the foreign body, including flexible nasopharyngoscopy, esophagogastroduodenoscopy, and a computed tomography (CT) scan of the neck. The exploration of the neck was done by the ENT team and the orthopaedic spine team via the left anterior cervical approach at the level of the C5 and C6 vertebral bodies. The foreign body was identified (15 mm fishbone) at the left lateral of the C5 body, lodged between the intramuscular substance of the longus coli muscle, and was successfully removed.

Pediatric Lemierre's Syndrome: A Comprehensive Literature Review.

BACKGROUND: Lemierre syndrome is a rare, potentially fatal complication of oropharyngeal infections characterized by septic thrombophlebitis of the internal jugular vein. It primarily affects healthy adolescents and young adults. Its incidence declined after the antibiotic era, but it may have resurged in recent decades, likely due to judicious antibiotic use and increasing bacterial resistance. Prompt diagnosis and treatment are imperative to prevent significant morbidity and mortality. METHODS: Lemierre syndrome has been called "the forgotten disease," with a reported incidence of around 3.6 cases per million. The mean age at presentation is around 20 years old, though it can occur at any age. Lemierre Syndrome follows an oropharyngeal infection, most commonly pharyngitis, leading to septic thrombophlebitis of the internal jugular vein. F. necrophorum is the classic pathogen, though other organisms are being increasingly isolated. Metastatic infections, especially pulmonary, are common complications. Contrast-enhanced CT of the neck confirming internal jugular vein thrombosis is the gold standard for diagnosis. Long-course broad-spectrum IV antibiotics covering anaerobes are the mainstays of the disease's treatment. Anticoagulation may also be considered. Mortality rates are high without treatment, but most patients recover fully with appropriate therapy. CONCLUSIONS: Lemierre syndrome should be suspected in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers. Early diagnosis and prompt antibiotic therapy are key, given the potential for disastrous outcomes if untreated. An increased awareness of Lemierre syndrome facilitates its timely management.

The Radiographic Characteristics of Mandibular Wisdom Teeth That Can Cause Severe Deep Neck Infection.

PURPOSE: Mandibular wisdom teeth can occasionally cause infections, which can progress to severe deep neck infections (DNIs) including deep neck abscesses or necrotizing soft tissue infections, which are fatal. This study aimed to identify the radiographic characteristics of mandibular wisdom teeth that developed severe DNIs. METHODS: This study included patients who were admitted for the treatment of severe mandibular wisdom tooth infection between July 2012 and June 2024 at a single center. Patient characteristics, clinical data, and radiographic findings were analyzed and compared between the severe DNI group and mild DNI group including patients with cellulitis or superficial abscess. P < 0.05 was considered significant. RESULTS: Nineteen of 42 patients (45.2%) were included in the severe DNI group. The multivariate analysis showed that the highest odds ratio (OR) was for the presence of a radicular cyst (OR=17.7), followed by the presence of a dentigerous cyst (OR =14.5). The most common mandibular wisdom tooth with a dentigerous cyst in patients with severe DNIs was inverted according to Winter's classification and type IIIC in the Pell and Gregory classification. CONCLUSION: Radiographic characteristics associated with severe DNIs included the presence of radicular and dentigerous cysts in the mandibular wisdom teeth. Especially in dentigerous cysts, deeply impacted teeth should be taken attention.

Open surgical excision vs. endoscopic radiofrequency ablation in managing congenital pyriform sinus fistula-a comprehensive analysis of 166 cases.

Background: Congenital pyriform sinus fistula (CPSF) is uncommon congenital abnormality, and the optimal definitive treatment has not yet been established. The aim of the present study was to comparatively evaluate patients with CPSF regarding the indications and outcomes of treatment with open surgical excision (OSE) vs. endoscopic Radiofrequency Ablation (RA), and the advantages of both therapeutic procedures were also analyzed. Methods: An observational, longitudinal, retrospective, analytical and comparative study was conducted on 166 consecutive pediatric patients with CPSF treated at Shanghai Children's Hospital between December 2018 and September 2023. Results: In this study, there were 79 males and 87 females. The median age at operation was 4.8 years (8 days to 15 years). OSE and Endoscopic RA were respectively performed in 48 and 118 children. The gastric tube retention time after RA was longer (3 days vs. 14 days) than after OSE. Patients with a history of incision and drainage (I&D) tended to choose OSE (75.0% vs. 39.0%, P < 0.01). There were no significant differences in postoperative complications and recurrence rates between these two groups (P > 0.05), but the hospitalization duration was shorter for RA group compared to OSE group [2 (2-3) vs. 4 (3-5), P < 0.01]. Conclusions: Both OSE and RA are recognized as first-line treatment options for CPSF, which show no significant differences in prognosis, except hospitalization duration and the gastric tube retention time. Nevertheless, the indications for OSE and RA differ, which are influenced by factors such as the inflammatory stage, specific typing, previous treatments, and the surgeon's expertise. The selection of surgical approach should be carefully determined based on individual circumstances.

Impact of Bacterial Etiology on Procalcitonin, C-reactive Protein and Hematological Parameters: Evaluating Mean Platelet Volume for Differentiating Gram-Negative and Gram-Positive Bacteria in Odontogenic Versus Non-odontogenic Head and Neck Abscesses.

Introduction Head and neck abscesses, which can originate from odontogenic or non-odontogenic sources, pose significant diagnostic challenges due to their diverse bacterial etiologies. This study aims to investigate the impact of bacterial etiology on procalcitonin (PCT), C-reactive protein (CRP), and various hematological parameters, and to assess the diagnostic performance of mean platelet volume (MPV) in differentiating between Gram-negative bacteria (GNB) and Gram-positive bacteria (GPB) in adults with odontogenic and non-odontogenic head and neck abscesses. Materials and methods Our retrospective analysis of a prospective study comprised 80 patients: 50 individuals (56% men, average age 41.6±18.18 years) with odontogenic and 30 patients (66.7% men, average age 44.53±15.49 years) with non-odontogenic head and neck abscesses during the period from July 2021 to June 2022. White blood cell count (WBC); neutrophil (Neu) and lymphocyte (Ly) count; MPV, and platelet count (PLT) were derived from the results of complete blood count. MPV/PLT (MPI) was calculated by dividing MPV by PLT. CRP levels (mg/l) were quantified via immunoturbidimetric analysis utilizing latex-enhanced particles and PCT levels (ng/ml) by latex-enhanced immunoturbidimetric assay. Results In 25 (31.3%) of all 80 patients, no microorganisms were isolated (sterile cultures); in 28 (35%) resident microflora were isolated; in seven (8.8%) GNB were isolated; and in 17 (21.3%) GPB were isolated. CRP and Neu were significantly higher in patients with odontogenic abscesses compared to non-odontogenic ones. PLT and PCT were lower in patients with odontogenic abscesses vs those with non-odontogenic abscesses. Additionally, according to bacterial type, MPV, MPI and PCT were significantly higher in GPB compared to GNB. WBC, Neu and PLT were higher in patients with GNB vs GPB. Significant correlations were found between MPV and Ly, and between MPV and Neu, regardless of the abscess origin or etiological factor. MPI exhibited an area under the curve of the receiver operating characteristic (AUC-ROC)=0.776, MPV of 0.541, and PCT of 0.568 in distinguishing patients with GPB from GNB. A cut-off value of 0.029 was derived for MPI (70.6% sensitivity and 80% specificity). Conclusions This study highlights the impact of bacterial etiology on inflammatory and hematological markers in head and neck abscesses. Odontogenic abscesses showed higher CRP and Neu, indicating a stronger inflammatory response, while non-odontogenic abscesses had higher PLT, Ly, and PCT. MPI proved to be a more effective diagnostic marker (cut-off value of 0.029) than MPV or PCT for distinguishing between GPB and GNB, suggesting its valuable role in clinical practice for accurate and timely diagnosis.

Lemierre's Syndrome Secondary to Shoulder Hematoma Complicated by COVID-19: A Case Report.

This case report illustrates a unique presentation of Lemierre's syndrome precipitated by Fusobacterium necrophorum. This case report describes a 20-year-old patient who developed Lemierre's syndrome secondary to a shoulder hematoma and neck abscess with multiple systemic complications in the absence of tonsillitis or oropharyngeal infection. Two weeks prior to presentation, the patient sustained a right shoulder injury and contracted COVID-19. Due to his Lemierre's syndrome, he developed right internal jugular vein and subclavian vein thrombosis, septic lung emboli, right sided Horner's syndrome, disseminated intravascular coagulation, pelvic collection, septic arthritis of pubic symphysis and osteomyelitis of the right pubic bone, and proximal left femoral shaft. The patient received non-operative and operative management to manage his Lemierre's syndrome including surgical drainage, antibiotics, and anticoagulation; he was discharged following an extended hospital stay. This case report highlights a rare presentation of Lemierre's syndrome secondary to a shoulder hematoma in a COVID-19 positive patient, and its potential systemic and life-threatening complications. Its importance is highly relevant in the context of the COVID-19 pandemic. Further studies are warranted to explore the effect of preceding COVID-19 infections on the microbiological profile in Lemierre's syndrome.