Abscess In Children Research Articles

Amoebic liver abscess with lung involvement in paediatric

Background: There are few reports of amoebic liver abscess in children, and the disease is life-threatening. It can rupture into the pleura to cause acute respiratory distress. Pulmonary amoebiasis, the second most common extra-intestinal pattern of infection, is frequently associated with amoebic liver abscesses. Case Description: We reported a case of amoebic liver abscess with lung involvement in a 10 y old Malaysian boy who presented with prolonged fever, lethargy, diarrhea, and right hypochondriac pain. He was diagnosed with possible ruptured liver abscess. Intravenous Ceftriaxone and Metronidazole were commenced. No organism was isolated in Blood culture, and stool microscopic examination for ova and cyst was negative. Ultrasonography of abdomen revealed of peritoneal collection with amoebic liver abscess in the superolateral segment of right lobe of liver whereas ultrasonography of thoracic showed pleural effusion and collapsed consolidation of right lower lobe of lung. After two days of admission, he developed acute respiratory distress Abdominal and chest drainage were done. Pleural fluid microscopic examination revealed Trophozoite of Entamoeba histolytica. Patient responded well clinically after completed four ws of treatment of Metronidazole. Discussion: The role of microscopic stool examination is limited. In this case, only one sample of stool was sent, and a microscopic stool examination of the cyst was negative. In view of the difficulty in demonstrating the causative pathogen in a clinical specimen, serological methods play an important role in diagnosing amoebic liver abscess. If the patient had undergone drainage of the abscess surgically, the aspiration material could be sent for microscopic examination. In this case, the microscopic examination of pleural fluid revealed the trophozoite of Entamoeba histolytica. Ultrasonography is easy and very useful in making early diagnosis and treatment. Most uncomplicated amoebic liver abscesses can be treated successfully with amoebicidal drug therapy alone. However, such in this case, ruptured amoebic liver abscess with lung involvement, surgical drainage is needed. In this case, the patient was responded well after four ws of treatment of Metronidazole. Conclusion: A multidisciplinary approach, including a gastroenterologist, radiologist, surgeon, and laboratory, is crucial for early diagnosis and successful treatment of these curable infections to prevent further complications, which can compromise the patient's outcome.

Renal abscess with bacteremia caused by extended-spectrum \u03b2-lactamase-producing Escherichia coli: a case report

BackgroundRenal abscess in children is a rare and severe form of infectious kidney disease that is responsible for several serious complications. In this report, we describe a previously healthy 5-year-old girl with a renal abscess caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli), which led to bacteremia and renal scarring.Case presentationThe patient presented to our department with high fever, headache, vomiting for 2 days and high inflammatory response. We diagnosed her with a urinary tract infection and initiated treatment with ampicillin and cefotaxime. Gram-negative bacilli bacteremia was noted on day 3. On day 4, her fever persisted, and a computed tomography (CT) scan revealed a renal abscess in the left kidney. After identifying the bacteria as ESBL-producing E. coli from the blood culture, we switched to the antibiotic meropenem and continued treatment for 3 weeks. The renal abscess was not drained. Although the renal abscess was successfully treated and it disappeared, a low-density area remained in same lesion on subsequent CT scans and a dimercaptosuccinic acid renal scan performed 4 months after onset revealed renal scarring.ConclusionGiven the increasing prevalence of ESBL-producing microorganisms, clinicians should be aware of the possibility of renal abscesses caused by community-acquired ESBL-producing organisms even in previously healthy children. Once a renal abscess is suspected, early diagnosis and management are important for reducing the risk of life-threating complications and renal scarring.

A pilot study on pediatric mononucleosis presenting with abscess

To describe this new clinical entity, diagnosis, and potential management of pediatric intratonsillar/peritonsillar abscesses in children affected by infectious mononucleosis. After institutional review board approval, a retrospective chart review of patients who underwent testing for infectious mononucleosis and also had a computed tomography scan of the head and neck was completed. Those who did not have imaging showing the palatine tonsils and those with insufficient testing to diagnose infectious mononucleosis were excluded. One hundred patients were included in the study; 15 had a peritonsillar abscess and 29 had an intratonsillar abscess. Four of the patients with a peritonsillar abscess (26.7%) had a positive Monospot or Epstein-Barr virus IgM result, and two of 15 (13.3%) had positive rapid strep or culture results. Of the 29 patients with an intratonsillar abscess, eight (27.6%) had a positive Monospot or Epstein-Barr virus IgM result while two (6.9%) had a positive rapid strep or culture result. Of those with bilateral intratonsillar abscess, five of 12 (41.7%) patients showed laboratory markers for infectious mononucleosis compared with three of 17 (17.6%) with unilateral intratonsillar abscess. This difference was not statistically significant (Fischer's, p=0.218). In our cohort of patients undergoing computed tomography scan and acute infectious mononucleosis testing, patients with intratonsillar and peritonsillar abscess tested positive for mononucleosis markers more commonly than for streptococcus markers. Recognizing uncomplicated intratonsillar and peritonsillar abscess in the setting of infectious mononucleosis in these pediatric patients may help tailor management in this population.

A case of perinephric abscess in a child with diabetes mellitus: A rare manifestation of group B Streptococcal infection

Perinephric abscess is an uncommon infection in children, but it is usually caused by Escherichia coli, Staphylococcus aureus, Proteus mirabilis and Pseudomonas aeruginosa . Group B Streptococcus (GBS) is an uncommon cause of perinephric abscess or serious bacterial infections beyond the neonatal period. Comorbid conditions such as diabetes mellitus and immunosuppression can increase the risk of GBS invasive disease. We describe a 10-year-old female who presented with 1-month of right-sided flank pain and swelling with ultrasound showing large (>3 cm) right perinephric and subcutaneous abscesses. She was additionally diagnosed with new onset type 2 diabetes mellitus (DM) during admission. Abscess cultures obtained after placement of two percutaneous drains and the initiation of broad-spectrum intravenous antibiotics grew beta-hemolytic GBS . Here, we present to our knowledge, the first known documented case of GBS perinephric abscess in a school-aged child with DM. Much of the knowledge of perinephric abscess management is extrapolated from adults, therefore making optimal treatment in the pediatric population challenging. We propose that GBS be considered in the etiology of perinephric abscess in children with DM and other immunosuppressing conditions. In addition, percutaneous drainage of larger abscesses (>3 cm) in conjunction with antibiotic therapy is a reasonable management strategy.

Nasal Septal Hematoma and Abscess in Children: An Uncommon Otorhinolaryngology Emergency Revisited.

To evaluate the demographic factors, trauma type, treatment, and long-term results in patients with nasal septal hematoma (NSH) and nasal septal abscess (NSA) in pediatric age group. Between the years 2006 and 2019, patients who received a diagnosis of NSA and NSH were included for the study. Demographic data, the surgical findings, and long-term follow-up results were recorded. A total of 68 patients were identified. Forty-five patients were diagnosed as NSA and 23 patients were diagnosed with NSA. Mean age of the patients was 7.00 ± 3.33 years. Patients did not differ in terms of age, gender, and etiology. Mean duration of the symptoms was significantly high in NSA group (4.11 ± 4.00 days for NSH and 7.61 ± 7.71 days for NSA, P = 0.011). Associated nasal fracture was significantly high in NSH group. Previous nasal examination was significantly high in NSA group. Epistaxis was present significantly high in NSH group (P = 0.013). Fever and purulent nasal discharge was observed significantly high in NSA group. Forty-seven (n = 47) patients can be reevaluated for long-term deformity (NSH, n = 34 [72.34%] and NSA, n = 13 [27.65%]). Mean follow-up period of the patients was 8.7 years. In total, 61.7% of the patients experienced minor or major sequelae. Both NSA and NSH groups did not differ in terms of minor sequelae and major sequelae. No sequleae was significantly high in NSH group (for NSH n = 17/34-(50,0%); for NSA n = 1/13- (7,7%), p = 0.008). Both NSA and NSH groups did not differ in terms of no sequelae and minor sequelae. The NSH and NSA are uncommon conditions that needed prompt diagnosis and intervention.

Abiotrophia defectiva liver abscess in a teenage boy after a supposedly mild blunt abdominal trauma: a case report

BackgroundA pyogenic liver abscess (PLA) represents a pus-filled cavity within the liver parenchyma caused by the invasion and multiplication of bacteria. The most common offender isolated from the PLA in children is Staphylococcus aureus. Abiotrophia defectiva is a Gram-positive pleomorphic bacterium, commonly found in the oral cavity, intestinal, and genitourinary mucosa as part of the normal microbiota. It has been proven to be an etiological factor in various infections, but rarely in cases of PLA. The case presented here is, to the best of our knowledge, the first pediatric case of PLA caused by A. defectiva.Case presentationA 13-year-old Caucasian boy presented with a two-day history of abdominal pain, fever up to 40 °C, and polyuria. Contrast-enhanced computed tomography (CT) scan revealed a single, multiloculated liver lesion, suggestive of a liver abscess. The boy had sustained a bicycle handlebar injury to his upper abdomen 3 weeks before the symptoms appeared and had been completely asymptomatic until 2 days before admission. He was successfully treated with antibiotic therapy and open surgical drainage. A. defectiva was isolated from the abscess material. Histopathology report described the lesion as a chronic PLA.ConclusionsA. defectiva is a highly uncommon cause of liver abscess in children. In such cases, various predisposing factors should be considered, including antecedent blunt abdominal trauma.

Laparoscopic treatment of appendiceal abscess in children

Abstract Objective To determine the role of laparoscopic surgery in the treatment of appendiceal abscess in children. Methods Case reports and a literature review of laparoscopic treatment of appendiceal abscess. Results In a two-year period, three children were diagnosed with appendiceal abscess presenting as abdominal or fever symptoms, and were treated by laparoscopic surgery. There were two girls and one boy. Mean operative time was 90 minutes (range, 60–120), and there were nopostoperative complications. Conclusion Laparoscopy is an effective and safe minimally invasive technique in the management of nocomplicated appendicitis. It is effective even in cases of appendiceal abscess.

Analysis of difficulties and influencing factors in treatment of appendiceal abscess in children with laparoscopic surgery

The purpose of this study was to investigate and analyze the difficulties and the influencing factors in the laparoscopic surgery for appendiceal abscess in children. Forty-six patients with appendiceal abscess receiving laparoscopic surgery (laparoscopic surgery group) in Xuzhou Children's Hospital from January 2012 to March 2017 were retrospectively analyzed. The surgery was performed using the 3-hole method, the 30° lens was placed in umbilical region, and the left lower abdomen and superior pubis were the operating holes. If the appendix was thick and big, 10 mm trocar was replaced on the superior pubis and the appendix was removed, followed by pelvic or lower abdominal drainage via the superior pubis incision. The laparoscopic surgery group was compared with 45 cases of laparotomy (traditional surgery group) for appendiceal abscess performed by the same group of operators in the past, and the perioperative period and postoperative complications between the two groups were compared. The child patients' age, history of abdominal pain and prediagnosis treatment were compared within the laparoscopic surgery group. Compared with those in traditional surgery group, the surgery time in laparoscopic surgery group had no statistically significant difference (P>0.05), the incidence rate of complications was lower, and the difference was statistically significant (P<0.05). In laparoscopic surgery group, the surgery time of child patients aged ≥6 years old with the medical history for more than 5 days and unreasonable preoperative treatment was longer than that of child patients aged <6 years old with the medical history for less than or equal to 5 days and reasonable preoperative treatment, and the difference was statistically significant (P<0.05). Compared with the traditional surgery, laparoscopic surgery for appendiceal abscess in children can significantly reduce the postoperative complications; at the same time, the history of abdominal pain and preoperative treatment are the influencing factors of surgery.

Primary splenic abscess in children

Abstract Primary splenic abscess in children is frequently missed due to the predominance of non-specific symptoms. A 7 year old girl presented with fever, vomiting, abdominal pain and diarrhea and there was mild generalised abdominal tenderness most marked in the left hypochondrium. Ultrasonography and computed tomography scan showed an enlarged spleen with a mixed density collection at the lower pole considered to be a splenic abscess. Intravenous broad spectrum antibiotics were commenced. Laparotomy confirmed a splenic abscess in the lower pole necessitating a partial splenectomy. Postoperative course was uneventful and the patient has remained well at 2 years of follow up. Streptococcus was cultured from the pus and histology confirmed splenic abscess in a healthy spleen. The literature on primary splenic abscess in children has been briefly reviewed for raised awareness and to facilitate early diagnosis and treatment.

Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure.

BackgroundThe optimal management of perianal abscess in children is controversial.PurposeTo evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure.MethodsAll cases of children younger than 14 years of age with perianal abscesses between 2001–2016 were evaluated.ResultsOf the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary surgery group). Conservative treatment was initiated in 49 patients (primary conservative group) but was stopped because of inefficiency in 25 patients, who were referred for surgery after a median 7.03 days (range, 2 to 16 days). The other 24 patients (48%) initially achieved complete remission after conservative treatment, but 10 were readmitted after a median 34 months (range, 3 to 145 months) with recurrent disease. There were no significant differences in permanent success after conservative treatment between infants (10 of 29, 34%) and older children (4 of 20 [20%], P=0.122). Overall, conservative treatment alone was effective in only 14 of 113 patients. Recurrence after surgery occurred in 16 patients (25%) in the primary surgery group and 11 patients (22%) in the primary conservative group (P=0.75). Univariate analysis of predictors for conservative treatment failure revealed inflammatory values (C-reactive protein and white blood count, P=0.017) and abscess size (P=0.001) as significant parameters, whereas multivariate analysis demonstrated that only abscess size (odds ratio, 3.37; P=0.023) was significant.ConclusionConservative treatment of perianal abscess is permanently efficient in only a minority of children but is not associated with a higher recurrence rate after subsequent surgery. Abscess size is a predictor for therapy failure.

Presence of red complex bacteria and Aggregatibacter actinomycetemcomitans in necrotic primary teeth with periapical abscess in children of Sinaloa, México.

Abstract Introduction: Pulp necrosis is a common reason of root canal treatment in primary teeth. The red complex and Aggregatibacter actinomycetemcomitans ( A.a. ) have been associated with pulpal pathologies. Objective: the present study was evaluate the prevalence of the red complex and A.a. in dental plaque, root canal and periapical abscesses of primary teeth with necrotic pulp in children from 3-to-9 years old. Materials and methods: Samples of the three sites were preserved and microorganisms were identified by PCR. Results : Twenty-six children (5.5 ± 1.7 years old) were evaluated, 92.3% were positive for bacteria at least in one place. The most prevalent microorganism was T. forsythia (76.9%) and the least T. denticola (11.5%). However, A.a was not found in any sample. Bacterial plaque was the most prevalent place of bacteria (80.7%, p<0.001). Interestingly, T. forsythia was related with bacterial plaque site, while T. denticola with fistula and P. gingivalis with root canal. Conclusion: The bacteria of the red complex ( P. gingivalis, T. denticola and T. forsythia ) were found in high frequencies in the three evaluated sites. A.a. was not found in any sample. T. forsythia was more prevalent in bacterial plaque site, while T. denticola in abscess and P. gingivalis in root canal. Resumen Introduccion: La necrosis pulpar es uno de los principales motivos por los cuales se realizan tratamientos en denticion infantil. El complejo rojo y Aggregatibacter actinomycetemcomitans (A.a.) han sido asociados con patologia pulpares. Objetivo: Evaluar la presencia del complejo rojo y A. a. en placa bacteriana, canal radicular y abscesos periapical en denticion infantil con diagnostico de necrosis pulpar en infantes de 3 a 9 anos de edad. Materiales y metodos: Las muestras de los tres sitios fueron preservadas y los microorganismos fueron identificados por PCR. Resultados: Veinte seis ninos (5.5 ± 1.7 anos) fueron evaluados, 92.3% fueron positivos para una bacteria en por lo menos uno de los lugares evaluados. El microrganismo mas prevalente fue T. forsythia (76.9%) y el menor T. denticola (11.5%). Sin embargo , A.a no fue encontrada en ninguna de las muestras. La placa bacteriana fue el lugar con mayor frecuencia de bacterias (80.7%, p<0.001 ). Un diagrama simetrico fue realizado dando como resultado que T. forsythia se relaciono con el sitio de placa bacteriana, mientras T. denticola con fistula y P. gingivalis con canal radicular. Conclusiones: Las bacterias del complejo rojo ( P. gingivalis, T. denticola y T. forsythia ) fueron encontradas en una alta frecuencia en los tres sitios analizados. A.a . no fue encontrada en ninguna muestra. T. forsythia fue la bacteria mas prevalente en placa bacteriana, mientras que T. denticola en absceso periapical y P. gingivalis en canal radicular.

Clinicoepidemiological profile and outcome of pyogenic liver abscess in children up to 12 years age

Background: Pyogenic liver abscess (PLA) is common in the Indian pediatric population and is an under-researched topic. It is a significant cause of morbidity and mortality. Objective: The objective of this study was to review the clinicoepidemiological profile of PLA in children and to evaluate the outcome in terms of mortality, prolonged hospital stay (&gt;3 weeks), and complications during a 1-month follow-up period. Materials and Methods: This was a hospital-based prospective observational cohort study conducted in the pediatric department of a tertiary care hospital. A total of 59 children of either sex up to 12 years of age were enrolled in the study. Associations of outcomes and various clinical symptoms were assessed using Student’s t-test and Chi-square test. Results: The median age was 7 years (ranging from 3 to 12 years) with a male preponderance (64.41%). Fever (94.91%) was the most common presenting symptom. A majority (61%) of the abscesses were found in the right lobe. Ultrasonography (USG) was the mainstay of diagnosis. About 54.23% of children were managed only medically, while 23.73% and 22.03% of children underwent USG-guided pigtail insertion and percutaneous aspiration, respectively, in addition to intravenous antibiotics. Pus and blood culture obtained from the abscess site that was sterile in more than 50% of cases. The mean duration of hospital stay was 15.34±4.71 days. There were 3 (5.08%) mortalities. The type of intervention done was shown to have a significant association with the length of hospital stay, mortality, complications, and findings on follow-up USG. Conclusions: The PLA is an important cause of morbidity in children below 12 years of age. If not managed appropriately, it may lead to rupture and mortality.

Use of Tissue Plasminogen Activator in Abdominal Abscesses in Children-A Single-Center Randomized Control Trial.

To establish the efficacy of once-per-day intracavitary tissue plasminogen activator (tPA) in the treatment of pediatric intra-abdominal abscesses. A single-center prospective, double-blinded, randomized controlled trial of the use of intracavitary tPA in abdominal abscesses in children. Patients were randomized to either tPA-treatment or saline-treatment groups. Primary outcome was drainage catheter dwell (hours). Secondary outcomes were length of hospital stay, times to discharge, clinical and sonographic resolution, and adverse events (AEs). Twenty-eight children were randomized to either group (n = 14 each). Demographics between groups were not significantly different (age P = .28; weight P = .40; gender P = .44). There were significantly more abscesses in the tPA-treated group (P = .03). Abscesses were secondary to perforated appendicitis (n = 25) or postappendectomy (n = 3). Thirty-four abscesses were drained, 4 aspirated, 3 neither drained/aspirated. There was no significant difference in number of drains (P = .14), drain size (P = .19), primary outcome (P = .077), or secondary outcomes found. No procedural or intervention drug-related AEs occurred. No patient in the saline-treated group required to be switched/treated with tPA. No significant difference in the length of catheter dwell time, procedure time to discharge, or time to resolution was found. Intracavitary tPA was not associated with morbidity or mortality. The results neither support nor negate routine use of tPA in the drainage of intra-abdominal abscess in children. It is possible that a multicentre study with a larger number of patients may answer this question more definitively.

A large-liver abscess with severe anaemia in 6 years-old patient: a case report

Background: Liver abscess are infectious, space-occupying lesions in the liver; the two most common abscesses being pyogenic and amoebic. A pyogenic liver abscess (PLA) is a potentially lethal condition. This study aims to describe the signs, symptoms, and prognosis of pyogenic liver abscess in children with severe anaemia.Case Description: Six years old boy complained about abdominal pain for 4 months before admitted to the hospital. The abdomen began to stiff 23 days before. Since 4 weeks, there was several episodes of fevers, more than 4 times but not more than 3 days, relieved by antipyretic. Every fever followed by a stomachache. His parents said he looked paler than before and his activities decreased, was sleepy and irritable. In physical examination, we found the patient looked anaemic, with a distended abdomen with hepatomegaly. Routine CBC revealed: WBC was 16.99, Hemoglobin was 5.45g/dL platelet was 796.20, iron parameters was: iron serum: 11.27 ug/dL (normal: 50-120 ug/dL) TIBC: 180 ug/dL(normal 225-450 ug/dL). A liver abscess 4.5 cm x 5.1 cm with liquefaction was obtained by ultrasound and confirmed by abdomen MSCT with contrast 4,4 x 4,3 x 6,1 cm. The patient family refused abscess draining surgery, so only conservative therapy by antibiotics was given and further followed up in polyclinic. Nine-month after therapy, follow up by ultrasound was normal.Conclusion: The sign and symptom of pyogenic LA were non-specific; abdomen MSCT confirmed the diagnosis with contrast. The prognosis was good.

Deep Neck Abscesses in Children: An Italian Retrospective Study.

Retropharyngeal and parapharyngeal abscesses (RPAs, PPAs) usually affect young children. Surgical drainage and/or antibiotic therapy are treatment of choice, but no specific guidelines exist. In order to reduce the risk of severe complications, appropriate diagnosis and therapy are necessary. The aims of the study were to review diagnosis and management of children with RPAs/PPAs and to compare surgical versus medical approach. This is a multicenter retrospective study including all patients younger than 15 years admitted at 4 Italian pediatric hospitals of Florence, Padua, Rome, and Treviso, with International Classification of Diseases, Ninth Revision discharge diagnosis code of RPAs and PPAs, from January 1, 2008, to December 31, 2016. One hundred fifty-three children were included. The median age was 4.4 years, with overall male predominance. Heterogeneous signs and symptoms (fever, neck cervical, lymphadenopathy, pain, and stiff neck most frequently) and a large mixture of bacteria from pus cultures were detected. Computer tomography (66.7%) and magnetic resonance imaging (27.5%) were performed to confirm the presence of abscess. Fifty-one percent of abscesses were greater than 3 cm. Eighty-seven patients (56.9%) underwent surgery, and 66 (43.1%) were treated with antibiotics alone (mostly ceftriaxone, metronidazole, amikacin, and clindamycin) with median days of therapy of 26.5 days and length of therapy of 16.0 days of median. Median length of stay was 11 days. None had severe complications. Multivariate analysis indicated as independent predictive factors of surgery abscess of 3 cm or greater, high white blood cell count, and-most of all-the hospital of admission. Deep neck abscesses mostly affect patients in early childhood, with a combination of nonspecific signs and symptoms, and it still emerges as a heterogeneous approach in diagnosis and management of these infections. Thus, common shared protocols represent an essential tool in order to standardize care and improve patients' outcomes.

Brain abscess in children, a two-centre audit: outcomes and controversies

ObjectiveThe aim of this study was to better characterise clinical presentation, management and outcome in infants and children with brain abscess.MethodsThe authors conducted a retrospective, multicentre study in two national...

Intracranial abscesses in children at Ile-Ife, Nigeria: a case series and review of literature.

Central nervous system (CNS) infections are significant causes of morbidities and mortalities in children with some being prone to the development of abscesses which can either be within the brain parenchyma or located in extracranial structures. We aimed to describe the clinical profile and outcome of children with cranial abscesses at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC). Consecutive cases presenting at the Children Emergency Ward of OAUTHC Ile-Ife were recruited. The pattern of presentation, predisposing factors and outcome of these children were studied. Among the 641 children admitted within a 6-month period, six were diagnosed with cranial abscess giving a hospital prevalence of 0.9%. The mean duration of symptom prior to presentation was 12.7 ± 13.4days. Five (83.3%) of the patients had intracranial abscesses which were multiple in two (33.3%) children. One patient had Pott's puffy tumour following frontal sinusitis. Surgical management was done for two (33.3%), and this was by craniotomy and evacuation. Two of the patients died with a case fatality rate of 33.3%. Though uncommon, cranial abscesses remain life threatening in children especially in resource-poor settings. Early presentation and early treatment of local infections will improve outcome.

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children

IntroductionCongenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it. ObjectivesThis study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children. MethodsWe performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis. ResultsChildren from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1year after the surgery. No recurrence occurred in any patient. ConclusionCongenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.

Outcome of management of brain abscess in children.

Objective:To find out the outcome of management of brain abscess in children.Methods:This is prospective observational study conducted in the Department of Paediatric Neurosurgery at Children’s Hospital and Institute of Child Health, Multan from July 2014 to June 2017. Children up to the age of 14 years suffering from brain abscess were admitted. After taking clinical history, general and systemic physical examination and necessary investigations, abscess was evacuated and abscess wall excised after performing craniotomy. Data was collected on a predesigned performa. Results were analyzed and compared with national and international literature through statistical package for social sciences (SPSS-20).Results:Twenty five patients up to 14 years of age were included. Seventeen (68%) were male and eight (32%) female. Fever and vomiting were present in all 25 (100%) patients. Paranasal sinusitis was predisposing causative factor in 9(36%) followed by otitis media in 7 (28%). Abscess was present in frontal lobe in 9 (36%), temporoparietal region in 8 (32%), posterior fossa in 5 (20%) and multiple abscesses in 3 (12%). Craniotomy was performed, pus evacuated and abscess wall excised in all 25 (100%) patients. Three (12%) patients expired.Conclusion:Incidence of brain abscess can be decreased by treatment of its predisposing causes as sinusitis and otitis media. Small abscess less than 2cm can be treated with antibiotics. Complete evacuation of pus and excision of abscess wall after performing craniotomy along with appropriate antibiotics is gold standard management of brain abscess in children.

Pattern and etiological agents of superficial soft tissue abscesses in children

Background: Superficial soft tissue abscesses (SSTAs) constitute a considerable proportion of the pediatric surgeon’s workload. SSTAs are abscesses involving skin, subcutaneous tissues, muscles superficial to bones, and deep body cavities such as pleural and peritoneal cavities. However, scientific publications assessing patterns of presentation in children, identifying the common bacterial etiological agents, and calculating multiple antibiotic resistance (MAR) index of positive abscess culture results in our environment are not common. Aims and Objectives: The aim of this study was to determine the pattern of presentation of SSTAs in children in our environment, determine their common bacterial etiological agents, and calculate MAR index. Materials and Methods: An observational study was conducted on children with SSTA over a 21-month period at the Federal Medical Center, Umuahia, Abia State, Nigeria. All patients had incision and drainage, packing of cavity with gauze drain, and a sample of the pus sent for aerobic culture and sensitivity. MAR index was calculated for each positive isolate after sensitivity testing. Data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) software, version 20.0 (SPSS, Chicago, Illinois). Results were presented as mean values, ratios, percentages, and in tables. Results: There were 40 patients with 45 abscess sites: 22 males and 18 females aged 7 days to 14 years (median of 21 months). Symptom duration before presentation ranged from 2 to 14 days. The most common site of abscess was the lower limb (12 of 45, 26.7%). Blunt trauma was the most common predisposing factor to abscess formation (17 of 45, 38%). MAR index ranged from 0.25 to 1 with a mean of 0.49. Staphylococcus aureus was the most common organism grown in all positive cultures (23 of 25, 92%). Conclusion: In our environment, most SSTAs in children occur in the lower limbs; S. aureus is the most common etiological bacterial agent involved in SSTAs, and blunt trauma is the most prevalent predisposing factor in SSTAs. Mean MAR index is high in this study.