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Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children

BACKGROUND: Acute cervical adenitis can evolve into suppurative cervical lymphadenitis and may sometimes be associated with infection of the retropharyngeal and parapharyngeal spaces (i.e., retropharyngeal and poststyloid parapharyngeal abscesses). This study aimed to describe the clinical presentat...

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Autores principales: Georget, Emilie, Gauthier, Anne, Brugel, Lydia, Verlhac, Suzanne, Remus, Natacha, Epaud, Ralph, Madhi, Fouad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158388/
https://www.ncbi.nlm.nih.gov/pubmed/25206314
http://dx.doi.org/10.1186/1472-6815-14-8
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author Georget, Emilie
Gauthier, Anne
Brugel, Lydia
Verlhac, Suzanne
Remus, Natacha
Epaud, Ralph
Madhi, Fouad
author_facet Georget, Emilie
Gauthier, Anne
Brugel, Lydia
Verlhac, Suzanne
Remus, Natacha
Epaud, Ralph
Madhi, Fouad
author_sort Georget, Emilie
collection PubMed
description BACKGROUND: Acute cervical adenitis can evolve into suppurative cervical lymphadenitis and may sometimes be associated with infection of the retropharyngeal and parapharyngeal spaces (i.e., retropharyngeal and poststyloid parapharyngeal abscesses). This study aimed to describe the clinical presentation of acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children and examine the management of these conditions. METHODS: This was a retrospective study including children from 3 months to 18 years old who were hospitalized in the Pediatric Department of the Centre-Intercommunal-de-Créteil between January 2003 and May 2010. Selected cases were based on the diagnosis of acute cervical lymphadenitis, suppurative cervical lymphadenitis, or infections of the retropharyngeal or parapharyngeal spaces. Case history, clinical signs, laboratory tests, imaging, treatment and clinical course were collected from patient charts. RESULTS: We included 75 children (54 males [72%]); 62 (83%) were < 6 years old. Diagnoses were acute cervical lymphadenitis in 43 patients (57%), suppurative cervical lymphadenitis in 13 (17%), retropharyngeal or poststyloid parapharyngeal abscess in 18 (24%) and cervical necrotizing fasciitis in 1 (1%). In total, 72 patients (96%) presented fever and 34 (45%) had torticollis. Suppurative cervical lymphadenitis or abscesses of the retropharyngeal or poststyloid parapharyngeal spaces was significantly higher for children with than without torticollis (52.9% vs. 4.8%, p < 0.001). In all, 21 patients among the 44 > 3 years old (48%) underwent a rapid antigen detection test (RADT) for group A beta-hemolytic Streptococcus pyogenes; results for 10 were positive (48%). Contrast-enhanced CT scan of the neck in children with torticollis (n = 31) demonstrated an abscess in 21 (68%). Fine-needle aspiration was performed in 8 patients (11%) and 8 (11%) required surgical drainage. Bacteriology was positive in 8 patients (11%), with a predominance of Staphylococcus aureus and S. pyogenes. All patients received intravenous antibiotics and the outcome was favorable regardless of surgery. Recurrence was observed in only 1 case among the 34 patients with a follow-up visit after discharge. CONCLUSION: Our data suggest that presentation with cervical lymphadenitis associated with fever and torticollis requires evaluation by contrast-enhanced CT scan. Furthermore, abscess drainage should be restricted to the most severely affected patients who do not respond to antibiotic therapy.
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spelling pubmed-41583882014-09-10 Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children Georget, Emilie Gauthier, Anne Brugel, Lydia Verlhac, Suzanne Remus, Natacha Epaud, Ralph Madhi, Fouad BMC Ear Nose Throat Disord Research Article BACKGROUND: Acute cervical adenitis can evolve into suppurative cervical lymphadenitis and may sometimes be associated with infection of the retropharyngeal and parapharyngeal spaces (i.e., retropharyngeal and poststyloid parapharyngeal abscesses). This study aimed to describe the clinical presentation of acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children and examine the management of these conditions. METHODS: This was a retrospective study including children from 3 months to 18 years old who were hospitalized in the Pediatric Department of the Centre-Intercommunal-de-Créteil between January 2003 and May 2010. Selected cases were based on the diagnosis of acute cervical lymphadenitis, suppurative cervical lymphadenitis, or infections of the retropharyngeal or parapharyngeal spaces. Case history, clinical signs, laboratory tests, imaging, treatment and clinical course were collected from patient charts. RESULTS: We included 75 children (54 males [72%]); 62 (83%) were < 6 years old. Diagnoses were acute cervical lymphadenitis in 43 patients (57%), suppurative cervical lymphadenitis in 13 (17%), retropharyngeal or poststyloid parapharyngeal abscess in 18 (24%) and cervical necrotizing fasciitis in 1 (1%). In total, 72 patients (96%) presented fever and 34 (45%) had torticollis. Suppurative cervical lymphadenitis or abscesses of the retropharyngeal or poststyloid parapharyngeal spaces was significantly higher for children with than without torticollis (52.9% vs. 4.8%, p < 0.001). In all, 21 patients among the 44 > 3 years old (48%) underwent a rapid antigen detection test (RADT) for group A beta-hemolytic Streptococcus pyogenes; results for 10 were positive (48%). Contrast-enhanced CT scan of the neck in children with torticollis (n = 31) demonstrated an abscess in 21 (68%). Fine-needle aspiration was performed in 8 patients (11%) and 8 (11%) required surgical drainage. Bacteriology was positive in 8 patients (11%), with a predominance of Staphylococcus aureus and S. pyogenes. All patients received intravenous antibiotics and the outcome was favorable regardless of surgery. Recurrence was observed in only 1 case among the 34 patients with a follow-up visit after discharge. CONCLUSION: Our data suggest that presentation with cervical lymphadenitis associated with fever and torticollis requires evaluation by contrast-enhanced CT scan. Furthermore, abscess drainage should be restricted to the most severely affected patients who do not respond to antibiotic therapy. BioMed Central 2014-09-05 /pmc/articles/PMC4158388/ /pubmed/25206314 http://dx.doi.org/10.1186/1472-6815-14-8 Text en Copyright © 2014 Georget et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Georget, Emilie
Gauthier, Anne
Brugel, Lydia
Verlhac, Suzanne
Remus, Natacha
Epaud, Ralph
Madhi, Fouad
Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children
title Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children
title_full Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children
title_fullStr Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children
title_full_unstemmed Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children
title_short Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children
title_sort acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158388/
https://www.ncbi.nlm.nih.gov/pubmed/25206314
http://dx.doi.org/10.1186/1472-6815-14-8
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