Korean Journal of Otorhinolaryngology-Head and Neck Surgery

Korean Society of Otolaryngology-Head and Neck Surgery (대한이비인후과학회)
권호 표지

Deep Neck Infections in Diabetic Patients

당뇨환자에서 심경부감염에 대한 임상적 고찰

이준규;임상철

  • Published : 20060000
⟨ Previous Next ⟩

Abstract

Patients with diabetes mellitus (DM) have suppressed immunity, and the clinical course are always more severe and may cause life-threatening complications. This article investigates the differences in clinical manifestation of deep neck infections between diabetic patients and nondiabetic patients and to take this into account for their treatment. Subjects and Method：The present study reviews the experience of 158 patients with deep neck infections from 1995 to 2004. Cases of peritonsillar abscess, superficial infection, and infections related to external neck wound and head and neck tumors were excluded. Among 158 patients, 27 patients were presented with DM. To find out the characteristics of diabetic patients, the author compared these patients with nondiabetic patients using student t-test and chi-square test. Results：Compared with the nondiabetic patients, the unique features of deep neck infections in diabetic patients were as follows：1) tendency to have Klebsiella pneumoniae as a pathogen, 2) prolonged hospitalization, and 3) higher complication rate (p<0.05). There were no significant differences in sex, duration of symptom, fever higher than 38.0℃, white blood cell count, etiology, and involved spaces between two groups (p>0.05). Conclusion：Patients with DM were found to have Klebsiella pneumoniae pathogen, higher complication rate, and longer hospitalization. Doctors should keep close observation, appropriately control the diabetes, detect life-threatening complications early, perform aggressive surgical treatment if fluctuations or complications occurs, and take into account the preponderance of Klebsiella pneumoniae when administering empirical antibiotics.

Keywords

References

  1. Barratt GE, Koopmann CF Jr, Coulthard Sw. Retropharyngeal abscess-- a ten-year experience. Laryngoscope 1984:94:455-63 https://doi.org/10.1288/00005537-198404000-00003
  2. Colmenero Ruiz C, Labajo AD, Yanez Vilas I, Paniagua J. Thoracic complications af deeply situated serous neck infections. J Craniomaxillafac Surg 1993:21:76-81 https://doi.org/10.1016/S1010-5182(05)80151-9
  3. Beck HJ, Salassa JR, McCaffrey TV, Hermans PE. Life-threatening soft tissue infections of the neck. Laryngoscope 1984:94:354-62
  4. Chen MK, Wen YS, Hsiao HC Thoracic complications of deep-neck infection-report of four cases. J Otolaryngol Soc Taiwan 1997:32:454-8
  5. Estrera AS, Landay MJ, Grisham JM, Sinn BP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983: 157:545-52
  6. Levine TM, Wurster CF, Krespi YP. Mediastinitis occurring as a complication of odontogenic infections. Laryngoscope 1986:96:747-50
  7. Lee JS, Lee CB, Kim KO, Cho SH, Yoon HR, Jo KH. A case of Ludwig's angina with parapharyngeal abscess, retropharyngeal abscess. and mediastinitis. Korean J Otolaryngol-Head Neck Surg 1986:29:929-34
  8. Paik JH, Kim JH, Kim JG. Mediastinitis complicated by peritonsillar abscess. Korean J Otolaryngol-Head Neck Surg 1986:29:262-5
  9. Bong JP, Kim SS, Heo W, Lee SJ, Park SI, Kim EG. Two cases of deep neck infection with mediastinal involvement. Korean J Otolaryngol-Head Neck Surg 1999:42: 1587-92
  10. Lee BH. Oh as, Choi CM, Yang CM. A case of internal jugular thrombosis accompanied by deep neck infection. Korean J Otolaryngol-Head Neck Surg 1998:41: 1216-9
  11. Marra S, Hotaling AJ. Deep neck infections. Am J Otolaryngol 1996:17:287-98 https://doi.org/10.1016/S0196-0709(96)90013-7
  12. Scott BA, Stiemberg CM, Driscoll BP. Infections of the deep spaces of the neck. In: Bailey BJ, editor. Head and Neck Surgery-Otolaryngology. 3rd ed. Philadelphia: JB Lippincott:2001. p.701 -15
  13. Nagy M, Pizzuto M, Backstrom J, Brodsky L. Deep neck infections in children: A new approach to diagnosis and treatment. Laryngoscope 1997: 107:1627-34 https://doi.org/10.1097/00005537-199712000-00010
  14. Casey JI. Host defense and infections in diabetes mellitus. In: Rifkin K, Porte D, editors. Diabetes Mellitus. Theory and Practice. 4th ed. New York: Elsevier: 1990. p.617-9
  15. Wilsom RM. Infection and diabetes mellitus. In: Pickup J. Williams G, editors. Textbook of Diabetes Mellitus. Cambridge: Blackwell Scientific:1991. p.813-9
  16. Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leukocyte junctions in diabetic patients. Diabet Med 1997:14:29-34 https://doi.org/10.1002/(SICI)1096-9136(199701)14:1<29::AID-DIA300>3.0.CO;2-V
  17. Gleckman RA, Czachor JS. Managing diabetes-related infections in the elderly. Geriatrics 1989:44:37-9. 43-4, 46
  18. Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC Deep neck infections in diabetic patients. Am J Otolaryngol 2000:21:169-73 https://doi.org/10.1016/S0196-0709(00)85019-X
  19. Sonnenwirth AC The enteric bacilli and bactemids. In: Davis BD Dulbecco R. Eisen N. editors. Micmbiology. 3rd ed. New York: Harper & Row:1981. p.659-60
  20. Gallacher SJ, Thomson G, Fraser WD, Fisher BM, Gemmell CG, MacCuish AC Neutrophil bactericidal junction in diabetes mellitus: evidence for association with blood glucose control. Diabet Med 1995:12:916-20 https://doi.org/10.1111/j.1464-5491.1995.tb00396.x