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Retropharyngeal abscess in children: a retrospective and historical analysis
J W Thompson1, S R Cohen, P Reddix
1Department of Surgery, Childrens Hospital of Los Angeles, CA.
Insights
Retropharyngeal abscesses may now appear later in childhood and without obvious preceding infections. Classic symptoms like neck stiffness are less common, with more gram-negative and anaerobic bacteria found, possibly due to antibiotic use.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Microbiology
Background:
- Retropharyngeal abscesses are serious infections in children.
- Historical data suggests typical presentations and causative agents.
- Recent trends in pediatric retropharyngeal abscesses require updated understanding.
Purpose of the Study:
- To analyze changes in retropharyngeal abscess presentation and microbiology over 36 years.
- To compare current findings with historical data from the early 20th century and recent decades.
- To investigate potential factors influencing observed trends.
Main Methods:
- Retrospective chart review of 65 pediatric patients diagnosed with retropharyngeal abscess.
- Comparison of findings with historical literature and data from previous decades.
- Analysis of microbiological culture results.
Main Results:
- Retropharyngeal abscesses appear to occur later in childhood.
- Classic diagnostic signs (bulge, neck stiffness) were present in less than half of patients.
- Increased prevalence of gram-negative and anaerobic organisms on cultures compared to historical data.
Conclusions:
- The clinical presentation of pediatric retropharyngeal abscesses may be evolving.
- Changes in microbiology suggest a potential impact of prior antibiotic exposure.
- Further research is needed to confirm the influence of antibiotics on retropharyngeal abscess characteristics.
Abstract:
The charts of 65 pediatric patients with the diagnosis of retropharyngeal abscess were reviewed. These represented a 36-year experience with the disease. The findings were compared with those documented at the turn of the century and were also compared with findings over the last four decades. The data suggests that retropharyngeal abscess may be occurring later in childhood and may not always be preceded by a major detectable infection. Classic diagnostic findings of retropharyngeal bulge and neck stiffness were present in less than half of the patients. Gram-negative and anaerobic organisms are being documented on culture more frequently than in the past. We theorize that liberal use of oral antibiotics prior to admission may have brought about these changes.