DESCENDING PURULENT MEDIASTINITIS: FEATURES OF THE COURSE, DIAGNOSIS AND TREATMENT

Abstract

Descending purulent mediastinitis is a rare but a life-threatening disease. The absence of characteristic symptoms and a rare incidence of descending purulent mediastinitis in clinical practice are the main reasons for the late diagnosis of this disease and high mortality due to it. In our practice, we have observed 21 cases of descending purulent mediastinitis. The aim of the study is to characterize the features of the course, methods of diagnosis and treatment for descending purulent mediastinitis used in the setting of a multidisciplinary hospital. The focus of infection was detected in 18 patients (85.7%). In most cases, the etiological factor was odontogenic infection – in the area of the second and third mandibular molars (52.3%). The results of bacterial culture test showed that streptococci (Strepto coccus viridans, β-hemolytic streptococci) and staphylococci (Staphylococcus aureus, hemolytic staphylococci) were most often plated from infected foci. In the subgroup of deceased patients, who made up 47.6% of the total number of patients, mixed cultures of microorganisms containing Staphylococcus aureus were more often detected during bacterial culture tests. These patients had to change groups of antibiotics several times. The unfavorable outcome of descending purulent mediastinitis may be due to a delay in the use of transthoracic mediastinal drainage. Early drainage of the neck and mediastinum, timely thoracotomy should be considered as the treatment method of choice in patients with descending purulent mediastinitis.