背景:一般来说,儿童中细菌的血行传播并不常见。菌血症,然而,是牙科手术和严重龋齿的已知并发症,但很少与小学联系在一起,无症状,与程序无关的,齿槽感染。
方法:患者是一名7岁以前健康的男孩,因“发烧”就诊于急诊科(ED),斑驳,和颤抖的寒战。\"在ED中,他出现全身不适,发烧,斑驳,延迟的毛细血管再填充,和严格。三位不同医生的体格检查未能发现任何感染重点。实验室评估,包括血培养,已获得。患者后来出现单侧面部肿胀和疼痛,发现了一个牙槽骨脓肿.他开始服用抗生素,接受了牙髓切除术,最终,提取,在症状改善之前。血液培养物生长了两种单独的厌氧细菌(Veillonella和乳酸杆菌)。这是,根据我们的知识,在儿科患者中,首次报道了两种不同的厌氧生物继发于隐匿性牙肺泡脓肿的小儿败血症病例。为什么急诊医生应该意识到这一点?:急诊医生必须认识到急性上颌或下颌疼痛中小儿败血症的可能性,以及在没有明确感染重点的患者中。这对于出现疾病或符合全身炎症反应综合征标准的患者尤其重要,并将受益于进一步的实验室评估。包括血培养,可能还有抗生素治疗.
BACKGROUND: In general, hematogenous spread of bacteria in children is uncommon. Bacteremia, however, is a known complication of dental procedures and severe caries, but is infrequently associated with primary, asymptomatic, non-procedural-related, dentoalveolar infection.
METHODS: The patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with \"fever, mottling, and shaking chills.\" In the ED, he appeared systemically ill with fever, mottling, delayed capillary refill, and rigors. Physical examination by three different physicians failed to reveal any focus of infection. Laboratory evaluation, including blood cultures, was obtained. The patient later developed unilateral facial swelling and pain, and a dentoalveolar abscess was found. He was started on antibiotics, underwent pulpectomy and eventually, extraction, prior to improvement in symptoms. Blood cultures grew two separate anaerobic bacteria (
Veillonella and Lactobacillus). This is, to our knowledge, one of the first reported cases of pediatric sepsis with two different anaerobic organisms secondary to occult dentoalveolar abscess in a pediatric patient. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is imperative for emergency physicians to recognize the possibility of pediatric sepsis in the setting of acute maxillary or mandibular pain, as well as in patients for whom no clear focus of infection can be found. This is particularly important for those who appear ill at presentation or meet systemic inflammatory response syndrome criteria and would benefit from further laboratory evaluation, including blood cultures, and possibly antibiotic therapy.