ÇOCUKLARDA DERİN BOYUN ENFEKSİYONLARI; ÜÇÜNCÜ BASAMAK HASTANESİ VERİLERİ

Year 2021, Volume: 22 Issue: 2, 106 - 111, 12.04.2021

Özlem Tezol , Mehmet Alakaya Necdet Kuyucu

https://doi.org/10.18229/kocatepetip.694067

Abstract

AMAÇ: Derin boyun enfeksiyonları (DBE) boyun bölgesinin fasya tabakaları arasında kalan potansiyel boşluklarda gelişen enfeksiyonlardır. Selülit, miyozit gibi erken bulgulardan flegmon, apse gibi ilerlemiş DBE’ye doğru bir seyir izlenebilir. Geç tanı, hızlı progresyon ve hayatı tehdit edici komplikasyonlar nedeniyle DBE kritik önem taşır. Bu tanımlayıcı çalışmanın amacı hastalarımızın klinik ve laboratuvar özelliklerine dayanarak yedi yıllık DBE verilerimizi sunmaktır.
GEREÇ VE YÖNTEM: Çocuk Enfeksiyon Hastalıkları Kliniğinde DBE tanısıyla Ocak 2010 – Ocak 2017 tarihleri arasında yatırılarak izlenen 58 hastanın anamnez ve fizik muayene bulguları, laboratuvar ve görüntüleme sonuçları, medikal ve cerrahi tedavileri, klinik seyirleri geriye dönük olarak incelendi.
BULGULAR: Hastaların 30’u (%51,7) erkekti, yaş ortalaması 5,6±4,9 yıldı. En sık başvuru yakınması ve fizik muayene bulgusu boyunda şişlik (%96,5) olarak belirlendi. Vakaların %93’ünde C-reaktif protein yüksekliği, %89'unda lökositoz, %72'sinde sedimantasyon yüksekliği saptandı. Başvuru anında genel durum ve klinik bulgulara dayanarak ciddi DBE düşünülmeyen (=selülit aşaması) hastalara ultrasonografik görüntüleme yapıldığı (n=26), ciddi DBE düşünülen (=apse) hastalara bilgisayarlı tomografi (BT) çekildiği (n=28), BT cihazı arızalı ise manyetik rezonans görüntüleme yapıldığı (n=4) belirlendi. Apse izlenen hastalarda en sık yerleşimin parafarengeal bölge olduğu (%75) saptandı. Ultrasonografi bulgularına göre en sık submandibüler bölgenin (%46) tutulduğu görüldü. DBE gelişiminde en sık iki etiyolojik neden olarak akut tonsillofarenjit (%34) ve odontojenik nedenler (%10) saptandı, hastaların %51’inde etiyoloji bulunamadı. Hastaların ortalama hastanede kalış süresinin 9,7±5,9 gün olduğu; %55’inin intravenöz ampisilin sulbaktam, %43’ünün intravenöz klindamisin tedavisi aldığı görüldü. Yirmi iki (%38) hastanın medikal tedavi ile iyileştiği, 36 (%62) hastaya medikal tedavi yanında cerrahi drenaj uygulandığı, drenaj örneğinden alınan kültürde üremesi olan hasta sayısının 18 (%50) olduğu belirlendi. İki hastada (%3,4) havayolu obstruksiyonu ve mediastinit olmak üzere komplikasyon geliştiği, mortalite görülmediği saptandı.
SONUÇ: Boyunda şişlik-ağrı ve ateş yakınmaları olan çocuklarda DBE akla getirilmeli ve tonsiller, dental muayene dikkatli yapılmalıdır. Ciddi DBE şüphesi varlığında kontrastlı BT çekilmelidir ve apse saptanan hastalara cerrahi drenaj uygulanmalıdır. Havayolu açıklığını tehdit eden DBE çocuk hastalarda önemli morbidite ve mortalite nedeni olabilir. Erken tanı, uygun antibiyoterapi ve gerektiğinde cerrahi drenaj ile prognoz iyileştirilebilir.

Keywords

boyunda şişlik, çocuk, derin boyun enfeksiyonu, drenaj, parafarengeal apse

DEEP NECK INFECTIONS IN CHILDREN; DATA FROM A TERTIARY HOSPITAL

Abstract

OBJECTIVE: Deep neck infections (DNIs) are the infections developing in potential spaces between the layers of deep servical fascia. Clinical course may progress from early manifestations such as cellulite, myositis to serious DNI such as phlegmon and abscess. DNIs have crucial importance because of delayed diagnosis, fast progression, and severe complications. In this descriptive study, we aimed to present our seven-year experience about pediatric DNIs based on the clinical and laboratory characteristic of our patients.
MATERIAL AND METHODS: Data of 58 hospitalized children who diagnosed with DNI between January 2010 and January 2017 in Pediatric Infectious Diseases Clinic were analysed retrospectively. Patients’ medical history and physical examination findings, laboratory and radiological imaging results, treatment modalities, and clinical courses were evaluated by reviewing medical records.
RESULTS: Thirty (51.7%) of the patients were male, average age was 5.6±4.9 years. The most common symptom and physical finding was neck swelling (96.5%). Rates of C-reactive protein elevation, leucocytosis, and sedimentation elevation were 93%, 89%, and 72% respectively. By considering clinical condition, ultrasound scan was performed on patients with nonserious DNI (=cellulite phase) (n=26), computed tomography scan was performed on patients with serious DNI (= abscess) (n=28), and magnetic resonance imagination was performed (n=4) if CT scanner is out of order. In patients with abscess formation parapharyngeal localization (75%) was the most common. According to ultrasound scan, submandibular involvement (%46) was the most frequent region. The most common two etiology were acute tonsillopharyngitis (34%) and odontogenic factors (10%), and unknown etiology rate was 51%. Average duration of hospitalization was 9.7±5.9 days, 55% of patients were treated with intravenous ampicillin-sulbactam whereas 43% were treated with intravenous clindamycin. Twenty-two (38%) patients healed with medical treatment. Surgical drainage was performed on 36 (62%) patients in addition to medical treatment. There were bacterial growths in 18 (50%) drainage material cultures. Two (3.4%) patients were complicated with airway obstruction and mediastinitis while there was no mortality.
CONCLUSIONS: Children with neck swelling and fever should be evaluated in terms of DNI, and also dental and tonsillar examinations should be done carefully. Contrast CT scan should be performed for pre-diagnosis of cases with serious DNI and surgical drainage should be performed in cases with abscess formation. DNIs threatening airway patency may cause severe morbidity and mortality, so early diagnosis, appropriate antibiotic therapy with or without surgical drainage may improve prognosis.

Keywords

neck swelling, child, deep neck infection, drainage, parapharyngeal abscess

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