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Int J Pediatr Otorhinolaryngol. 2017 Aug;99:95-99. doi: 10.1016/j.ijporl.2017.05.028. Epub 2017 Jun 5.

Clinical and bacteriological differences of deep neck infection in pediatric and adult patients: Review of 123 cases.

Author information

1
Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
2
Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. Electronic address: ZAY00015@nifty.com.
3
Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Otolaryngology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan.
4
Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Nara, Japan.

Abstract

OBJECTIVES:

Deep neck infections (DNIs) can lead to life-threatening disease. However, the detailed pathophysiology remains unclear due to its rarity and only a few reports have directly compared DNIs in children and adults. This study aimed to reveal the clinical differences between DNIs in children and adults.

METHODS:

We retrospectively reviewed 123 patients who suffered from DNIs at Tohoku University Hospital from August 2005 to July 2015. We extracted data on patient sex, age, antecedent illness, extension of infections, operative procedures, and bacteriology results. The patients were categorized into pediatric (≤18 years) and adult (>18 years) groups. Fisher's exact test was performed to determine significant differences between the two groups.

RESULTS:

Fifteen children (6 males and 9 females) and 108 adults (71 males and 37 females) were identified. The most common antecedent illness in pediatric patients was lymphadenitis, which was the least common in adult patients (73% vs 7%, p < 0.0001). The incidence of DNIs extending below the hyoid bone was significantly lower in pediatric patients than in adult patients (20% vs 53%, p < 0.05). Regarding bacterial culture analysis, Staphylococcus species was the most common pathogen in children (60%), whereas only 9% of adults were positive for Staphylococcus (p < 0.001). Streptococcus species were significantly less common in children than in adults (27% vs 56%, p = 0.05). Anaerobes were also significantly less common in children than in adults (13% vs 45%, p < 0.01). Concerning surgical intervention, 53% of pediatric patients underwent external incision compared with 70% of adults. Specifically, tracheostomy was significantly less frequently performed in children than in adults (7% vs 54%, p < 0.01).

CONCLUSION:

DNIs in children feature different characteristics from those in adults regarding severity, antecedent illness, bacteriology, and clinical management.

KEYWORDS:

Abscess; Children; Deep neck infections; Lymphadenitis; Parapharyngeal; Retropharyngeal; Staphylococcus species

PMID:
28688574
DOI:
10.1016/j.ijporl.2017.05.028
[Indexed for MEDLINE]

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