Abstract

Usually, a case of retropharyngeal abscess (RPA) in children represents a suppurative stage in the evolution of lymphadenitis in the retropharyngeal space, secondary to infection elsewhere in the head or neck (eg, sinusitis, tonsillitis, otitis). Modern medicine has contributed to a significant decrease in childhood RPA incidence and mortality. In many cases, infections which could have produced a case of RPA were resolved with antimicrobial therapy; recently, antimicrobial therapy has emerged as a conservative approach for some cases of RPA management. Over the past decade, particularly since 1999, we noted a recrudescence of medical reports on RPA, indicating an increase in the incidence of this entity.1–5 In this issue of the Southern Medical Journal, Abdel-Haq et al report 64 cases over a 10-year period, a 4.5-fold increase in RPA incidence, during the 1993 to 2003 period, as compared with the 1978 to 1989 period at the same institution.1 There was a sharp increase after the year 2000, with 16 cases in 2003, more than the highest previously reported multi-annual case rate of 12.8 per year.3 In other studies, the start of this increase occurs in 19951 or during the 1993 to 1998 period.3 This increased incidence may be partially explained by more accurate diagnoses, due, in part, to the increased use of contrast-enhanced computed tomography (CT). In instances where antibiotics are prescribed for the primary infection, RPA may remain undiagnosed. The positive predictive value of the CT scan was estimated to be between 84 to 94%.1,2