Septic complications of head and neck infections as emerging conditions in the post-COVID-19 era: an epidemiological study in a pediatric care center in Sicily

TL;DR

This study shows a significant rise in severe head and neck infections in children in Sicily during the post-COVID-19 period, highlighting the need for increased monitoring.

Contribution

The paper reports a novel epidemiological observation of increased suppurative complications in pediatric patients following the pandemic.

Findings

The incidence of head and neck abscesses rose from 0.32% to 2.42% between 2017–2019 and 2022–2024.

Periorbital cellulitis was the most common complication, with a notable case of cerebral abscess in 2022.

The increase may be linked to the 'immunity gap' or antimicrobial resistance, though causality cannot be confirmed.

Abstract

Head and neck area abscesses are severe bacterial infections that commonly arise as complications of viral upper respiratory tract infections in pediatric patients. These infections can affect various anatomical structures, including the tonsils, retropharyngeal spaces, paranasal sinuses, middle ear, and salivary glands. The most frequent clinical presentations include otomastoiditis, retropharyngeal abscesses, and periorbital cellulitis. Although traditionally considered rare in developed countries, in recent years, particularly in the post-COVID-19 (COronaVIrus Disease 19) pandemic period, we have observed a notable increase in these complications at our center.

We conducted a retrospective, single-center epidemiological study on our cases of septic complications involving the head and neck region, comparing two three-year periods (from January to December): 2017–2019 and 2022–2024. Cases were classified into four categories: otomastoiditis, periorbital cellulitis, retropharyngeal abscesses, and other abscesses (including lateral cervical and cerebral abscesses). For each year the incidence rate of these complications was calculated in relation to the total number of hospital admissions. Statistical comparison was performed using the Chi-square test.

The comparison between the two three-year periods (2017–2019 vs. 2022–2024) revealed a dramatic increase in head and neck suppurative infections: 8 cases in 2017–2019 compared to 56 cases in 2022–2024. The incidence rose from 0.32% to 2.42%, a statistically significant difference (p < 0.01). The incidence rate peaked in 2024, reaching 3.3%. The most frequent complication was periorbital cellulitis, followed by otomastoiditis. Notably, in 2022, a case of cerebral abscess occurred, requiring transfer to intensive care.

Our study highlights an unexpected increase in head and neck suppurative-inflammatory complications. While recent publications have documented a rise in pediatric respiratory infections in the post-COVID-19 era, specific studies addressing the surge in these conditions remain scarce. This trend may be linked to the so-called COVID-19 immunity gap and/or to emerging patterns of antimicrobial resistance. However, given the retrospective observational design of our study, establishing a causal link is not possible. Pending further scientific evidence, enhanced surveillance remains essential to promptly identify these conditions, given their rapid progression and high morbidity.

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