Infectious Disorders - Drug Targets (Formerly Current Drug Targets - Infectious Disorders) - Volume 12, Issue 4, 2012

Infectious diseases of the head and neck in children are very common but may sometimes cause upper airway obstruction. Various degrees of respiratory distress are possible, but one will be extra-cautious with newborns and neonates, because the clinical features can evolve especially fast in young children. A child with a respiratory compromise should never be left unattended. Nasal, pharyngeal, and laryngeal airways can be involved and require specific management. Each time the airway of a child may be compromised, the pediatrician and otolaryngologist have to be prepared for the worst-case scenario: anticipation is essential and allows avoidance of serious troubles.

Otitis media is one of the most common disease entities in children worldwide. This critical review of the literature will focus on the demographics, pathophysiology, diagnosis, and medical and surgical management of the various types of otitis media.

Otitis media is the most common reason for antibiotic prescription in the United States. Whether due to disease virulence or growing antimicrobial resistance, complications of otitis media seem to be seen more frequently. These complications may be difficult to identify and treat. This article focuses on the pathophysiology of these complications and address medical and surgical approaches to safe treatment.

Acute tonsillitis is an inflammatory process of the tonsillar tissues and is usually infectious in nature. Acute infections of the palatine tonsils predominantly occur in school-aged children, but patients of any age may be affected. Tonsillitis of viral origin is usually treated with supportive care. Bacterial tonsillitis is most commonly caused by Streptococcus pyogenes. Polymicrobial infections and viral pathogens are also important sources of infection. Penicillins remain the treatment of choice for S. pyogenes tonsillitis, and augmented aminopenicillins have gained utility in concert with the increasing incidence of beta-lactamase producing bacteria. We describe the anatomic features and the immunologic function of the palatine tonsils, including a detailed discussion of history and physical examination findings, treatment recommendations, and possible complications of acute tonsillitis. Establishing an accurate diagnosis and initiating appropriate treatment are key components of managing this common pathologic process.

Peristonsillar abscess (PTA) is a common deep neck space infection in children. Children with PTA often present with sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus, and a muffled voice. The diagnosis of PTA can be made based on history and physical examination in the majority of children. Treatment of pediatric PTA necessitates aspiration or surgical drainage and antibiotic therapy. Challenges exist with the diagnosis and management of PTA that are unique to pediatric patients. Examples include difficulty with examination of the oropharynx in an uncooperative child and controversy surrounding bedside needle aspiration verses operative incision and drainage. Early identification of PTA and initiation of appropriate treatment can prevent serious complications.

Pharyngitis is a common medical problem in the outpatient medical setting, resulting in more than seven million pediatric visits each year. Most types of pharyngitis are caused by infectious etiologies. The most common cause of pharyngitis is viral infection; however, some of the more serious types of pharyngitis are attributed to bacterial etiologies, such as group A β-hemolytic Streptococcus pyogenes (GAS). Complications from GAS pharyngitis include rheumatic fever, deep space abscesses, and toxic shock. Although most episodes of pharyngitis are acute in nature, a small percentage becomes recurrent or chronic. With regards to chronic pharyngitis, non-infectious etiologies, such as laryngopharyngeal reflux and periodic fever, aphthous ulcers, pharyngitis, and adenitis syndrome also need to be considered. Both medical and surgical therapies are effective in managing pharyngitis. First-line medical therapy includes antibiotic therapy. For certain indications, surgical management via adenotonsillectomy is recommended. Adenotonsillectomy has been shown to be effective in reducing disease burden and improving disease-specific and global quality of life. Several techniques for adenotonsillectomy exist, including traditional and intracapsular tonsillectomies.

Deep neck space infections are commonly seen and managed across various medical and surgical specialties. Common presentations permit straightforward management but still pose the risk of severe complications sometimes even with appropriate management. This article emphasizes the anatomic and physiologic process to heed when managing children with deep neck infections. The roles of radiography and medical versus surgical management are discussed.

Retropharyngeal abscess is a deep neck space infection that may present in various subtle ways permitting potentially lethal complications to occur before appropriate diagnosis is made and expedient management undertaken. This article reviews in detail the pertinent anatomy, diagnostic pearls, and clinical recommendations to optimally manage these common infections in children.

Periodontal pathogens in plaque biofilm initiate periodontitis, which is influenced by genetic and environmental factors. The resultant pro-oxidant status imposed on the periodontium, exacerbated by episodic hyperinflammatory damage contributes to progression of periodontitis and tooth loss in susceptible subjects. Increasing documentation of bi-directional connections between periodontal and cardiometabolic disorders makes it an intriguing area of therapeutic intervention for mutual benefit. Periodontitis and associated comorbidities demonstrate similar risk markers of inflammation during disease progression. Depending on the extent and severity of the inflammatory response, periodontitis could impact significantly on systemic inflammatory loading and influence the progression of endothelial dysfunction, atherosclerotic plaque instability, dyslipidaemia and insulin resistance. Some of the common mechanisms involved are discussed, relevant to periodontal and cardiometabolic disorders which have been documented as having a bidirectional relationship with periodontal disease progression; abating in response to treatment. Periodontal disease may be a useful marker of a susceptible immune system, or directly affect the progression of systemic diseases due to inflammatory loading. These mechanisms mediated by coordinated actions of cytokines, acute phase proteins, enzymes and their sequelae are addressed in the context of conventional periodontal therapy and its outcome with a modulatory role on metabolic diseases. Applications for the role of nutritional and therapeutic antioxidants as adjuncts in diseases with a distinctly prooxidant profile are discussed. Accurate therapeutic targeting as an adjunct to conventional periodontal treatment in this context, for mutual benefit to subjects with periodontitis and cardiometabolic diseases is a challenge.

A new bacteriocin, lacticin LC14, produced by Lactococcus lactis BMG6.14, was isolated and characterized. It was purified to homogeneity from overnight broth culture by ammonium sulfate precipitation, Sep-Pak chromatography, and two steps of reversed-phase HPLC. Lacticin LC14 showed bactericidal-type antimicrobial activity against several lactic acid bacteria and pathogenic strains including Listeria monocytogenes. It was inactivated by proteinase K and pronase E, but was resistant to papain, lysozyme, lipase and catalase. Lacticin LC14 was heat resistant, stable over a wide range of pH (2-10) and after treatment by solvents and detergents. Its N-terminal end was found unreactive towards Edman sequencing. Based on MALDI-TOF mass spectrometry, its molecular mass was 3333.7 Da. LC14 amino acid composition revealed a high proportion of hydrophobic residues, but no modified ones. LC14 may be able to challenge other well known other bacteriocins in probiotic and therapeutic applications.