1Scuola di Specializzazione in Pediatria, 2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
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Key words: Retropharyngeal abscess, Infant, Jugular vein thrombosis, Case report
Retropharyngeal abscess is a suppurative infection of deep neck spaces that rarely complicates upper respiratory infections. It most commonly occurs in children under five years of age. The clinical picture can be aspecific, especially in infants, resembling that of pharyngitis, with irritability, refuse of feeding and fever. Limited neck mobility, specifically pain with neck extension, should be the clinical clue to diagnosis, while respiratory findings (airway obstruction or stridor) are rare. Computed tomography of the neck with intravenous contrast is the gold standard for diagnosis. Initial therapy depends upon the severity of respiratory distress and the likelihood of drainable fluid on the basis of imaging. Empiric antibiotic therapy should provide coverage for group B streptococcus, Staphylococcus aureus and respiratory anaerobes. Sometimes surgical management is required. Internal jugular vein thrombosis represents a possible complication with potential of spreading to adjacent structures and to the bloodstream. This paper reports the case of a four-month-old infant with retropharyngeal abscess complicated by jugular vein thrombosis, successfully treated with surgery, antibiotic and anticoagulant therapy.
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1Divisione di Pediatria e Neonatologia, Ospedale Versilia,
Lido di Camaiore (Lucca)
2Dipartimento di Infezioni Parassitosiche e Malattie immunomediate, Istituto Superiore di Sanità, Roma
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Key words: Neonatal sepsis, Neonatal surgery, Staphylococcus aureus, Necrotizing fasciitis, Panton-Valentine leukocidin
Necrotizing fasciitis is an infection of the skin and soft tissues that diffuses rapidly to the connective tissue with necrosis of the subcutaneous fat and underlying layers that extends to the muscular fasciae. It is more frequent in adults and is typically associated with immune deficiencies or comorbidities. In neonates, it is a very rare condition and its mortality reaches 59%. Less than 100 neonatal cases have been described, most of which secondary to omphalitis, mastitis or infection of post-operative wounds. Actually, only 7 cases of idiopathic necrotizing fasciitis have been described. The causative organism is usually Streptococcus, Escherichia coli, Clostridium perfringens, Bacteroides fragilis, and Staphylococcus aureus. The paper presents the case of a previously healthy 6-day-old infant with rapidly progressive community-acquired necrotizing fasciitis caused by methicillinsusceptible Staphylococcus aureus infection. The isolate harboured the genes encoding for the Panton-Valentine leukocidin. Although therapy usually involves early surgery, especially if the arms and legs are involved, the described case was treated with a conservative therapy, awaiting spontaneous colliquation and demarcation of the necrotic regions with excellent results, thus avoiding the risks of surgery.
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