title: Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children.
abstract: BACKGROUND
  Acute cervical adenitis can evolve into suppurative cervical lymphadenitis and may sometimes be associated with infection of the retropharyngeal and parapharyngeal spaces (i.e., retropharyngeal and poststyloid parapharyngeal abscesses). This study aimed to describe the clinical presentation of acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children and examine the management of these conditions.
  
  
  METHODS
  This was a retrospective study including children from 3 months to 18 years old who were hospitalized in the Pediatric Department of the Centre-Intercommunal-de-Créteil between January 2003 and May 2010. Selected cases were based on the diagnosis of acute cervical lymphadenitis, suppurative cervical lymphadenitis, or infections of the retropharyngeal or parapharyngeal spaces. Case history, clinical signs, laboratory tests, imaging, treatment and clinical course were collected from patient charts.
  
  
  RESULTS
  We included 75 children (54 males [72%]); 62 (83%) were < 6 years old. Diagnoses were acute cervical lymphadenitis in 43 patients (57%), suppurative cervical lymphadenitis in 13 (17%), retropharyngeal or poststyloid parapharyngeal abscess in 18 (24%) and cervical necrotizing fasciitis in 1 (1%). In total, 72 patients (96%) presented fever and 34 (45%) had torticollis. Suppurative cervical lymphadenitis or abscesses of the retropharyngeal or poststyloid parapharyngeal spaces was significantly higher for children with than without torticollis (52.9% vs. 4.8%, p < 0.001). In all, 21 patients among the 44 > 3 years old (48%) underwent a rapid antigen detection test (RADT) for group A beta-hemolytic Streptococcus pyogenes; results for 10 were positive (48%). Contrast-enhanced CT scan of the neck in children with torticollis (n = 31) demonstrated an abscess in 21 (68%). Fine-needle aspiration was performed in 8 patients (11%) and 8 (11%) required surgical drainage. Bacteriology was positive in 8 patients (11%), with a predominance of Staphylococcus aureus and S. pyogenes. All patients received intravenous antibiotics and the outcome was favorable regardless of surgery. Recurrence was observed in only 1 case among the 34 patients with a follow-up visit after discharge.
  
  
  CONCLUSIONS
  Our data suggest that presentation with cervical lymphadenitis associated with fever and torticollis requires evaluation by contrast-enhanced CT scan. Furthermore, abscess drainage should be restricted to the most severely affected patients who do not respond to antibiotic therapy.
authors.affiliation: Service de Pédiatrie, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40, allée de la source, 94195 Villeneuve Saint Georges, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Georget
authors.affiliation: Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Gauthier
authors.affiliation: Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France.
authors.forename: Lydia
authors.initials: L
authors.lastname: Brugel
authors.affiliation: Service de Radiologie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Verlhac
authors.affiliation: Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Remus
authors.affiliation: Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France ; Inserm U955, Equipe 11, Faculté de Médecine, Université Paris-Est, 94000 Créteil, France.
authors.forename: Ralph
authors.initials: R
authors.lastname: Epaud
authors.affiliation: Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France.
authors.forename: Fouad
authors.initials: F
authors.lastname: Madhi
keywords: Acute cervical lymphadenitis; Children; Infection; Retropharyngeal and parapharyngeal space