DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20210502

Deep neck space infections: comparison of outcomes between diabetic and non-diabetic patients

Sona Ashokan, K. V. Rajan, Santhi T.

Abstract


Background: The objective of the study was to study the clinical presentation, microbiological profile, treatment protocol of deep neck space infections in diabetics and non diabetics.

Methods: This was a prospective study conducted on 76 patients (diabetics and non diabetics) admitted in the Department of Otorhinolaryngology, TD Medical college, Alappuzha over a period of 18 months from January 2012 to June 2013.

Results: The age distribution was 15-75 years. Male to female ratio was 2:1. Fever, pain, neck swelling and odynophagia were the common symptoms with dyspnoea and chest pain indicative of complications. The most common etiology was odontogenic (68.4%) followed by tonsillopharyngeal infection and foreign bodies. No etiological factor was found in 34.2%. The commonest site was submandibular space (64.2%) followed by parapharyngeal space (26.6%). Abscess was present in majority needing surgical drainage. The most common organism isolated was streptococcus viridans (37.5%). Preponderance of klebsiella species was noted in diabetics. Streptococcus showed susceptibility to pencillin (83.33%), ampicillin (92%), cefotaxime (60.526%). Klebsiella showed susceptibility to gentamicin (42.3%) and ciprofloxacin (28.57%). The complication rate was more in diabetics (34.21%). Contrast enhanced CT was done in cases suspected to have complication. The mean hospital stay was longer in diabetics (19.6 days) than non diabetics (6.4 days).

Conclusions: Deep neck space infection still remains life threatening if not heeded promptly. Senescence and diabetes demand surgical intervention and meticulous glycemic control to prevent complications. Judicious use of antimicrobials and timely radiological and surgical interventions have come a long way in the management and in providing a cure to this dreaded condition.


Keywords


Deep neck space infection, Diabetes abscess, Complications, Microbiological profile, Antibiotics

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References


Kamath PM, Shetty AB, Hegde MC, Sreedharan S, Bhojwani K, Padmanabhan K et al. Presentation and management of deep neck space abscess. Indian J Otolaryngol Head Neck Surg. 2003;55(4):270-5.

Patigaroo SA, Patigaroo FA, Mehfooz N, Khan NA, Kirmani MH, et al. Pediatric Deep Neck Space Abscesses: A Prospective Observational Study. Emergency Med. 2012;2:117.

Das R, Nath G, Mishra A. Clinico-Pathological Profile of Deep Neck Space Infection: A Prospective Study. Indian J Otolaryngol Head Neck Surg. 2017;69(3):282-90.

Aiken AH, Shatzkes DR. Approach to Masses in Head and Neck Spaces. 2020 Feb 15. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020;16.

Vieira F, Allen SM, Stocks RSM, Thompson JW. Deep neck infections. Otolaryngol Clin N Am. 2008;12:459-83.

Weed HG, Forest LA. Deep neck infection. In: Cummings CW, Flint PW, Harker LA, et al, editors. Otolaryngology: head and neck surgery. Volume 3. 4th edition. Philadelphia: Elsevier Mosby. 2005;2515-24.

Gujrathi AB, Ambulgekar V, Kathait P. Deep neck space infection - A retrospective study of 270 cases at tertiary care center. World J Otorhinolaryngol Head Neck Surg. 2016;2(4):208-13.

Pandey SK, Sharma V. World diabetes day 2018: Battling the Emerging Epidemic of Diabetic Retinopathy. Indian J Ophthalmol. 2018;66(11):1652-653.

Anjana RM, Pradeepa R, Deepa M. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011;54(12):3022-027.

Ravikumar P, Bhansali A, Ravikiran M. Prevalence and risk factors of diabetes in a community-based study in North India: the Chandigarh Urban Diabetes Study (CUDS). Diabetes Metab. 2011;37(3):216-21.

Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. Australas Med J. 2014;7(1):45-8.

Huang TT, Tseng FY, Liu TC, Hsu CJ, Chen YS. Deep neck infection in diabetic patients: comparison of clinical picture and outcomes with nondiabetic patients. Otolaryngol Head Neck Surg. 2005;132(6):943-47.

Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24(2):111-17.

Kataria G, Saxena A, Singh B, Kaur M, Kaur G. Deep Neck Space Infections: A Study of 76 Cases Iran J Otorhinolaryngol. 2015;27(81):293-99.

Motahari SJ, Poormoosa R, Nikkhah M, Bahari M, Shirazy SM, Khavarinejad F. Treatment and prognosis of deep neck infections. Indian J Otolaryngol Head Neck Surg. 2015;67(Suppl1):134-37.

Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. Int J Infect Dis. 2009;13(3):327-33.

Pierce TB, Razzuk MA, Razzuk LM, Luterman DL, Sutker WL. Acute mediastinitis. Proc (Bayl Univ Med Cent). 2000;13(1):31-3.

İsmi O, Yeşilova M, Özcan C, Vayisoğlu Y, Görür K. Difficult Cases of Odontogenic Deep Neck Infections: A Report of Three Patients. Balkan Med J. 2017;34(2):172-79.

Garca MF, Budak A, Demir N, Cankaya H, Kiroglu AF. Characteristics of deep neck infection in children according to weight percentile. Clin Exp Otorhinolaryngol. 2014;7(2):133-7.

Cmejrek RC, Coticchia JM, Arnold JE. Presentation, diagnosis, and management of deep-neck abscesses in infants. Arch Otolaryngol Head Neck Surg. 2002;128(12):1361-364.

Sharma K, Das D, Joshi M, Barman D, Sarma AJ. Deep Neck Space Infections-A Study in Diabetic Population in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg. 2018;70(1):22-27.

Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000;13(4):547-58.

Shin JH, Lee HK, Kim SY, Choi CG, Suh DS. Imaging of parapharyngeal space lesions focus on the prestyloid compartment American Journal Roentgenology.2001;177:1465-1470 American Journal of Roentgenology. 2001;177:1465-70.

Decré D, Verdet C, Emirian A, Le Gourrierec T, Petit JC, Offenstadt G et al. Emerging severe and fatal infections due to Klebsiella pneumoniae in two university hospitals in France. J Clin Microbiol. 2011;49(8):3012-4.

Freling N, Roele E, Schaefer-Prokop C, Fokkens W. Prediction of deep neck abscesses by contrast-enhanced computerized tomography in 76 clinically suspect consecutive patients. Laryngoscope. 2009;119(9):1745-752.

Babu VR, Ikkurthi S, Perisetty DK, Babu KAS, Rasool M, Shaik S. A Prospective Comparison of Computed Tomography and Magnetic Resonance Imaging as a Diagnostic tool for Maxillofacial Space Infections. J Int Soc Prev Community Dent. 2018;8(4):343-8.