BACKGROUND: Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton-Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.
METHODS: A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.
CONCLUSIONS: Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.

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本文报道1例发生于老年女性的弥漫大B细胞淋巴瘤误诊病例。患者女，84岁，因“咽痛、咽部不适1个月”以“扁桃体周围脓肿（右）”收入院。入院前于外院给予抗感染治疗1个月，症状无改善。入院后予抗感染治疗，同时行诊断性穿刺，“脓腔”内抽出空气和血液，未抽出脓液。进一步行口咽CT、增强MR检查，考虑为恶性肿瘤，且有颈部淋巴结转移。在局麻下行B超引导下颈部淋巴结穿刺活检，病理示弥漫大B细胞淋巴瘤。转入血液科进行分期后行化疗，6周期化疗结束复查未发现肿瘤残留。.

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本文报道1例扁桃体周围脓肿穿刺术后继发颈动脉假性动脉瘤的患者诊治过程。患者男，23岁，因“扁桃体周围脓肿穿刺术后6 d，术后出现咽痛、吞咽痛、呼吸困难加重2 d”就诊。经颈动脉数字减影血管造影术明确诊断为颈内动脉假性动脉瘤，之后行选择性动脉栓塞并成功治愈，随访3年患者无咽痛及出血，无神经系统后遗症。.

Objective: To explore the clinical manifestation and treatment strategy for descending necrotizing mediastinitis (DNM). Methods: A total of 27 cases diagnosed as DNM from January 2010 to August 2018 in the First People\'s Hospital of Foshan were reviewed. There were 16 males and 11 females, age ranged from 16 to 84 years. The clinical data were collected. SPSS 16.0 software and chi square test were used for statistical analysis. Results: ALL 27 cases were diagnosed as DNM by contrast-enhanced CT scan of the neck and chest. Among the 27 cases, 13 cases resulted from peritonsillar abscess, 8 cases from esophageal foreign body perforation, 5 cases from parapharyngeal and retropharyngeal space abscess, and one case from infection of oral cavity. These 27 cases were divided into three subtypes according to the sites of mediastinitis, including 11 cases for typeⅠ, 5 cases for type ⅡA and 11 cases for type ⅡB. Of 27 cases, 20 cases underwent transcervical drainage for DNM, of which 5 cases with tracheotomy and 6 cases with thoracic drainage, and finally 19 of the 20 patients were cured, and one patient died of bacteremia; 7 cases refused to received surgery and were routinely treated with antibiotics, of which, one case was cured and 6 cases died. The curative rate in patients underwent surgery was significantly higher than that in patients treated with medication (χ(2)=13.638, P<0.001). Among the 20 cured cases, 4 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis, while in the 7 died cases, 5 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis. The comorbidity rates of diabetes mellitus (χ(2)=4.074, P=0.044) and necrotizing fasciitis (χ(2)=4.457, P=0.035) in died cases were significantly higher than those in cured cases. Conclusion: DNM is a serious infection, with high mortality especially in patients with diabetes and necrotizing fasciitis. Timely cervical and chest enhanced CT scan play vital role in its diagnosis. DNM can be treated effectively with transcervical drainage.
目的： 探讨下行坏死性纵隔炎（descending necrotizing mediastinitis，DNM）的临床特点及诊断治疗方法。 方法： 回顾分析2010年1月至2018年8月在佛山市第一人民医院耳鼻咽喉头颈外科诊治的27例DNM患者的临床资料，其中男16例，女11例，年龄16~84岁，总结患者病程规律、影像学检查特点，治疗方式及预后。使用SPSS 16.0软件，计数资料采用χ(2)检验进行统计学分析。 结果： 本组患者均行颈胸部CT增强扫描确诊为DNM。27例患者中，感染源于扁桃体周脓肿者13例，源于食管异物穿孔并脓肿形成者8例，源于咽旁间隙及咽后间隙脓肿者5例，源于口腔感染及脓肿者1例；根据下行性纵隔脓肿的部位进行分型，Ⅰ型者11例，ⅡA型者5例，ⅡB型者11例。所有患者中，20例接受经颈部纵隔脓肿清创引流术（手术组），同期有5例行气管切开术，6例行胸腔积液引流术，19例治愈出院，1例死亡；7例拒绝手术行抗菌药物抗感染治疗（非手术组），仅1例感染得到有效控制治愈出院，6例死亡。手术组治愈率明显高于非手术组，差异有统计学意义（χ(2)=13.638，P<0.001）。治愈的20例患者中，4例合并糖尿病，6例合并坏死性筋膜炎；死亡的7例患者中，5例合并糖尿病，6例合并坏死性筋膜炎，治愈患者中合并糖尿病（χ(2)=4.074，P=0.044）、坏死性筋膜炎（χ(2)=4.457，P=0.035）的比例均显著低于死亡患者中相应比例。 结论： DNM为危重感染性疾病，起病凶险、病死率高，及时行颈胸部CT增强扫描是诊断的关键，尽早行经颈部纵隔脓肿清创引流术可有效控制感染，合并糖尿病及坏死性筋膜炎可能是患者死亡的危险因素。.

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Objective:To study the etiology, presentation, diagnosis and treatment of infection of deep neck space with superior mediastinal infection in order to accumulate experience in clinical diagnosis and treatment.Method:We reviewed medical records of 15 patients who were diagnosed with deep neck infection with superior mediastinal infection and those who were hospitalized in Guizhou provincial people\'s hospital from Janurary 2011 to July 2015.The patients were screened retrospectively for demographic characteristics, presenting symptoms, laboratory examinations, imaging features, bacteriologies and etiologies. The treatment and outcomes of the patients were investigated.Result:In 15 patients, 7 cases（46.67%) were related to foreign body in esophagus, 3（20%) cases were related to peritonsillar abscess, 2（13.33%) cases who had diabetes with poor blood glucose control were related to exodontias, 3（20%) cases were related to unknown reasons. The serum CRP［(151.82±22.12)mg/L］ at the time of admission had a positive correlation with the time of hospitalization. The time of CRP decreased to normal range after admission ［(15.3±2.1)d］ were apparently related to the hospitalization time［(23.8±4.1)d］(r=0.79, P<0.01). The results of bacteria culture of 7 cases was positive(46.67%), 2 cases were infected by Klebsiella pneumoniae and 1 case was mixed with Escherichia coli, 2 cases were infected by the Streptococcus viridans infection, 2 cases were infected by Hemolytic streptococcus A group and B group, 1 case was infected by Staphylococcus Aureus. Appropriate antibiotics for organisms were given based on the results of culture identification and empiric therapy. The patients with abscesses were treated with cervical and superior mediastinal drainage. In 15 patients who were complex treatment, 4 patients including 2 patients with diabetes were succumbed to the disease （mortality is 26.67%）,11 patients were healed up(effective rate is 73.33%).Conclusion:The patients with deep neck space infection with superior mediastinal infection had rapid onset, rapid development and the patients with diabetes had high mortality. The patients should be analyzed in detail the history and clinical manifestations combined with imaging examination, bacterial culture and drug sensitive test and so on in order to determine the diagnosis. The patients should be cured with effective antibiotics and active surgical intervention.

Objective:The aim of this study is to investigate the clinical value of visual analogue scale combined with serum C-reactive protein in evaluating the prognosis of peritonsillar abscess. Method:Thirty-one patients be hospitalized with peritonsillar abscess were enrolled in this study, who were treated by puncture and antibiotic from January 2016 to February 2017. VAS and CRP level were detected on the 1, 3, 5 day of hospitalization for all the patients. Result:Twenty-five patients were cured after 5 days. The 1, 3, 5 day\'s VAS of forty-seven patients were 8.20±1.25, 4.42±1.05, 1.41±0.55, respectively, and the CRP level were (62.41±8.61), (20.46±5.32), (5.41±1.95)mg/L, respectively (P<0.05) in the three days. The 1, 3 day\'s VAS of six patients were 8.41±1.44, 7.37±1.15, respectively, and the CRP level were (59.85±8.35), (45.33±7.46)mg/L, with no significant difference (P>0.05) in the two days. But the fifth day\' VAS was 1.55±0.65, and the CRP level was 10.24±2.57 mg/L, with statistically significant difference (P<0.05)) compared with the first day. Conclusion:Subjective evaluation used by VAS and objective evaluation used by CRP level to assess the prognosis of peritonsillar. Therefore, VAS score combined with C-reactive protein detection is more accurate for the prognosis of tonsil abscess evaluation..

Two bacterial strains, HKU33(T) and HKU34, were isolated in Hong Kong from the pus aspirated from the right peritonsillar abscess of a patient with quinsy and the left elbow joint fluid of another patient with tophaceous gout and left elbow septic arthritis, respectively. The bacteria were Gram-stain-negative, non-motile, non-spore-forming, non-haemolytic pleomorphic bacilli. They grew best on Columbia agar with 5 % defibrinated sheep blood in an anaerobic environment or aerobic environment with 5 % CO2. They also grew on chocolate agar but not on MacConkey agar. They were catalase- and cytochrome oxidase-negative. They showed a unique profile of enzyme activities distinguishable from their closely related species. Phylogenetic analysis of the complete 16S rRNA gene, and partial groEL, gyrB and recA gene sequences showed the two isolates formed a distinct branch within the family Leptotrichiaceae, being related most closely to Streptobacillus moniliformis. Hierarchical cluster analysis of mass spectra of whole-cell protein contents showed that strains HKU33(T) and HKU34 were closely related to each other, but were distinct from Streptobacillus moniliformis, Sneathia sanguinegens and \'Leptotrichia amnionii\'. The DNA G+C content of strain HKU33(T) was 26.0±2.1 mol% (mean±sd; n = 3). DNA-DNA hybridization demonstrated ≤45.02 % DNA relatedness between the two isolates and Streptobacillus moniliformis CCUG 13453(T). A novel species, Streptobacillus hongkongensis sp. nov., is proposed to accommodate strains HKU33(T) and HKU34, with HKU33(T) ( = JCM 18691(T) = NCTC 13659(T) = DSM 26322(T)) designated the type strain. Emended descriptions of the genus Streptobacillus and Streptobacillus moniliformis are also given.