title: Pediatric Sepsis Secondary to an Occult Dental Abscess: A Case Report.
abstract: BACKGROUND
  In general, hematogenous spread of bacteria in children is uncommon. Bacteremia, however, is a known complication of dental procedures and severe caries, but is infrequently associated with primary, asymptomatic, non-procedural-related, dentoalveolar infection.
  
  
  METHODS
  The patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with "fever, mottling, and shaking chills." In the ED, he appeared systemically ill with fever, mottling, delayed capillary refill, and rigors. Physical examination by three different physicians failed to reveal any focus of infection. Laboratory evaluation, including blood cultures, was obtained. The patient later developed unilateral facial swelling and pain, and a dentoalveolar abscess was found. He was started on antibiotics, underwent pulpectomy and eventually, extraction, prior to improvement in symptoms. Blood cultures grew two separate anaerobic bacteria (Veillonella and Lactobacillus). This is, to our knowledge, one of the first reported cases of pediatric sepsis with two different anaerobic organisms secondary to occult dentoalveolar abscess in a pediatric patient. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is imperative for emergency physicians to recognize the possibility of pediatric sepsis in the setting of acute maxillary or mandibular pain, as well as in patients for whom no clear focus of infection can be found. This is particularly important for those who appear ill at presentation or meet systemic inflammatory response syndrome criteria and would benefit from further laboratory evaluation, including blood cultures, and possibly antibiotic therapy.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Peter
authors.initials: P
authors.lastname: Holmberg
authors.affiliation: Pediatric Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hellmich
authors.affiliation: Pediatric Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: James
authors.initials: J
authors.lastname: Homme
mesh_terms: D000038:Abscess / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D023341:Chills / Q000209:etiology; D003731:Dental Caries / Q000150:complications* / Q000601:surgery*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005334:Fever / Q000209:etiology; D006801:Humans; D007778:Lactobacillus / Q000472:pathogenicity; D008297:Male; D011670:Pulpectomy / Q000379:methods; D018805:Sepsis / Q000209:etiology*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000601:surgery; D014678:Veillonella / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents
keywords: Lactobacillus; Veillonella; abscess; anaerobic; bacteremia; bacteria; dental; dentoalveolar; emergency; hematogenous; occult; odontogenic; pediatric