Deep neck infections in children.
OBJECTIVE
Deep neck infections (DNIs) often have a rapid onset and can progress to life-threatening complications. There are only a few reports on pediatric DNIs' clinical manifestations, diagnostic clues, and etiology in Taiwan.


METHODS
A retrospective chart review of patients (aged ≤ 18 years) diagnosed with DNI from January 2005 to December 2014 was performed. DNIs were classified into retropharyngeal, parapharyngeal, peritonsillar, submandibular, and multispace abscesses.


RESULTS
A total of 52 patients with DNI were identified. The most common site of DNI was the parapharyngeal space (n = 22, 42.3%). The most commonly associated antecedent illness was preceding upper respiratory tract infection (30.8%). The most common clinical presentation was neck mass or swelling (82.7%) and fever (75%). Pus drainage or needle aspiration was performed to obtain pus samples from the infection site for pus culture (n = 31). The most commonly isolated pathogen was Staphylococcus aureus (n = 7). Amoxicillin-clavulanic acid (56.6%) was the most commonly used antibiotics, followed by penicillin (15.1%). There was no long-term morbidity or mortality.


CONCLUSIONS
When a patient (regardless of age) presents with neck mass or swelling, the DNI should always be included in the differential diagnosis. The low culture rate in Taiwan and previous partial treatment of infections may have affected identification of pathogens in cultures. Performing Gram staining and acid-fast staining of pus, instead of culture alone, as early as possible before initiating the initial antimicrobial therapy are thus crucial. The recurrence of DNI should alert the physician to the possibility of an underlying bronchogenic cyst. Excision surgery is required to cure recurrent infections.
Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan.
Chung-Ming
CM
Huang
Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
Fang-Liang
FL
Huang
Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
Ya-Li
YL
Chien
Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan. Electronic address: pychen@vghtc.gov.tw.
Po-Yen
PY
Chen
D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001419:Bacteria; D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009333:Neck / Q000382:microbiology* / Q000503:physiopathology; D010406:Penicillins / Q000627:therapeutic use; D000039:Peritonsillar Abscess / Q000453:epidemiology / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology; D017703:Retropharyngeal Abscess / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000472:pathogenicity; D013624:Taiwan
D000890:Anti-Infective Agents; D010406:Penicillins
deep neck infection; parapharyngeal abscess; peritonsillar abscess; retropharyngeal abscess; submandibular abscess