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Children (Basel, Switzerland) Sep 2023As there is currently no consensus on managing deep neck infections in pediatric populations, we report a case series from a large pediatric hospital. Clinical data of...
As there is currently no consensus on managing deep neck infections in pediatric populations, we report a case series from a large pediatric hospital. Clinical data of patients discharged from Istituto Gaslini-Children's Hospital from January 2014 to June 2020 with peritonsillar, parapharyngeal, or retropharyngeal abscess diagnoses were collected. A total of 59 patients were identified. Patients underwent surgical drainage in 47% of cases. Streptococcus mitis/oralis was the most isolated pathogen. Surgically treated patients did have larger abscesses compared to others, but there were no differences in the duration of hospitalization. Children who received NSAIDs at home had significant delays in diagnosis (median 4 vs. 1.5 days, = 0.008). In our experience, clinical presentation of DNIs is often evocative, but evaluation should include imaging with CT/MRI. Surgery is effective in larger abscesses, allowing for etiological diagnosis with consequent antibiotic adjusting. From an anamnestic point of view, home medications such as NSAIDs could delay diagnosis.
PubMed: 37761467
DOI: 10.3390/children10091506 -
World Journal of Clinical Cases Aug 2023Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and...
BACKGROUND
Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton-Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.
CASE SUMMARY
A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.
CONCLUSION
Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
PubMed: 37621581
DOI: 10.12998/wjcc.v11.i22.5391 -
Clinical Microbiology and Infection :... Jan 2024We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA).
OBJECTIVES
We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA).
METHODS
We performed a cross-sectional analysis of all patients with PTA and their microbiological findings in the 2 years preceding versus the 2 years following the COVID-19 lockdown in Denmark (11 March 2020), who were admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Age-stratified population data for the catchment area were obtained from Statistics Denmark.
RESULTS
The annual incidence rate was significantly higher in the 2-year period before (21.8 cases/100 000 inhabitants) compared with after (14.9 cases/100 000) the lockdown (p < 0.001). The number of cases with growth of Streptococcus pyogenes was significantly higher in the period before (n = 67) compared with after (n = 28) the lockdown (p < 0.001), whereas the number of cases positive for Fusobacterium necrophorum (n = 60 vs. n = 64) and streptococcus anginosus group (SAG) (n = 37 vs. n = 43) were stabile (p 0.79 and p 0.58, respectively). The relative prevalence of S. pyogenes was significantly higher in the period before (67/246 cultures, 27%) compared with after (28/179, 16%) the lockdown (p 0.007). On the contrary, the relative prevalence of F. necrophorum and SAG is significantly lower before (60/246, 24% and 37/246, 15%) compared with after (64/179, 36% and 43/179, 24%) the lockdown (p 0.013 and p 0.023).
DISCUSSION
Social distancing had a significant impact on the incidence and microbiology of PTA. Our findings suggest that S. pyogenes-positive PTA is highly related to direct social interaction, and represents a contagious pathogen. By contrast, PTA development caused by F. necrophorum and SAG is unrelated to direct social interaction and may be derived from flora imbalance.
Topics: Humans; Peritonsillar Abscess; Incidence; Retrospective Studies; Cross-Sectional Studies; Fusobacterium Infections; Streptococcus pyogenes
PubMed: 37562694
DOI: 10.1016/j.cmi.2023.08.003 -
IDCases 2023Infectious mononucleosis (IM) is a relatively common infection in healthy young patients with few complications. Here we present a case of severe IM complicated with...
Infectious mononucleosis (IM) is a relatively common infection in healthy young patients with few complications. Here we present a case of severe IM complicated with extensive bilateral peritonsillar abscesses. Clinicians should be aware of this complication of IM in patients with persistent or progressive symptoms. Epstein-Barr virus is a herpes virus that causes infectious mononucleosis (IM) in young adults. Symptoms are usually sore throat, lymphadenopathy, fever, and malaise Sylvester et al. [1]. IM has been associated with complications such as hemolytic anemia, myocarditis, splenic rupture, thrombocytopenia, hepatitis, etc Sylvester et al. [1]. There have been reports of suppurative processes involving the tonsils such as intratonsillar or peritonsillar abscesses, but these seem to be rare complications. Herein, we present a case of bilateral peritonsillar abscesses in a patient with severe mononucleosis.
PubMed: 37448377
DOI: 10.1016/j.idcr.2023.e01829 -
Healthcare (Basel, Switzerland) Jul 2023Primary healthcare is the pillar of a well-functioning healthcare system. General practitioners (GPs) should have a broad skillset to cope with the various conditions...
Primary healthcare is the pillar of a well-functioning healthcare system. General practitioners (GPs) should have a broad skillset to cope with the various conditions they encounter in everyday practice. Ear, nose, and throat (ENT) cases are some of the most common reasons for seeking care. The study aimed to define the frequency and type of ENT disorders seen in the emergency department of a tertiary hospital in Greece. All patients examined by an ENT specialist in the emergency department setting, within a year, were recorded, as well as all referrals from private practice or primary care facilities. From September to December 2021, data were collected from patients who agreed to complete a two-minute survey, namely, the Generalized Anxiety Disorder Scale (GAD-2) questionnaire. During the study year, 4542 cases were documented, from which the most common conditions listed were external otitis (6.9%/314), epistaxis (6.7%/305), and impacted earwax (5.7%/261). The diagnoses that led to hospitalization were 336 and the most common were peritonsillar abscess (16.4%/55), epistaxis (8.0%/27), and facial nerve paralysis (7.4%/25). Referrals from GPs working in the public sector represented more than the half of the total. There was a significant correlation between an increased number of hospital visits and an increased GAD-2 score, in the semester before the current visit ( < 0.001). Referrals to ENT specialists represent around 5% of all cases examined, and about 8% of all visits required hospitalization. Interdisciplinary clinical and research investment into GP training is compulsory to regulate ENT referrals by GPs.
PubMed: 37444776
DOI: 10.3390/healthcare11131943 -
Archivos Argentinos de Pediatria Feb 2024The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval...
The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval tonsillectomy should be performed. Here we describe the case of a 14-year-old boy with sore throat, trismus, and fever. He had bilateral tonsillar hypertrophy, convex arches, and soft palate edema. Computed tomography: bilateral tonsillar hypertrophy, with post-contrast enhancement, both with collection, edema with moderate pharyngeal stenosis. The patient was hospitalized for intravenous therapy and tonsillectomy with bilateral drainage resulting in a complete resolution of his condition and discharge at 48 hours. In the presence of a peritonsillar abscess, an unsuspected contralateral abscess should be considered. It should be diagnosed and managed adequately to prevent complications. Quinsy tonsillectomy could be safe and should be considered in patients who will undergo anesthesia for abscess drainage. The final decision should be made for each patient on an individual basis.
Topics: Male; Humans; Adolescent; Peritonsillar Abscess; Tonsillectomy; Pharyngitis; Hypertrophy; Edema
PubMed: 37382552
DOI: 10.5546/aap.2023-03034.eng -
Ugeskrift For Laeger Jun 2023
Topics: Humans; Peritonsillar Abscess; Emergency Service, Hospital; Ultrasonography
PubMed: 37325984
DOI: No ID Found -
Indian Journal of Otolaryngology and... Jun 2023Peritonsillar abscess (PTA) is the most common deep neck infection of the head and neck, but pharyngeal edema extending behind or below the tonsil and spreading to the...
UNLABELLED
Peritonsillar abscess (PTA) is the most common deep neck infection of the head and neck, but pharyngeal edema extending behind or below the tonsil and spreading to the larynx is atypical. Accurate diagnosis and prompt treatment are required because airway obstruction, descending mediastinitis, or thrombophlebitis may result. We evaluated surgical outcomes of inferiorly extended PTA (IEPTA) using an endoscope and a radiofrequency device for intraoral drainage. We retrospectively reviewed the medical records of 56 patients with IEPTA who underwent incisional drainage between 2013 and 2021. Two experienced surgeons performed intraoral drainage using an endoscope and a radiofrequency device (endoscopic group [EG]) or without such devices (WEG). Thirty (male: 26, female: four; mean age: 51.3 years), and 26 (male: 21, female: five; mean age: 55.9 years) patients in the EG and WEG, respectively, were evaluated. The mean hospitalization durations were 6.7 and 14.5 days for the EG and WEG, respectively (p<0.01). There were significant between-group differences regarding the number of tracheostomies conducted to secure an airway or surgical field (EG: four (13.3%); WEG: 16 (61.5%); p<0.01. The hospitalization duration for patients undergoing tracheostomy was significantly shorter in the EG than in the WEG (9.3 vs. 18.5 days, respectively; p=0.01). No significant difference in the mean hospital stay was observed for patients who did not undergo tracheostomy ([EG: 6.3, WEG: 8.2] days; p=0.081). IEPTA drainage using an endoscope and a radiofrequency instrument can reduce duration of hospitalization and tracheostomy procedures compared with the conventional method.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-022-03362-0.
PubMed: 37275022
DOI: 10.1007/s12070-022-03362-0