Deep neck infection in Northern Thailand

Abstract

The aim of this retrospective study, conducted by the Department of Otolaryngology, Chiang Mai University, Thailand, is to understand the clinical characteristics of patients with deep neck infection (DNI), especially in immunocompromised hosts, as well as to analyze the factors that influence multiple spaces' involvement and complications. The data collected (January 2004-July 2009) from 177 patients with DNI, excluding peritonsillar abscess, were reviewed, including demography, clinical presentation, etiology, involved fascial spaces, bacteriology, treatment, and complications. SPSS (15.0) was used to analyze the data. A p value of <0.05 was considered statistically significant. Among 177 DNI patients, there were 30 diabetic and 4 HIV infected patients, who were considered immunocompromised. Furthermore, two characteristics (complications and the Hb level) were statistically significant (p value <0.05) in the immunocompromised and immunocompetent groups. The 87 patients who presented with multiple space involvement were predicted by the level of white blood cell count (<5,000 or >12,000/μl) (OR 2.62; 95% CI 1.38-4.96) in univariate analysis. Complications were affected by both host immunity and abnormal Hb level (<10 or >15 g/dl), in univariate analysis, but Hb level was the only risk factor (OR 4.46; 95% CI 1.81-10.99) in multivariate analysis. Comorbidities such as diabetes mellitus and HIV infection required certain clinical assessment because of potential complications. In addition, blood tests (WBC and Hb levels) are the most important investigations necessary in patients suspected of having multiple space involvement and complications.

End-stage renal disease: a risk factor of deep neck infection – a nationwide follow-up study in Taiwan

“…In previous case-series-based studies, the rate of mediastinitis developing after DNI was reported to be 1.7%–2.7% [4, 9, 18, 19], and in reviewing those articles, we observed a high proportion of comorbidities, such as DM, in the DNI cases with mediastinitis. In our study, the patients with ESRD did not have a significantly higher rate of mediastinal complications after DNI in comparison with the controls (ESRD: 2.5%, control: 1%, p  = 0.249), and the rates of mediastinitis development in both cohorts were relatively consistent with the preceding data.…”

“…However, the two aforementioned studies provided no information about the severity of uremia and conducted no further investigation on the influence of uremia on DNI. Moreover, we reviewed relevant studies conducted worldwide, but no case of DNI with end-stage renal disease (ESRD) has been reported [3, 5–8, 11–19]. …”

Clinical and bacteriological influence of diabetes mellitus on deep neck infection: Systematic review and meta‐analysis

“…After excluding 9 reports addressing duplicate results, 16 reports were noted to have addressed the clinical features of deep neck infection without clarifying differences between diabetic and nondiabetic groups of patients. Quantitative synthesis was performed on the remaining 20 eligible studies . The study by Srivanitchapoom et al categorized 177 patients into those with diabetes mellitus or human immunodeficiency virus (HIV; n = 34) and an immunocompetent host group.…”

Increased risk of deep neck infection among HIV-infected patients in the era of highly active antiretroviral therapy—a population-based follow-up study

“…Francisco Vieira et al suggested that immune suppression diseases, such as chronic renal disease and hepatic disease, and chronic steroid therapy for autoimmune disease could be risk factors for DNI [2-8]. In Srivanitchapoom’s study, they emphasized that clinical physicians were required to make certain assessments because of the potential for complications when DNI was diagnosed in patients with compromised immune systems [9]. The human immunodeficiency virus (HIV) epidemic is one of the most important public health problems of this century and has caused the deaths of a significant number of immune-compromised patients.…”

“…Consequently, it is reasonable to project that more and more HIV-infected patients will suffer from DNI as their immune systems gradually decline. One previous study indicated that immune-compromised patients are more apt to develop complicated and life-threatening DNI as compared to normal people [9]. However, the sample size was small and the risk of DNI among HIV-infected patients was still unknown, especially in the era of highly active antiretroviral therapy (HAART).…”