Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses.
This review describes the microbiology, diagnosis, and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses in children. Predominant anaerobic organisms isolated in peritonsillar, lateral pharyngeal, and retropharyngeal abscesses are Prevotella, Porphyromonas, Fusobacterium and Peptostreptococcus spp.; aerobic organisms are group A streptococcus ( Streptococcus pyogenes ), Staphylococcus aureus and Haemophilus influenzae . Anaerobic bacteria can be isolated from most abscesses whenever appropriate techniques for their cultivation have been used, while S. pyogenes is isolated in only about one third of cases. More than two thirds of deep neck abscesses contain beta-lactamase producing organisms. Management of tonsillar, peritonsillar, and retropharyngeal abscesses is similar. Systemic antimicrobial therapy should be given in large doses whenever the diagnosis is made. However, when pus is formed, antimicrobial therapy is effective only in conjunction with adequate surgical drainage. Untreated abscesses can rupture spontaneously into the pharynx, causing catastrophic aspiration. Other complications are extension of infection laterally to the side of the neck or dissection into the posterior mediastinum through facial planes and the prevertebral space. Death can occur from aspiration, airway obstruction, erosion into major blood vessels, or extension to the mediastinum.
Brook
Itzhak
I
Department of Pediatrics, Georgetown University School of Medicine, Washington, DC 20016, USA. ib6@georgetown.edu
D000038:Abscess / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D006801:Humans; D000039:Peritonsillar Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D010608:Pharyngeal Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D010614:Pharynx / Q000033:anatomy & histology / Q000382:microbiology / Q000503:physiopathology*; D012008:Recurrence; D017703:Retropharyngeal Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents