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 card...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.展开更多
Objective:Deep neck infections(DNI)are responsible for significant morbidity in children and healthcare expenditures.Few studies exist specifically addressing the clinical and epidemiologic characterization and manage...Objective:Deep neck infections(DNI)are responsible for significant morbidity in children and healthcare expenditures.Few studies exist specifically addressing the clinical and epidemiologic characterization and management of DNI's in the pediatric population.Our goal was to analyse the demographic characteristics,clinical presentation,diagnostic and therapeutic approaches of peritonsillar and DNI in pediatric patients.Methods:The medical records of patients,aged up to 18 years,admitted for peritonsillar and DNI at our department,from 2011 to 2016,were retrospectively reviewed and compared with the literature available.Ninety-eight patients were enrolled.Results:The mean age was higher in patients with peritonsillar abscess and lower in patients with retropharyngeal and parapharyngeal infections.Admissions have significantly increased from 2011.There was a seasonal variation for DNI incidence,with a peak incidence in Summer and Spring.All patients included were treated as inpatient and received empirical intravenous antibiotic therapy and steroids regardless of drainage procedures.Incision and drainage was performed in 72 patients.The hospital length of stay was higher among patients with retropharyngeal abscess and in the group with complications.Only 2 patients developed complications during hospital stay.The most common microbiological pattern was monomicrobial and the most commonly isolated pathogens were Streptococcus Pyogenes,Streptococcus Mitisand anaerobic bacteria.Conclusions:Surgical incision and drainage followed by intravenous antibiotic and steroids proved to be successfull with low morbidity related to surgical approach.However,in selected cases,medical therapy may be an alternative to surgical management in uncomplicated infections.展开更多
文摘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.
文摘Objective:Deep neck infections(DNI)are responsible for significant morbidity in children and healthcare expenditures.Few studies exist specifically addressing the clinical and epidemiologic characterization and management of DNI's in the pediatric population.Our goal was to analyse the demographic characteristics,clinical presentation,diagnostic and therapeutic approaches of peritonsillar and DNI in pediatric patients.Methods:The medical records of patients,aged up to 18 years,admitted for peritonsillar and DNI at our department,from 2011 to 2016,were retrospectively reviewed and compared with the literature available.Ninety-eight patients were enrolled.Results:The mean age was higher in patients with peritonsillar abscess and lower in patients with retropharyngeal and parapharyngeal infections.Admissions have significantly increased from 2011.There was a seasonal variation for DNI incidence,with a peak incidence in Summer and Spring.All patients included were treated as inpatient and received empirical intravenous antibiotic therapy and steroids regardless of drainage procedures.Incision and drainage was performed in 72 patients.The hospital length of stay was higher among patients with retropharyngeal abscess and in the group with complications.Only 2 patients developed complications during hospital stay.The most common microbiological pattern was monomicrobial and the most commonly isolated pathogens were Streptococcus Pyogenes,Streptococcus Mitisand anaerobic bacteria.Conclusions:Surgical incision and drainage followed by intravenous antibiotic and steroids proved to be successfull with low morbidity related to surgical approach.However,in selected cases,medical therapy may be an alternative to surgical management in uncomplicated infections.
