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. 2014 Sep 5:14:8.
doi: 10.1186/1472-6815-14-8. eCollection 2014.

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

Emilie Georget  1 , Anne Gauthier  2 , Lydia Brugel  2 , Suzanne Verlhac  3 , Natacha Remus  4 , Ralph Epaud  5 , Fouad Madhi  4
Affiliations

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

Emilie Georget et al. BMC Ear Nose Throat Disord. .

Abstract

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.

Keywords: Acute cervical lymphadenitis; Children; Infection; Retropharyngeal and parapharyngeal space.

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Figures

Figure 1
Figure 1
Age of 75 children with acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces included in the study.
Figure 2
Figure 2
Frequency of diagnoses and surgical drainage. ACL: acute cervical lymphadenitis; SCL: suppurative cervical lymphadenitis; RA: retropharyngeal abscess; PPA: poststyloid parapharyngeal abscess; CHF: cervical necrotizing fasciitis. Percentages are given in parentheses.
Figure 3
Figure 3
Monthly incidence of acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces.
Figure 4
Figure 4
Annual incidence of acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces. The incidence was calculated for each year from 2003 (03) to 2010 (10).
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