Background: Neck abscesses are serious conditions in children, posing a risk of life-threatening complications such as airway obstruction, mediastinitis, and sepsis. Epidemiological and clinical data can vary significantly by geographic region.
This study aims to characterize the demographics, clinical presentation, microbiological spectrum, management strategies, and outcomes of pediatric neck abscesses at Infectious Diseases Clinic of "Muratsan" University Hospital to optimize local diagnostic and therapeutic protocols.
Method: We conducted a retrospective chart review of all patients aged 0-18 years diagnosed with a neck abscess and admitted to the Infectious Diseases Clinic of "Muratsan" University Hospital between December 2022 and April 2025.
Data collection included demographic details, clinical symptoms and signs, laboratory parameters (complete blood count, C-reactive protein), radiological findings (ultrasound, CT), microbiological results, treatment modalities (medical vs. surgical), duration of hospital stay, and final outcome. Statistical analysis was performed using Python with the Pandas library (v.2.3.2) for data manipulation and descriptive statistics.
Results: Sixteen patients were included. The median age was 6.5 years (range: 7 months-16 years), with a male predominance (62.5%, n=10). Most children were from urban areas (75%, n=12).
All patients (100%) presented with fever and leukocytosis (Mean WBC: 13.98*10⁹/L ± 3.67). CRP was universally elevated (Mean: 70.4 mg/L ± 42.3). The most frequent symptoms were neck pain/swelling (81.3%, n=13), oropharyngeal pain (68.8%, n=11), and trismus/dysphagia (56.3%, n=9). The predominant abscess locations were parapharyngeal (31.3%, n=5), peritonsillar (18.8%, n=3), and retropharyngeal (12.5%, n=2). Complicated presentations included two cases of tularemia (12.5%). Microbiological culture (pus/oropharyngeal swab) was positive in 31.3% (n=5) of cases, identifying Group A Streptococcus, Staphylococcus pneumoniae, and alpha-hemolytic Streptococcus.
All patients received intravenous empiric antibiotics, primarily a beta-lactam (Ceftriaxone or Amoxiclav) combined with metronidazole (87.5%, n=14). Adjuvant surgical drainage was required in 18.8% (n=3) of cases. The mean hospital stay was 11.4 days (± 10.8), with one outlier (50 days) due to tularemia management. All patients were discharged with full recovery, and only one was referred to another department to continue treatment.
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Conclusion: Our study confirms that pediatric neck abscesses are a significant cause of hospitalization. School-aged males are most commonly affected. Markedly elevated inflammatory markers (CRP and WBC) are consistent laboratory findings. While empiric broad-spectrum antibiotic therapy is highly successful, a subset of patients (approximately 20%) requires surgical intervention. The emergence of tularemia as an etiological agent in our region is a critical finding, underscoring the importance of considering zoonotic infections in the differential diagnosis, especially in cases refractory to standard treatment. This analysis reinforces the need for a high index of suspicion, prompt imaging, and a multidisciplinary approach to ensure excellent outcomes in managing these complex infections.
