Concurrent Postinfectious Glomerulonephritis and Retropharyngeal Abscess in 12 Year Boy: A Case Report

Acute Poststreptococcal Glomerulonephritis: The Most Common Acute Glomerulonephritis

Background: Acute post‐streptococcal glomerulonephritis (APSGN) is the most prevalent form of glomerulonephritis in children. It is caused by an immune‐mediated glomerular injury, most commonly secondary to Group A β-hemolytic streptococcus. This study aims to describe the characteristics and outcomes of hospitalized children with APSGN.Methods: This was a retrospective descriptive study of 83 pediatric patients (<15 years) admitted to the pediatric nephrology department in the Mohamed VI Hospital in Marrakech with APSGN between January 2019 and December 2023, with a follow-up of one year. Children with acute glomerulonephritis not related to APSGN were excluded.Results: The mean age was 8.34 ± 3.58, and 69.9% (n = 58) were male. Among the 83 APSGN patients, 17 (20.4%) progressed to rapidly progressive glomerulonephritis (RPGN). The most often given presentations were hematuria (90.3%, n=75), edema (77.1%, n=64), hypertension (66.3%, n=55), and oliguria (12%, n=10). 15.6% (n=13) of the patients had an acute kidney injury (AKI). Nephrotic syndrome was found in 33.7% (n=28) of children, reduced C3 level in 84.3% (n=70), and elevated antistreptolysin O titer (ASOT) in 69.9% (n=58). Kidney biopsy was performed in 50.6% of children (n=42). 38.6% (n=32) of our patients required two anti‑hypertensives such as furosemide and nicardipine. Kidney replacement therapy was required for 6% (n=5) of patients, antibiotics for 36.1% (n=30), methylprednisolone pulses for 56.6% (n=47), and cyclophosphamide pulses for 20.4% (n=16). The outcome was favorable for all children, except for one girl with RPGN who developed a chronic kidney disease.Conclusions: APSGN is still one of the most frequent causes of glomerulonephritis in Morocco. The main presenting features were hematuria and hypertension. Although the outcome of APSGN is good, sequential follow-up is necessary to detect long-term complications and prevent morbidity and mortality.

I mages Images in Emergency Medicine : Retropharyngeal Abscess Corey McLeod, MD Kristi A. Stanley, BA Department of Emergency Medicine, LAC+USC Medical Center Submission history: Submitted May 8, 2007; Accepted June 18, 2007. Reprints available through open access at www.westjem.org [WestJEM. 2008;9:55.] A 40-year-old female presented to the emergency department with a one-week history of URI symptoms and a one-day history of more severe throat pain and swelling. Upon physical examination the patient was afebrile and although she did not demonstrate any signs of respiratory distress, examination of her neck revealed fullness on the right. A lateral plain film of the neck showed soft tissue swelling anterior to the vertebral bodies (Figure 1) and a CT scan demonstrated fluid in the retropharyngeal space and an abscess. Fiberoptic laryngoscopy was performed and the airway was found to be swollen and compromised. The patient was taken to the operating room for an awake tracheostomy, the abscess was incised and drained, and she was admitted for overnight observation. Despite the advent of antibiotics and improvement of dental hygiene, deep space neck infections persist as a cause of morbidity and mortality. Retropharyngeal abscess (RPA) is an ENT emergency due to the possibility of life-threatening airway complications. 1 Patients with RPA typically have localized symptoms of dysphagia, voice changes, odynophagia, trismus, and neck/jaw pain. 2 Generalized symptoms of fever, chills, and loss of appetite may be present as well. Indicators of RP abscess during the physical exam are stridor, shortness of breath, drooling, cervical lymphadenopathy, and bulging of the pharyngeal wall. 3 Lateral radiographs will manifest with preveterbral air/fluid levels or abnormal widening of the prevertebral soft tissue, normally 5 – 7 mm wide at the level of the second cervical vertebrae. 2 Treatment in the Emergency Department should focus primarily on ensuring a patent airway. Oral intubation may be compromised by a large abscess or in turn may lead to rupture of the abscess, so ENT should be consulted for emergency tracheostomy. Antibiotic choices include high-dose penicillin plus metronidazole, piperacillin/ tazobactam, ampicillin/sulbactam or ticarcillin/clavulanate. 2 Figure. Address for correspondence: Kristi Stanley BA. Department of Emergency Medicine, LAC+USC Medical Center, Unit #1, Room 1011, 1200 N. State St., Los Angeles, CA 90033. REFERENCES Wang LF. Kuo WR. Tsai SM. Huang KJ. Characterizations of life- threatening deep cervical space infections: a review of one hundred ninety-six cases. American Journal of Otolaryngology. 2003; 24:111-7. Calder K and Ruben J. Opthalmologic Emergencies. In: Henderson SO, ed. Emergency Medicine. Georgetown, TX: Landes Bioscience; Marra S. Hotaling AJ. Deep neck infections. American Journal of Otolaryngology. 196; 17:287-298. Volume IX, no . 1 : January 2008 Western Journal of Emergency Medicine

To review the recent diagnosis and treatment experience with deep neck infection and emphasize the importance of radiologic evaluation, microbiology and appropriate treatment selection in these patients. A respective review was conducted in 95 cases who were diagnosed as having deep neck from Jan. 2006 to March 2015. The primary diseases in 95 patients with deep neck infection were acute tonsillitis or acute laryngitis (27 cases), infection of upper respiratory tract (23 cases), odontogenic infection or oral inflammation (16 cases), foreign bodies in esophagus (9 cases), acute cervical lymphadenitis (5 cases) and cause uncertain (15 cases). Computed tomography was performed in all of patients to identify the location, extent, and character (cellulitis in 47 cases or abscesses in 48 cases) of the infections. The locations of abscess were parapharyngeal abscess (25 cases), retropharyngeal abscess (9 cases), submaxillary space abscess (6 cases), pretracheal space abscess (5 cases) and esophageal abscess (3 cases). mediastinitis (2 cases), pericarditis (1 case), bilateral pneumothorax (2 cases), and upper digestive tract (1 case). Bacterial cultivation performed in 35 patients and positive results were detected in 21. All patients were given intravenous antibiotic therapy. Tracheotomy was performed in 4 cases. Preoperative contrast enhanced CT was performed in 42 patients and indicated the formation of abscess. Three cases with the symptoms of septic shock were transferred to ICU and one was cured. All the patients were cured except two who died of massive hemorrhage of upper digestive tract and septic shock. The airway patency in patients with deep neck infections must be ensured. Drainage may be mandatory in selected cases at presentation or in cases who fail to respond to parenteral antibiotics within the first 24-48 hours. Imaging evaluation plays a significant role in the diagnosis and rational therapeutic management in deep neck infection. Bacterial cultivation can help to make the effective treatment and provide reliable evidence for the etiopathogenisis.

Global Disease Burden From Acute Glomerulonephritis 1990–2019

Acute post streptococcal glomerulonephritis (APSGN) is the most common type of acute glomerulonephritis (AGN) in childhood. It has not been studied well in Bangladesh. To evaluate the clinical characteristics, complications and outcome of Acute post streptococcal glomerulonephritis (AGN). the department of Pediatric Nephrology at Sir Salimullah Medical College and Mitford Hospital, Dhaka. A prospective study from April 2011 to March 2012 were conducted among the patients diagnosed as AGN in outdoor and indoor department. Hospital records of all 34 children who had been admitted to Sir Salimullah Medical College and Mitford Hospital were reviewed. All demographic, clinical, paraclinical data and consumed medications were obtained. Among 34 cases female and male ratio were 2.4:1; mean age of was 8.76 yrs. ± 2.5 SD and peak age 7.6. Etiology of AGN was post infectious glomerulonephritis (PIGN) 85.3%, ASO titer was raised in 88.2%, 41.2% had raised blood urea, and 32.4%raised serum creatinine level. All children presented with microscopic hematuria (100%), hypertension (100%), and edema (100%), other findings are fever (55.9%), oliguria (94.1%), abdominal pain (52.9%). History of sore throat and pyoderma was present in 41.2% and 44.1% cases respectively. Complications like hypertensive encephalopathy three (8.8%), urinary tract infection (UTI) one (2.9%) total seven (20%) were heart failure two (5.9%) and Acute kidney injury (AKI) one (2.9%), total seven (20%) were expired. Majority of cases manifest typically with edema, oliguria and hematuria. It usually has an uneventful course.&#x0D; Bangladesh Med J. 2019 Jan; 48 (1): 13-17

Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) are the most common. DNIs remain an important health problem, especially in children. The aim of this narrative review is to describe the management of peritonsillar, retropharyngeal and parapharyngeal abscesses in pediatric age. Despite relatively uncommon, pediatric DNIs deserve particular attention as they can have a very severe course and lead to hospitalization, admission to the intensive care unit and, although very rarely, death. They generally follow a mild upper respiratory infection and can initially present with signs and symptoms that could be underestimated. A definite diagnosis can be made using imaging techniques. Pus collection from the site of infection, when possible, is strongly recommended for definition of diseases etiology. Blood tests that measure the inflammatory response of the patient may contribute to monitor disease evolution. The therapeutic approach should be targeted toward the individual patient. Regardless of the surgical treatment, antibiotics are critical for pediatric DNI prognosis. The diagnostic-therapeutic procedure to be followed in the individual patient is not universally shared because it has not been established which is the most valid radiological approach and which are the criteria to be followed for the differentiation of cases to be treated only with antibiotics and those in which surgery is mandatory. Further studies are needed to ensure the best possible care for all children with DNIs, especially in this era of increased antimicrobial resistance.

Deep Neck Infections in Different Age Groups of Children

Background and Objectives : Kawasaki diseases (KD) sometimes present themselves as cervical lymphadenitis or deep neck infection. These unusual Kawasaki diseases then lead to unnecessary antibiotic therapy or surgical intervention or delaying therapy. The purpose of this study is to determine clinical characteristics of early expressions of atypical Kawasaki diseases presenting as deep neck infection. Subjects and Method : We reviewed the medical records of the 6 patients who had been treated for Kawasaki disease that initially presented as fever and cervical lymphadenitis between March, 2007 and December, 2008. Results : The contrast neck CT scan of four of the cases revealed no ring enhancement but retropharyngeal space fluid collection suggestive of retropharyngeal abscess. The contrast neck CT scan of the other two cases showed homogenous nonsuppurative cervical lymph node enlargement. We administered intravenous antibiotics but patients did not response to them. We then immediately administered intravenous immunoglobulin and aspirin after making the diagnosis of Kawasaki disease. The clinical condition of all the cases improved dramatically with defervescence. Conclusion : The possibility of Kawasaki disease should be considered in the following three situations: first, if the fever is refractory to intravenous antibiotic treatment in the febrile child with cervical lymphadenopathy, secondly, if the neck CT scan reveals a soft tissue swelling with no ring enhancement, and lastly, if the fever subsides dramatically after starting intravenous immunoglobulin and aspirin. Echocardiography should be performed as early as possible.

Deep neck infections are severe complications of the inflammatory processes in the upper respiratory tract. They can be divided into retropharyngeal, parapharyngeal, peritonsillar and submandibular abscesses, depending on the affected region. Deep neck infections are considered as acute bacterial complications with a progressive course and life-threatening character and that’s why they require immediate wide-range, intravenous antibiotic therapy. A 7-year-old female patient presented to her general practitioner with persistent, recurrent fever lasting for 3 days. Fever subsided after 2 days of antibiotic therapy, but she developed trismus, severe sore throat, especially on the right side, radiating to the right ear and dysphagia. The patient was referred to the Pediatric Otolaryngology Department as a matter of urgency. On examination she had enlarged lymph nodes on the right side of the neck with limited head and neck movements to the right side and posteriorly. There was also an asymmetry of the pharynx behind the right palatopharyngeal arch observed. Laboratory blood tests showed high CRP level (3.84 mg/dl, n &lt; 0.5). CT scan was performed and showed multiloculated abscess in right retropharyngeal space. Our patient was qualified for the surgical procedure – drainage of the abscess under general anaesthesia together with wide spectrum antibiotic therapy in a form of cefuroxime and clindamycin. During procedure a large amount of pus was evacuated, and a sample was sent for microbiological results. It showed growth of Staphylococcus hominis, probably multiplication of local physiological colonization. She also received anti-inflammatory drugs and has had physiotherapy throughout the hospitalization period to prevent torticollis. We observed gradual local and general improvement, together with normalization of the inflammatory markers. She was discharged from the hospital after 7 days of intravenous treatment. Accurate diagnosis and immediate proper treatment of deep neck infections are essential in prevention of further local (to the surrounding regions) and general expansion (like thrombosis, sepsis, meningitis) of the inflammatory process and of persistent changes (like stenosis of the respiratory tract). Fortunately, in the post-antibiotic era most patients are fully healed, further complications are almost unseen and mortality rates are low.

Retropharyngeal abscess due to Staphylococcus aureus complicated by bilateral neck and intraabdominal abscesses in an immunocompetent infant

Retropharyngeal and epidural abscess from a swallowed fish bone

Background: Acute glomerulonephritis is a common pediatric kidney disease which places a huge burden in developing countries. This study aimed to evaluate causes, clinical manifestations, laboratory findings and complications of acute glomerulonephritis in children presented to a tertiary care center of Nepal. Methods: This was a retrospective review of records of children admitted with acute glomerulonephritis at Chitwan Medical College from April 2018 to February 2021. Socio-demographic data, clinic-laboratory profile and outcomes were obtained from medical records and descriptive analysis was carried out. Results: Among 48 recruited children with acute glomerulonephritis, 60.4% were male and the mean age was 9.5 ± 3.7 years. Post infectious glomerulonephritis including post streptococcal glomerulonephritis (48%) was the main cause of acute glomerulonephritis. The major clinical features were edema (81.3%), hypertension (72.9%), dyspnea (29.2%) and hematuria (25%). ASO titer was positive in 45.8%. The complications noted were acute kidney injury (6.3%), hypertensive emergency (6.3%) and congestive cardiac failure (2.1%). Conclusions: Most of the patients were above 5 years of age and presented most commonly during autumn and summer season. The complications of acute glomerulonephritis were acute kidney injury, hypertensive emergency and congestive cardiac failure.

Abscesos periamigdalino y retrofaríngeo: estudio de 13 años

The COVID-19 period influence on pediatric deep neck abscess: Occurrences and clinical presentation