Hari Kapila, Mungul Sheetal, Maharaj Shivesh
Internal Medicine, School of Medicine, University of the Witwatersrand, Johannesburg, ZAF.
Neurosciences, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, ZAF.
Cureus. 2020 Oct 21;12(10):e11081. doi: 10.7759/cureus.11081.
Background Deep neck space infections (DNSIs) in children may lead to airway compromise and damage to the great vessels in the neck. They occur more commonly in the HIV-infected population. To our knowledge, this is the first case series of DNSI in HIV-infected children Objectives The aim of this study was to describe the demography and document the sites of infection; organisms identified and resistance patterns in HIV-infected children with DNSI. Methods We retrospectively reviewed the clinical records of children (<16 years) diagnosed with deep neck infections at the teaching hospitals for the Department of Otolaryngology, Head and Neck Surgery, University of the Witwatersrand, between January 2010 and December 2018. Results We identified 17 patients with DNSI of which six children had concomitant HIV infection. The average age at presentation was six years (range: 0.35-13 years); there were four males and two females. The most common site involved was the submandibular space, which was affected in four patients. The detected organisms included: Coagulase-negative staphylococcus, Streptococcus viridans, Prevotella, Proteus mirabilis and Bacteroides fragilis. The organisms were universally resistant to penicillin and ampicillin resistance was documented in all but one patient. Conclusion Our findings on microbiology, resistance and tuberculosis culture are significant even in the face of a small series and have implications for the diagnosis and treatment of DNSI in HIV-infected children. Tuberculosis should routinely be considered in high burden settings. We recommend the empiric use of a β-lactamase-resistant antibiotic until targeted therapy based on culture and sensitivity can be instituted.
儿童深部颈部间隙感染（DNSIs）可能导致气道受压以及颈部大血管受损。此类感染在感染艾滋病毒的人群中更为常见。据我们所知，这是首例关于感染艾滋病毒儿童的DNSI病例系列研究。目的：本研究旨在描述感染艾滋病毒且患有DNSI儿童的人口统计学特征，并记录感染部位、鉴定出的病原体及耐药模式。方法：我们回顾性分析了2010年1月至2018年12月期间在威特沃特斯兰德大学耳鼻喉科、头颈外科教学医院被诊断为深部颈部感染的16岁以下儿童的临床记录。结果：我们确定了17例DNSI患者，其中6名儿童同时感染了艾滋病毒。就诊时的平均年龄为6岁（范围：0.35 - 13岁）；4名男性，2名女性。最常受累的部位是下颌下间隙，4例患者受此影响。检测到的病原体包括：凝固酶阴性葡萄球菌、草绿色链球菌、普雷沃菌属、奇异变形杆菌和脆弱拟杆菌。这些病原体对青霉素普遍耐药，除1例患者外，所有患者均记录有氨苄西林耐药。结论：即便本研究样本量较小，但我们关于微生物学、耐药性及结核培养的研究结果仍具有重要意义，对感染艾滋病毒儿童的DNSI诊断和治疗具有启示作用。在高负担地区应常规考虑结核病。我们建议在基于培养和药敏结果制定针对性治疗方案之前，经验性使用β-内酰胺酶耐药抗生素。
