A Rare Bacteria in Deep-Neck Infection: Streptococcus Anginosus

Objectives Descending necrotizing mediastinitis (DNM) developing after deep neck infection (DNI) is a potentially lethal disease of the mediastinum with a mortality rate as high as 40% prior to the 1990s. No standard treatment protocol is available. Here, we present the outcomes of our multidisciplinary approaches for treating DNM originating from a DNI. Methods Between June 2016 and July 2021, there were 390 patients with DNIs admitting to our tertiary hospital. A total 21 patients with DNIs complicated with DNM were enrolled. The multidisciplinary approaches included establishment of airway security, appropriate surgery and antibiotics, extracorporeal membrane oxygenation, and intensive care unit management. The clinical variables were analyzed. Results Two patients died and 19 survived (mortality 9.5%). The patients who died had a higher mean C-reactive protein (CRP) level than did those who survived (420.0 ± 110.3 vs 221.8 ± 100.6 mg/L) (P = .038). The most common pathogens were Streptococcus constellatus and Streptococcus anginosus. From 2001 to 2021, the average mortality rate of studies enrolling more than 10 patients was 16.1%. Conclusion Multidisciplinary approaches, early comprehensive medical treatment, and co-ordination among departments significantly reduce mortality. Patients with severe inflammation and high CRP levels require intensive and aggressive interventions.

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Parotid Space, a Different Space from Other Deep Neck Infection Spaces

Microorganisms ◽

10.3390/microorganisms9112361 ◽

2021 ◽

Vol 9 (11) ◽

pp. 2361

Author(s):

Shih-Lung Chen ◽

Chi-Kuang Young ◽

Chun-Ta Liao ◽

Tsung-You Tsai ◽

Chung-Jan Kang ◽

...

Keyword(s):

Medical Center ◽

Patient Characteristics ◽

Population Based ◽

Deep Neck Infection ◽

Duration Of Symptoms ◽

Neck Infection ◽

Streptococcus Anginosus ◽

Reactive Protein ◽

Medical Emergencies ◽

Deep Neck Space Infections

Deep neck infections (DNIs) such as parotid abscesses are medical emergencies with a seemingly different etiology and treatment course from other DNIs. We sought to confirm this in the present retrospective population-based cohort study. Between August 2016 and January 2020, 412 patients with DNIs seen at a tertiary medical center were enrolled in this study. Infections of the parotid space were compared with those of other deep neck spaces, according to patient characteristics. All patients were divided into parotid space (PS; n = 91, 22.08%) and non-parotid space (NPS; n = 321, 77.92%) subgroups. We further divided the patients into single parotid space (PS-single; n = 50, 12.13%), single non-parotid space (NPS-single; n = 149, 36.16%), multiple parotid space (PS-multiple; n = 41, 9.95%), and multiple non-parotid space (NPS-multiple; n = 172, 41.76%) DNI subgroups. In the PS-single and PS-multiple subgroups, a longer duration of symptoms (p = 0.001), lower white blood cell count (p = 0.001), lower C-reactive protein level (p = 0.010), higher rate of ultrasonography-guided drainage (p < 0.001), and lower rates of surgical incision and drainage (p < 0.001) were observed compared with the NPS-single and NPS-multiple subgroups. The PS group had a higher positive Klebsiella pneumoniae culture rate (p < 0.001), and lower positive Streptococcus constellatus (p = 0.002), and Streptococcus anginosus (p = 0.025) culture rates than the NPS group. In a multivariate analysis, K. pneumoniae was independently associated with parotoid space involvement in comparisons of the PS and NPS groups, PS-single and NPS-single subgroups, and PS-multiple and NPS-multiple subgroups. The clinical presentation of a parotid space infection differs from that of other deep neck space infections.

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Clinical Characteristics of Medically Intractable Deep Neck Infection Patients

Korean Journal of Otolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2009.52.1.62 ◽

2009 ◽

Vol 52 (1) ◽

pp. 62 ◽

Cited By ~ 6

Author(s):

Kyoungrai Cho ◽

Youngsam Yoo

Keyword(s):

Clinical Characteristics ◽

Deep Neck Infection ◽

Neck Infection

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A dangerous cause of airway obstruction: deep neck infection

10.22514/sv.2020.16.0101 ◽

2020 ◽

Keyword(s):

Airway Obstruction ◽

Upper Airway ◽

Deep Neck Infection ◽

Jugular Vein Thrombosis ◽

Neck Infection ◽

Vein Thrombosis ◽

Lethal Complications ◽

Life Threatening ◽

Fascial Spaces ◽

Emergency Doctors

Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

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