Peritonsillar and deep neck infections: a review of 330 cases

The aim of this study is to review different factors that may influence peritonsillar and deep neck infections and may play a role as bad prognosis predictors.

Methods:

We present a retrospective study of 330 patients with deep neck infections and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS.

Results:

There has been an increase in incidence of peritonsilar and deep neck infections. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%).

Conclusion:

Systemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.

KEYWORDS
Deep neck infections; Mediastinitis; Peritonsillar infections; Complications; Antibiotics

Comorbidity	No. of patients (%) n = 330
Diabetes Mellitus	9 (2.7%)
Haematologic malignancies	5 (1.5%)
Hepatopathy	4 (1.2%)
Isquemic cardiomyopathy	3 (0.9%)
HIV	2 (0.6%)
Tuberculosis	2 (0.6%)
Chronic renal failure	2 (0.6%)
Neoplasm	1 (0.3%)
No comorbidity	302 (91.5%)

Origin of infection	No. of patients (%) n = 330
Pharyngotonsillar	277 (83.9%)
Dental	11 (3.3%)
Salivary glands	4 (1.2%)
Foreign bodies	2 (0.6%)
Previous cervical surgery	1 (0.3%)
Bacteriemia	1 (0.3%)
Non identified cause	34 (10.3%)

Cervical space involved	No. of patients (%) n = 330
Peritonsillar	215 (65.2%)
Parapharyngeal	91 (27.6%)
Retropharyngeal	11 (3.3%)
Submandibular	3 (0.9%)
Base of tongue	3 (0.9%)
Ludwig angina	2 (0.6%)
Cervical anterior space	2 (0.6%)
Multiple space	3 (0.9%)

Pathogen	No. of patients with positive bacterial culture (%) n = 137
S. viridans	44 (32.1%)
S. pyogenes	31 (22.6%)
Anaerobic bacteria	17 (12.4%)
Polymicrobe	11 (8.0%)
Haemophilus spp.	10 (7.3%)
S. aureus	7 (5.1%)
Strepto spp.	5 (3.6%)
S. epidermidis	3 (2.2%)
A. odontolyticus	3 (2.2%)
Gram negative bacteria (Klebsiella spp., E. coli, Neisseriae spp.)	4 (2.8%)
Candida	1 (0.7%)
Mycobacterium tuberculosis	1 (0.7%)

	No. (%) of patients with complications		p-Value	No. (%) of patients who required ICU stay		p-Value
Sex	No	Yes		No	Yes
Male	167 (94.9)	9 (5.1)	0.241	171 (97.2)	5 (2.8)	0.035
Female	150 (97.4)	4 (2.6)		154 (100)	0
Antibiotic allergy
None	296 (96.7)	10 (3.3)	0.140	303 (99)	3 (1)	0.038
Penicillin	15 (83.3)	3 (16.7)		16 (88.9)	2 (11.1)
Other antibiotic	6 (100)	0		6 (100)	0
Comorbidity
No	293 (97)	9 (3)	<0.0001	300 (99.3)	2 (0.7)	<0.0001
DM	8 (88.9)	1 (11.1)		8 (88.9)	1 (11.1)
Hepatopathy	1 (25)	3 (75)		2 (50)	2 (50)
Other comorbidity	15 (100)	0		15 (100)	0
Microorganisms	No	Yes		No	Yes
S. viridans	42 (95.5)	2 (4.5)	<0.0001	43 (97.7)	1 (2.3)	<0.0001
Polymicrobe	8 (72.7)	3 (27.3)		9 (81.8)	2 (18.2)
S. pyogenes	31 (100)	0		31 (100)	0
Others	240 (98.4)	4 (1.6)		243 (99.6)	1 (0.4)
Etiology
Unknown	31 (91.2)	3 (8.8)	0.199	33 (97.1)	1 (2.9)	0.523
Pharyngotonsillar	269 (97.1)	8 (2.9)		274 (98.9)	3 (1.1)
Dental	10 (90.9)	1 (9.1)		10 (90.9)	1 (9.1)
Salivary glands	3 (75)	1 (25)		4 (100)	0
Foreign bodies	2 (100)	0		2 (100)	0
Previous cervical surgery	1 (100)	0		1 (100)	0
Bacteriemia	1 (100)	0		1 (100)	0

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:pmartinez.3@alumni.unav.es (P. Martínez Pascual).

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Peritonsillar and deep neck infections: a review of 330 cases☆ ☆ Please cite this article as: Martínez Pascual P, Pinacho Martínez P, Friedlander E, Martin Oviedo C, Scola Yurrita B. Peritonsillar and deep neck infections: a review of 330 cases. Braz J Otorhinolaryngol. 2018;84:305-10.

Abstract

Introduction:

Objective:

Methods:

Results:

Conclusion:

Peritonsillar and deep neck infections: a review of 330 cases^☆ ☆ Please cite this article as: Martínez Pascual P, Pinacho Martínez P, Friedlander E, Martin Oviedo C, Scola Yurrita B. Peritonsillar and deep neck infections: a review of 330 cases. Braz J Otorhinolaryngol. 2018;84:305-10.