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Cervical adenitis caused by anaerobic bacteria
1060
Letters to the Editor
REFERENCES
1. McCracken G: Group B streptococci: the new challenge in neonatal infections, J PEOIAXR 82:703, 1973. 2: Howard J, and McCracken G: The spectrum of group B streptococcal infections in infancy, Am J Dis Child 128:815, 1974. 3. McGowan JE Jr, et al: Bacteremia in febrile children seen in a "walk-in" pediatric clinic, N Engl J Med 288:1309, 1973. 4. Smith A: Childhood bacteremia, N Engl J Med 288:1351, 1973.
The Journal of Pediatrics June 1976
34 patients and Powers and Boisvert ~ in a series in excess of 100 patients did not report isolation o f any anaerobic organisms. In reviewing the microbiological data for all anaerobic isolates at the Massachusetts General Hospital, Bornstein and associates 4 noted that the only anaerobic pathogen causing upper respiratory tract infections was Bacteroides. However, we have been unable to find a previous report of isolation of Bacteroides from cervical adenitis. With improved methods of anaerobic isolation in the bacteriology laboratory, and an increased recognition of the importance of routine anaerobic cultures of cervical adenitis, more anaerobes will undoubtedly be recovered.
Bradley J. Bradford, M.D. Resident Georgetown University Medical Center Department of Pediatrics Washington, D. C. Stanley A. Plotkin, M.D. Children's Hospital of Philadelphia 34 Civic Center Blvd. Philadelphia, Pa. 19104
Cervical adenitis caused by anaerobic bacteria To the Editor: The subject of cervical adenitis in childhood was recently reviewed in THE JOURNAL by Barton and Feiginr who point out the necessity for anaerobic as well as aerobic cultures in evaluating the bacterial etiology of these infections. This report is intended to substantiate their contention with specific reference to two children with cervical adenitis from whom anaerobic organisms were cultured by using modern techniques. CASE REPORTS Case 1. Patient D. O. was a five-year-old Puerto Rican male admitted with a three-day history of an earache, associated with fever and cervical swelling. On admission his temperature was 39~ and the left cervical area was red and swollen with a 4 by 2 cm tender mass. The white blood count was 14,400/mm 3 with 76% polymorphonuclear leukocytes, 11% band forms, 11% lymphocytes, and 2% atypical lymphocytes. Aspiration o f the mass revealed purulent material, the cultures of which grew two organisms (both penicillin sensitive) an alpha hemolytic viridans Streptococcus and a Bacteriodes species. The patient received a seven-day course of intravenous penicillin and recovered uneventfully. Case 2. Patient L. S. a 16-year-old female, was admitted with a right cervical mass of two months' duration. Temperature was 39~ On physical examination the tonsils were red with obvious exudate; the neck had a right 3 by 2 cm submandibular mass and left 1 by 1 cm mass in the strenocleidomastoid area. The admission white blood count was 4,700/mm ~ with 60% segmented forms and 40% lymphocytes. The area was surgically drained, and a culture of the recovered purulent material grew peptostreptococcus and a Bacteroides species. The organisms were sensitive to penicillin and the patient received two weeks of intravenous penicillin therapy. Recovery was complete. DISCUSSION Cervical adenitis is a fairly common entity in the pediatric age group as a sequel of pharyngotonsillar infections. The two cases reported here are examples of anaerobic organ!sms as the cause of bacterial adenitis which finding seems unusual as a survey of the literature demonstrated. Dajani and associates, ~ in a series Of
REFERENCES
1. Barton L, and Feigin R: Childhood cervical lymphadenitis, A reappraisal, J PEDIATR 84:846, 1974. 2. Dajani AS, Garcia R, and Wolinsky E: Etiology of cervical adenitis in children, N Engl J Med 268:1329, 1965. 3. Powers G, and Boisvert P: Age in streptococcocis, J PEDIATR 25:481, 1944. 4. Bornstein DL, Weinberg A, Swartz M, and Kunz L: Anaerobic infections: Review of current experience, Medicine 43:207, 1964.
IgA deficiency and recurrent pneumonia in the Schwartz-Jampel syndrome To the Editor: A girl with the Schwartz-Jampel syndrome (myotonia, blepharophimosis, and joint limitation 1) and repeated infections had a selective deficiency of IgA in serum and external secretions. CASE REPORT Patient A. R., 3% years of age, had a stiff gait and recurrent pneumonias. She was below the third percentile for both height (82 cm) and weight (9.3 kg) and displayed (Fig. 1) hypertelorism , blepharophimosis, decreased lid fissure length (18 ram), bilateral ptosis, pursed lips, a hypoplastic mandible, and severe dental caries. A kyphotic thorax with pectus carinatum supported an elevated shoulder girdle, which was contracted with a restricted
From the LaRabida Children's Hospital and Research Center, University of Chicago.
Letters to the Editor
REFERENCES
1. McCracken G: Group B streptococci: the new challenge in neonatal infections, J PEOIAXR 82:703, 1973. 2: Howard J, and McCracken G: The spectrum of group B streptococcal infections in infancy, Am J Dis Child 128:815, 1974. 3. McGowan JE Jr, et al: Bacteremia in febrile children seen in a "walk-in" pediatric clinic, N Engl J Med 288:1309, 1973. 4. Smith A: Childhood bacteremia, N Engl J Med 288:1351, 1973.
The Journal of Pediatrics June 1976
34 patients and Powers and Boisvert ~ in a series in excess of 100 patients did not report isolation o f any anaerobic organisms. In reviewing the microbiological data for all anaerobic isolates at the Massachusetts General Hospital, Bornstein and associates 4 noted that the only anaerobic pathogen causing upper respiratory tract infections was Bacteroides. However, we have been unable to find a previous report of isolation of Bacteroides from cervical adenitis. With improved methods of anaerobic isolation in the bacteriology laboratory, and an increased recognition of the importance of routine anaerobic cultures of cervical adenitis, more anaerobes will undoubtedly be recovered.
Bradley J. Bradford, M.D. Resident Georgetown University Medical Center Department of Pediatrics Washington, D. C. Stanley A. Plotkin, M.D. Children's Hospital of Philadelphia 34 Civic Center Blvd. Philadelphia, Pa. 19104
Cervical adenitis caused by anaerobic bacteria To the Editor: The subject of cervical adenitis in childhood was recently reviewed in THE JOURNAL by Barton and Feiginr who point out the necessity for anaerobic as well as aerobic cultures in evaluating the bacterial etiology of these infections. This report is intended to substantiate their contention with specific reference to two children with cervical adenitis from whom anaerobic organisms were cultured by using modern techniques. CASE REPORTS Case 1. Patient D. O. was a five-year-old Puerto Rican male admitted with a three-day history of an earache, associated with fever and cervical swelling. On admission his temperature was 39~ and the left cervical area was red and swollen with a 4 by 2 cm tender mass. The white blood count was 14,400/mm 3 with 76% polymorphonuclear leukocytes, 11% band forms, 11% lymphocytes, and 2% atypical lymphocytes. Aspiration o f the mass revealed purulent material, the cultures of which grew two organisms (both penicillin sensitive) an alpha hemolytic viridans Streptococcus and a Bacteriodes species. The patient received a seven-day course of intravenous penicillin and recovered uneventfully. Case 2. Patient L. S. a 16-year-old female, was admitted with a right cervical mass of two months' duration. Temperature was 39~ On physical examination the tonsils were red with obvious exudate; the neck had a right 3 by 2 cm submandibular mass and left 1 by 1 cm mass in the strenocleidomastoid area. The admission white blood count was 4,700/mm ~ with 60% segmented forms and 40% lymphocytes. The area was surgically drained, and a culture of the recovered purulent material grew peptostreptococcus and a Bacteroides species. The organisms were sensitive to penicillin and the patient received two weeks of intravenous penicillin therapy. Recovery was complete. DISCUSSION Cervical adenitis is a fairly common entity in the pediatric age group as a sequel of pharyngotonsillar infections. The two cases reported here are examples of anaerobic organ!sms as the cause of bacterial adenitis which finding seems unusual as a survey of the literature demonstrated. Dajani and associates, ~ in a series Of
REFERENCES
1. Barton L, and Feigin R: Childhood cervical lymphadenitis, A reappraisal, J PEDIATR 84:846, 1974. 2. Dajani AS, Garcia R, and Wolinsky E: Etiology of cervical adenitis in children, N Engl J Med 268:1329, 1965. 3. Powers G, and Boisvert P: Age in streptococcocis, J PEDIATR 25:481, 1944. 4. Bornstein DL, Weinberg A, Swartz M, and Kunz L: Anaerobic infections: Review of current experience, Medicine 43:207, 1964.
IgA deficiency and recurrent pneumonia in the Schwartz-Jampel syndrome To the Editor: A girl with the Schwartz-Jampel syndrome (myotonia, blepharophimosis, and joint limitation 1) and repeated infections had a selective deficiency of IgA in serum and external secretions. CASE REPORT Patient A. R., 3% years of age, had a stiff gait and recurrent pneumonias. She was below the third percentile for both height (82 cm) and weight (9.3 kg) and displayed (Fig. 1) hypertelorism , blepharophimosis, decreased lid fissure length (18 ram), bilateral ptosis, pursed lips, a hypoplastic mandible, and severe dental caries. A kyphotic thorax with pectus carinatum supported an elevated shoulder girdle, which was contracted with a restricted
From the LaRabida Children's Hospital and Research Center, University of Chicago.