A child with neck swelling

2004

Cengiz AB, Kara A, Kanra G, Seçmeer G, Ceyhan M, Özen M. Acute neck infections in children. Turk J Pediatr 2004; 46: 153-158.

Journal of Microbiology, Immunology and Infection, 2010

BACKGROUND/PURPOSE: Deep neck infections (DNIs) can cause significant morbidity in children. This study analyzes the clinical presentations, diagnostic clues, and age relationship of DNI in pediatric patients. METHODS: Pediatric patients admitted to our hospital from January 1996 to December 2007 with a diagnosis of DNIs were reviewed retrospectively. Diseases were categorized according to the site of infection: peritonsillar, parapharyngeal, and retropharyngeal spaces. Patients were divided into two groups: children (aged < 10 years) and adolescents (aged 10-18 years). RESULTS: Fifty pediatric patients were enrolled, including nine with DNI in the retropharyngeal space, 17 in the parapharyngeal, 21 in the peritonsillar and three with mixed type abscesses. A total of 21 patients belonged to the child group, and 29 were adolescents. All retropharyngeal abscesses occurred in children; whereas most peritonsillar abscesses (81%) were found in adolescents. Most retropharyngeal and parapharyngeal abscesses were associated with fever (100% and 65%, respectively) and neck masses (67% and 94%, respectively); while odynophagia was the most common symptom in peritonsillar abscess (100%). Thirtytwo abscess cultures were obtained and seven grew mixed pathogens, followed by Streptococcus pyogenes (n = 5), and normal flora (n = 5). Complications of airway obstruction arose in one patient with parapharyngeal abscess, and mediastinitis in another two patients with retropharyngeal abscesses. Recurrent DNIs were observed in six patients; three had congenital bronchogenic cysts. CONCLUSION: The location of the DNI appears to vary in different pediatric age groups. Its insidious presentation, with a potentially complicated course, warrants careful inspection in children with fever and neck masses, especially young children.

American Journal of Otolaryngology, 2009

Introduction: Dermatopathic lymphadenitis (DL) represents a benign form of reactive lymph node hyperplasia. Symptoms attributed to DL alone are expected to be mild. The purpose of this study was to present a rare case of DL in a young girl that manifested as a deep neck space infection. Differential diagnostic process and the difficulties we faced in managing this case will be discussed. Case presentation: A 10-year-old girl with clinical signs indicative of deep neck space infection was admitted in our department. Her clinical course and imaging findings strongly suggested the presence of a deep cervical abscess, although this was not proven in the operating room, in 2 operating sessions. The complete clinical picture developed during her in-hospital care set the suspicion of Kawasaki disease; however, the results of the histology of the cervical nodes were consistent with dermatopathic lympadenitis, which was the final diagnosis in our patient. Conclusion: Dermatopathic lymphadenitis is a rare diagnosis in the head and neck area. However, it must be included in the differential diagnostic process because its management differs from that of other head and neck lymphadenopathies, keeping in mind that the spectrum of its clinical symptomatology may vary from a mild lymph node enlargement to acute symptoms and signs of a deep neck infection.

Einstein (São Paulo), 2015

Cervical adenitis &gt;1.5cm in diameter is the less frequently observed criteria in patients with Kawasaki disease and it is usually found in association with other symptoms during the acute phase. Moreover, the finding of fever and lymphadenitis with intense local signs of inflammation and phlegmon is rarely seen as the initial manifestation of Kawasaki disease. We report the case of a 7-year-old boy who had cervical lymphadenitis with adjacent cellulitis and phlegmon mimicking bacterial adenitis as the first presentation of Kawasaki disease. The patient had fever, cervical lymphadenitis with adjacent cellulitis, and severe headache. Cefadroxil was prescribed based on the clinical diagnosis of bacterial adenitis. Because he remained febrile and phlogistic signs worsened, after 1 day of hospitalization, antibiotics were administrated intravenously (ceftriaxone and oxacillin). The computed tomography of the neck showed primary infectious/inflammatory process. On the fourth day, the p...

BMC infectious diseases, 2006

Streptococcus intermedius belongs to the Streptococcus anginosus group. It is part of the normal flora of the human mouth, but it can be etiologically associated with deep-site infections. We present a case of deep neck infection complicating Streptococcus intermedius lymphadenitis, which developed in an immunocompetent 14-year-old boy with a history of recent dental work. The infection was ultimately eradicated by a combined medical and surgical approach. Our report suggests that combined medical and surgical therapy is essential for the complete resolution of deep infections caused by Streptococcus intermedius. Molecular biological techniques can be useful in guiding the diagnostic investigation and providing insight into the possibility of occult abscesses, which are particularly common with Streptococcus intermedius infections.

Current Infectious Disease Reports, 2009

Cervical lymphadenopathy is a common problem in children. The condition most commonly represents a transient response to a benign local or generalized infection. Acute bilateral cervical lymphadenitis is usually caused by a viral upper respiratory tract infection or streptococcal pharyngitis. Acute unilateral cervical lymphadenitis is caused by streptococcal or staphylococcal infection in 40% to 80% of cases. Common causes of subacute or chronic lymphadenitis include cat-scratch disease and mycobacterial infection. Generalized lymphadenopathy is often caused by a viral infection, and less frequently by malignancies, collagen vascular diseases, and medications. Laboratory tests are not necessary in most children with cervical lymphadenopathy. Most cases of cervical lymphadenitis are self-limited and require no treatment. The treatment of acute bacterial cervical lymphadenitis without a known primary source should provide adequate coverage for both Staphylococcus aureus and Streptococcus pyogenes .

Pediatria Polska, 2020

Deep neck space infection (DNSI) is a rare clinical entity in the paediatric age group. However, it can cause significant morbidity and mortality in children. It has insidious presentations but can lead to a fatal and rapid course, which warrants careful observation by the clinician. Common causes of DNSIs are odontogenic and pharyngotonsillar infections. Children with DNSI may present with fever, neck swelling, and breathing difficulty. The fatal complications of DNSI in children are airway obstruction, mediastinitis, internal jugular vein thrombosis, pneumonia, and meningitis. The diagnosis of the DNSI is often challenging to the paediatrician or otolaryngologist. The three important things for successful treatment of the DNSI are antibiotic therapy, surgical drainage, and protection of the airway. Because of the complex anatomy of the neck, the airway management and surgical treatment may be challenging. The aim of this review article is to describe details of aetiopathology, clinical presentation, investigations, and current treatment.

VIRAL AND BACTERIAL PHARYNGOTONSILITIS: DIFFERENTIAL CLINICAL ASPECTS ( Atena Editora), 2022

Acute pharyngotonsillitis (FT) is defined as an infection of the pharynx and/or tonsils that can be caused by a range of pathogens. When the infection is viral, there is no specific treatment. Because it is a self-limiting disease in 5 to 7 days and has a good prognosis in previously healthy children, general measures are more indicated in these cases: hydration, symptoms for pain and/or fever, preventive measures and observation. However, although most bacterial infections are also benign and self-limiting, a small number of patients infected with some strains of hemolytic beta group A Streptococcus can complicate matters. Given this risk, early treatment with antibiotics is well indicated. Despite this, the abusive use of antibiotics has globally worried health authorities. Therefore, the current study aims to demystify differential clinical aspects of the manifestation of TF in order to improve medical accuracy in choosing the most appropriate treatment. METHODOLOGY: This is a literature review initiated from the selection of the main etiological agents for pharyngotonsillitis based on the incidence in scientific literature of its different types (viral or bacterial). Among the inclusion criteria, studies with description of clinical history and/or physical examination for the disease were selected. Finally, a literature review of the main data related to. RESULTS: The age group does not exclude the possibility, but it confirms it as a favorable factor for differentiation. In children under 3 years of age, the incidence of viral infections is much higher than that of bacterial origin. Children with viral infections also manifest more extra-pharyngeal symptoms, such as nasal discharge, conjunctivitis, cough, hoarseness, diarrhea, ulcerations, or others. In addition, high fever, sudden onset, intense odynophagia, petechiae on the palate, and cervical adenopathy that is painful on palpation are more frequently associated with bacterial infection. Currently, one of the most used clinical tools to indicate the possibility of the etiologic agent and, consequently, the need for treatment with antibiotic therapy, is the McIsaac Modified Centor Score. CONCLUSIONS: The difference in management makes a thorough clinical diagnosis important, despite the recommendation to use complementary exams, to avoid the irrational use of antibiotics - which already represents a situation of global alert. Finally, literature review studies such as this one allow to support medical practice with more illustrative and objective information, whose expected result involves the improvement of the clinical diagnosis and, finally, the more accurate and rational prescription of antibiotics in cases of TF.