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Mycoplasma hominis is a bacterium that colonizes the genital tract of some females and males, as well as their respiratory tracts. Although only two cases of deep neck infection have been reported, the associations between the onset and sexual intercourse have not been reported. A healthy 19-year-old female was diagnosed with a left peritonsillar abscess. The patient had sexual intercourse with a new partner, including oral sex, two days prior to symptom onset. It was not known whether the male partner had urethritis symptoms. M. hominis and Fusobacterium necrophorum were isolated from the abscess culture. The patient's condition improved after drainage, and sulbactam ampicillin was switched to oral clindamycin. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate the influence of the COVID-19 pandemic on the incidence of deep neck infections (DNIs) in pediatric patients. In addition, it describes the clinical, laboratory, and microbiology presentation as well as the clinical outcomes. Retrospective cohort study. A single tertiary medical center. All patients ≤18 years with a diagnosis of DNI, between the years 2010–2022, were included in the study and the yearly incidence of DNI was calculated. Patients were divided according to their diagnosis of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs), and according to age; Group 1 (aged 0 to ≤4 years) and Group 2 (aged>4 to ≤18 years). A total of 46 cases of DNIs; 24 were RPAs and 22 were PPAs, age group 1 had 20 patients, and age group 2 had 26 patients. The overall DNI incidence during 2010 was 0.81 and declined in 2020 (COVID-19 pandemic period) to 0.33, followed by a surge in the incidence of 4.85 in 2022 (post-COVID-19 period). In age group 1 RPAs were more dominant (70 %) while PPAs were dominant (61.5 %) in group 2. (p = 0.034). A higher prevalence of positive cultures was seen in the RPA group compared to the PPA group (75 % vs 33 %, p = 0.025, respectively), and in age group 1 compared to age group 2 (77 % vs 30 %, p = 0.001, respectively). In conclusion, our study provides valuable insights about the disease and vulnerable communities. In addition, we showed a decrease during the COVID-19 pandemic followed by an increase in DNI incidence post-COVID-19 pandemic era. A larger comprehensive prospective study is warranted to gain a deeper understanding of these trends and their underlying causes. [ABSTRACT FROM AUTHOR]

Abstract We retrospectively studied the clinical features, complications, and outcomes of deep neck infections in 31 adult patients with the human immunodeficiency virus (HIV) (HIV group) and 192 patients without (non-HIV group). In the HIV group, the cause was more likely to be odontogenic (21 (68%) compared with 90 (47%); odds ratio (OR) 2.38; 95% CI 1.06 to 5.32). In both groups, the parapharyngeal, submandibular, and masticator spaces, were those most often involved. However, in the HIV group, Ludwig's angina was common, and was the main cause of airway obstruction. Streptococcus pneumoniae , Staphylococcus aureus, and Pseudomonas aeruginosa were most often isolated in the HIV group. Upper airway obstruction tended to be more common in the HIV group (5/31 compared with 13/192). These patients also had a higher risk of other complications (sepsis, mediastinitis, jugular vein thrombosis, and pneumonia) (6/31 compared with 12/192; OR 3.60; 95% CI 1.24 to 10.45), a higher mortality rate (3/31 compared with 2/192), and longer hospital stay (19 days compared with 16 days). Factors associated with an increased risk of complications in this group were an age of 55 years or over and a CD4 count of less than 350 cells/mm3. Deep neck infections in these patients are more severe. Dental health care, appropriate empirical antibiotics, early detection, and management of the airway and complications, may improve outcomes. [ABSTRACT FROM AUTHOR]

Abstract Objective To assess geographical sociodemographic differences in neck abscesses that require surgical drainage in Los Angeles. Study Design: retrospective review. Methods We reviewed the medical records of 119 consecutive pediatric patients at Children's Hospital Los Angeles (CHLA) from 2014 to 2017 with a diagnosis of a neck abscess requiring incision and drainage. Sociodemographic information including zip code of residence was extracted and analyzed with Chi-square, Fisher's exact test, and multivariate logistic regression. Results The average age of patients with a neck abscess in this study was 3.4 years old, 53.8% were female, 54.6% were Hispanic, and 82.5% had public health insurance. 79% of patients had an abscess located in the superficial neck, and 10.1% had an abscess located in the retropharyngeal space. There were no significant differences in gender, race, type of health insurance, or income between patients that lived within 10 miles of CHLA versus those that lived farther than 10 miles. On multivariate analysis, zip codes with a high volume of neck abscesses were more likely to be lower income neighborhoods. Gender, race, type of health insurance, and distance from CHLA were not associated with zip codes with a high volume of neck abscesses. Conclusion Geographic areas in the greater Los Angeles community with a high volume of neck abscesses requiring incision and drainage at our institution were associated with lower income neighborhoods. Level of evidence IV. [ABSTRACT FROM AUTHOR]

Pyolaryngocele is a very rare and serious complication of laryngocoele. The clinical presentation can be extremely severe acute epiglottitis with laryngeal dyspnea and major dysphagia. The treatment of choice is surgical excision. Our aim is to attract the intention of the surgeon to this unusual entity and describe its clinical features. We report a case of a 70-year-old male patient with a five-day history of left neck swelling, sore throat, and low-grade fever. An urgent CT scan showed a mixed pyolaryngocele. The management consisted of high-dose antibiotics and excision of the residual laryngocoele via an external approach. A pyolaryngocele is an unusual complication of laryngocoele that becomes secondarily infected causing serious symptoms. The management consists of administrating broad-spectrum antibiotics and aspiration of purulent material to decompress the sac. At a later stage, after relieving the acute symptoms we performed an external approach with formal excision of the laryngocele. Pyolaryngocele is a rare complication of laryngocele and can present with serious complaints like dyspnea and sepsis. Excision of the laryngocoele is still the best treatment option to prevent this complication and recurrence. • emphasize the challenge confronted in diagnosing clinically. • Add a new case to the literature • mandatory to look for associated malignant lesions. • The treatment starts with securing the airways. • monthly follow-up, should be done regularly for 1 year [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) can be used as a predictor for deep neck space infections (DNSIs) that occur as a complication of acute bacterial tonsillitis in the pediatric population. Materials and methods We evaluated the NLR values of 180 pediatric patients diagnosed with acute bacterial tonsillitis with or without DNSI who presented to the Otolaryngology Department of Marmara University Hospital between 2010 and 2013. In cases in which DNSI was suspected, the patients underwent complete otolaryngological examination and radiological imaging including CT and MRI. NLR was calculated in all the subjects and was compared between the patients with acute bacterial tonsillitis without DNSI and those with DNSI. Results With regard to the tonsillitis-related complications, 17 patients had peritonsillar abscess (9.4%); five, parapharyngeal abscess (2.8%); and two, retropharyngeal abscess (1.1%). The mean NLR was significantly higher in the patients of acute bacterial tonsillitis with DNSI ( P < 0.05). The optimum cut-off value of NLR was determined to be 5.4. Conclusion This study is the first to investigate the relationship between NLR and DNSI as a complication of acute bacterial tonsillitis. The results demonstrated that the NLR value could be a potential laboratory parameter for diagnosing DNSIs. [ABSTRACT FROM AUTHOR]

Purpose There have been various incision and drainage methods for deep neck infection (DNI). Closed-suction drainage (CSD) has been used to decrease hematoma or to drain pus in other forms of medical surgery. The purpose of this investigation was to evaluate the usefulness of CSD for DNI. Patients and methods This study consisted of 30 patients who underwent CSD after incision and drainage for DNI between January 2006 and December 2011. The patients' demographics, systemic diseases, methods of airway control, involved spaces, incision, CSD results, duration of hospitalization, and complications were investigated. Results CSD was used to treat 30 DNI patients. Eleven patients (37%) had underlying systemic diseases like diabetes mellitus, hypertension, hepatitis, asthma, etc. Twenty four patients (80%) had odontogenic infections in the mandibular molar region. Tracheostomy was performed in 5 patients (17%). The involved spaces were various from parapharyngeal space to mediastinum (mean: 4.8 spaces), and CSD was applied with drainage lines (mean: 3; 2–7 drains) over the course of 4–37 days (mean 14.6 days). The total amount of drained pus was 8–1344 cc (mean: 406 cc) and the daily amount was 1–61 cc (mean: 28 cc) from each patient. The mean length of hospital stay was 26 days, with a range of 9–83 days. Wound rupture happened in 7% of 56 total incision sites and spontaneous removal of the drain tube occurred in 3% of 91 total tubes. Four patients died because of cardiac arrest, pulmonary edema, and hypoxia. A statistical significance was accepted about total and daily amount of drainage at Pearson's correlation test ( p < 0.001). Conclusion Accurate diagnosis, safe airway management, and early surgical drainage were important in DNI treatment. Compared to other drainage systems, CSD is clinically useful for treating DNI due to minimal incision, convenience of post-operative management, and less postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To clarify the clinical risk factors that aggravate deep neck infection. Patients and methods: Sixty-five patients with deep neck infection (abscess or cellulitis), 42 males and 23 females, who were treated at the ear, nose, and throat department in Iwaki Kyoritsu General Hospital in the past 10 years, were retrospectively reviewed. Cases of inflammation of the upper airway including the oral cavity, laryngopharynx, palate tonsil and salivary gland, and cases of lymphadenitis were investigated. These patients were divided into five localized types and one wide range type according to the abscess locations as follows: oral cavity floor type, upper deep cervical type, submandibular type, submental type, retropharyngeal type, and wide range type. Results: Seventeen of the 65 patients had diabetes, and significantly more diabetics had the wide range type than the localized type (P <0.05, Fisher''s test). Diabetes complication was more often seen in the upper deep cervical type among patients aged 61 years or older, and in the wide range type among males aged 41 years or older and elderly women aged 61 years or older. No patients with odontogenic infection or sialolithiasis had associated diabetes mellitus. Two cases developed mediastinitis, and one was caused by retrotonsillar abscess and needed thoracic drainage. More than half of the wide range type cases and more than a quarter of each of the localized type cases except the upper deep cervical type also had laryngeal edema, and eight of them needed emergency tracheotomy. Thirteen of the 40 cases had bacteria belonging to the Streptococcus milleri group (SMG), and all were detected in patients who underwent surgical drainage. Four of the 13 cases where SMG was detected showed drug resistance to some sorts of antibiotics. Conclusion: Oral disorders can develop deep neck infection independently of the presence of diabetes mellitus, compared with other causes. The presence of diabetes mellitus is associated with deep neck infection, aggravating parotitis and wide spread of inflammation. Retrotonsillar abscess often spreads to the retropharyngeal and parapharyngeal spaces, causing mediastinitis, so caution is necessary. Infection due to SMG tends to form abscess independently of diabetes mellitus. Since more than half of the wide range type and more than a quarter of each of the localized types except the upper deep cervical type were associated with laryngeal edema, airway management should be considered. [Copyright &y& Elsevier]

Sialolithiasis represents the most common issue of the salivary gland, ranging from asymptomatic to airway compromising. In rapidly progressing, completely obstructive salivary stones, the presentation can mimic emergent oropharyngeal diseases, primarily Ludwig's angina. We present a case of a large and obstructive sialolith with abscess whose initial presentation was concerning for Ludwig's angina with impending airway compromise. While a common complaint, emergency providers should be aware of the nefarious presentation of an everyday complaint. [ABSTRACT FROM AUTHOR]

Summary: Ludwig''s angina is a rapidly spreading and potentially lethal infection involving the floor of the mouth and neck. We present a rare case of Ludwig''s angina caused by an unusual microorganism, Morganella morganii, and the group D α-hemolytic streptococcus. To our knowledge, this is the first case of Ludwig''s angina and deep neck infection caused by Morganella morganii. Adequate airway maintenance, appropriate use of antibiotics and surgical drainage resulted in survival of the patient without complications. [Copyright &y& Elsevier]