Mariani Marcello, Saffioti Carolina, Mesini Alessio, Palmero Candida, D'Agostino Roberto, Garofolo Sabrina, Rossi Andrea, Damasio Maria Beatrice, Castagnola Elio
Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.
Microbiology Laboratory, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.
Children (Basel). 2023 Sep 4;10(9):1506. doi: 10.3390/children10091506.
As there is currently no consensus on managing deep neck infections in pediatric populations, we report a case series from a large pediatric hospital. Clinical data of patients discharged from Istituto Gaslini-Children's Hospital from January 2014 to June 2020 with peritonsillar, parapharyngeal, or retropharyngeal abscess diagnoses were collected. A total of 59 patients were identified. Patients underwent surgical drainage in 47% of cases. Streptococcus mitis/oralis was the most isolated pathogen. Surgically treated patients did have larger abscesses compared to others, but there were no differences in the duration of hospitalization. Children who received NSAIDs at home had significant delays in diagnosis (median 4 vs. 1.5 days, = 0.008). In our experience, clinical presentation of DNIs is often evocative, but evaluation should include imaging with CT/MRI. Surgery is effective in larger abscesses, allowing for etiological diagnosis with consequent antibiotic adjusting. From an anamnestic point of view, home medications such as NSAIDs could delay diagnosis.
由于目前在儿童深部颈部感染的管理上尚未达成共识，我们报告了一家大型儿童医院的一系列病例。收集了2014年1月至2020年6月在加斯利尼儿童医院出院的、诊断为扁桃体周围、咽旁或咽后脓肿的患者的临床数据。共识别出59例患者。47%的病例接受了手术引流。缓症链球菌/口腔链球菌是最常分离出的病原体。与其他患者相比，接受手术治疗的患者脓肿确实更大，但住院时间并无差异。在家中服用非甾体抗炎药（NSAIDs）的儿童诊断明显延迟（中位数分别为4天和1.5天， = 0.008）。根据我们的经验，深部颈部感染的临床表现通常具有提示性，但评估应包括CT/MRI成像。手术对较大脓肿有效，可实现病因诊断并据此调整抗生素。从既往史角度来看，NSAIDs等家庭用药可能会延迟诊断。
