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Head and neck space infections in infants and children
K Ungkanont1, R F Yellon, J L Weissman
1Department of Otolaryngology, University of Pittsburgh School of Medicine, PA.
Insights
Head and neck space infections in children are often caused by specific aerobic and anaerobic bacteria. Early diagnosis with imaging and appropriate antibiotic therapy are crucial for effective treatment.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Medical Imaging
Background:
- Head and neck space infections are common in children.
- Understanding the causative pathogens and effective treatment strategies is essential.
Purpose of the Study:
- To analyze the epidemiology and microbiology of head and neck space infections in pediatric patients.
- To evaluate the utility of computed tomography (CT) scans in diagnosing these infections.
- To recommend optimal treatment approaches.
Main Methods:
- Retrospective study of 117 children treated between 1986 and 1992.
- Identification of common pathogens, including aerobic and anaerobic bacteria.
- Review of computed tomography (CT) scans for abscess detection.
Main Results:
- Peritonsillar space infections were most frequent (49%).
- Common pathogens included beta-hemolytic streptococcus, Staphylococcus aureus, Bacteroides melaninogenicus, Veillonella, and Haemophilus parainfluenzae.
- CT scans showed high sensitivity (91%) but low specificity (60%) for abscess detection.
Conclusions:
- Accurate physical diagnosis, supported by imaging, is vital.
- Empiric antibiotic therapy should target a broad spectrum of potential pathogens.
- Timely surgical intervention is indicated when necessary.
Abstract:
A retrospective study was performed in 117 children with head and neck space infections treated at the Children's Hospital of Pittsburgh from January 1986 through June 1992. Peritonsillar space infections were the most common (49%), followed by retropharyngeal (22%), submandibular (14%), buccal (11%), parapharyngeal (2%), and canine (2%) space infections. The most common pathogens isolated (N = 78) were the aerobes beta-hemolytic streptococcus (18%) and Staphylococcus aureus (18%), the anaerobes Bacteroides melaninogenicus (17%) and Veillonella (14%), and the gram-negative organism Haemophilus parainfluenzae (14%). beta-Lactamase production by aerobic pathogens was detected in 22% of cultures. Computed tomography scans (N = 16) were reviewed in blinded fashion and compared with operative findings. The sensitivity of computed tomography scan in detecting the presence of an abscess vs. cellulitis was high (91%), whereas the specificity was rather low (60%). Treatment of head and neck space infections in children should consist of accurate physical diagnosis aided by imaging studies, empiric antibiotic therapy that covers gram-negative and beta-lactamase--producing organisms as well as gram-positive organisms and anaerobes, and timely surgical intervention, when indicated.