Original Article

Retropharyngeal Abscess in Children: The Emerging Role of Group A Beta Hemolytic Streptococcus

Authors: Nahed M. Abdel-Haq, MD, Ashraf Harahsheh, MD, Basim I. Asmar, MD

Abstract

Background:Because of a recent increase in the number of cases of retropharyngeal abscess (RPA) admitted to our hospital, we reviewed the incidence, microbiology, and treatment outcome of RPA during an 11-year period (1993–2003). Methods:A retrospective review of medical records of children with RPA. Results:Sixty-seven children (46 males) with RPA were identified, representing a 4.5-fold increase in incidence over a previous 12-year period. The majority (66%) of patients presented during the last 4 years. Computed tomography revealed inflammatory or ring enhancing lesion in all patients. Abscess drainage was performed in 51 (76%) patients. A total of 101 isolates (84 aerobes, 17 anaerobes) were recovered from 41 specimens (a mean of 2.5 isolates per specimen). Group A beta hemolytic streptococcus (GABHS) was recovered from 22 (54%) of 41 specimens compared with 6 (35%) of 17 over the previous 12 years. Treatment included IV antibiotics: ampicillin/sulbactam or clindamycin plus either cefuroxime or ceftriaxone, followed by oral amoxicillin/ clavulanate or clindamycin. All patients recovered. Conclusions:RPA, an aerobic/anaerobic polymicrobial infection, is increasing in frequency and is associated with increased recovery of GABHS in our patients. Whether this rise in incidence is due to increased invasiveness of GABHS strains is to be determined.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Seid AB, Dunbar JS, Cotton RT. Retropharyngeal abscesses in children revisited. Laryngoscope1979;89:1717–1724.
 
2. Thompson JW, Cohen SR, Reddix P. Retropharyngeal abscess in children: a retrospective and historical analysis. Laryngoscope 1988;98 (6 Pt 1):589–592.
 
3. Goldenberg D, Golz A, Joachims HZ. Retropharyngeal abscess: a clinical review. J Laryngol Otol1997;111:546–550.
 
4. Barratt GE, Koopmann CF Jr, Coulthard SW. Retropharyngeal abscess–a ten-year experience.Laryngoscope 1984;94:455–463.
 
5. Asmar BI. Bacteriology of retropharyngeal abscess in children. Pediatr Infect Dis J 1990;9:595–597.
 
6. Abuhammour WM, Asmar BI. A sixteen-year-old male youth with fever, dysphagia and weight loss.Pediatr Infect Dis J 1999;18:732, 748–749.
 
7. Brook I. Microbiology of retropharyngeal abscesses in children. Am J Dis Child 1987;141:202–204.
 
8. Wald ER. Expanded role of group A streptococci in children with upper respiratory infections. Pediatr Infect Dis J 1999;18:663–665.
 
9. Quinn RW, Vander Zwaag R, Lowry PN. Acquisition of group A streptococcal M protein antibodies.Pediatr Infect Dis 1985;4:374–378.
 
10. Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J 1999;18:1096–1100.
 
11. Bronze MS, Dale JB. The reemergence of serious group A streptococcal infections and acute rheumatic fever. Am J Med Sci 1996;311:41–54.
 
12. Marrack P, Kappler J. The staphylococcal enterotoxins and their relatives. Science 1990;248:705–711.
 
13. Zervas SJ, Zemel LS, Romness MJ, et al. Streptococcus pyogenes pyomyositis. Pediatr Infect Dis J 2002;21:166–168.
 
14. Kaplan EL. Recent epidemiology of group A streptococcal infections in North America and abroad: an overview. Pediatrics 1996;97 (6 Pt 2):945–948.
 
15. Wong YK, Novotny GM. Retropharyngeal space - a review of anatomy, pathology, and clinical presentation. J Otolaryngol 1978;7:528–536.
 
16. Wholey MH, Bruwer AJ, Baker HL Jr. The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 1958;71:350–356.
 
17. Morrison JE Jr, Pashley NR. Retropharyngeal abscesses in children: a 10-year review. Pediatr Emerg Care 1988;4:9–11.
 
18. Endicott JN, Nelson RJ, Saraceno CA. Diagnosis and management decisions in infections of the deep fascial spaces of the head and neck utilizing computerized tomography. Laryngoscope 1982;92 (6 Pt 1):630–633.
 
19. Holt GR, McManus K, Newman RK, et al. Computed tomography in the diagnosis of deep-neck infections. Arch Otolaryngol 1982;108:693–696.
 
20. Yeoh LH, Singh SD, Rogers JH. Retropharyngeal abscesses in a children's hospital. J Laryngol Otol1985;99:555–566.
 
21. Al-Sabah B, Bin Salleen H, Hagr A, et al. Retropharyngeal abscess in children: 10-year study. J Otolaryngol 2004;33:352–355.
 
22. Reinhardt JF, Johnston L, Ruane P, et al. A randomized, double-blind comparison of sulbactam/ampicillin and clindamycin for the treatment of aerobic and aerobic-anaerobic infections. Rev Infect Dis 1986;8 (Suppl 5):S569–575.
 
23. Brogan TV, Nizet V, Waldhausen JH, et al. Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients. Pediatr Infect Dis J 1995;14:588–594.
 
24. Doctor A, Harper MB, Fleisher GR. Group A beta-hemolytic streptococcal bacteremia: historical overview, changing incidence, and recent association with varicella. Pediatrics 1995;6 (3 Pt 1):428–433.
 
25. Broughton RA. Nonsurgical management of deep neck infections in children. Pediatr Infect Dis J1992;11:14–18.
 
26. Craig FW, Schunk JE. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. Pediatrics 2003;111 (6 Pt 1):1394–1398.