Parotid abscess caused by Burkholderia pseudomallei in children : Report of 3 cases from Kalasin Hospital

Abstract

Background : Parotid abscess caused  by Burkholderia pseudomallei in children was the common disease in northeastern  Thailand . Early diagnosis and proper management can decrease severity and prevent  important  complication of the  disease.

Objective :  To dissemimate and inform  the cases for general physicians to be careful of the diagnosis and management of parotid abscess in children.

Design:Retrospective study by review of medical records between January 1,2003 and December 31 ,2004.

Setting : Kalasin  Hospital , Kalasin Province.

Result :  There were three cases of childrem with parotid abscess caused by Burkholderia pseudomallei .

One case had dental caries before development of parotid abscess .  The other two cases had no underlying diseases. All three cases were initially treated with parenteral antibiotics used for treatment of  Staphylococcus aureus and anaerobes .  Surgical drainage was done in all cases .  When the diagnosis was made by positive culture of pus from parotid abscess which produced colonies of Burkholderia pseudomallei , the antibiotics were changed to parenteral  ceftazidime .  When the patients were stable ,   the antibiotics were switched to oral trimethoprim – sulfamethoxazole.  They recieved periodic follow – up and all responded well.   Two cases had full recovery but one case had persistent  facial nerve paralysis.

Conclusion : Three cases of children with parotid abscess caused by Burkholderia pseudomallei had good response to parenteral ceftazidime and surgical drainage. The physician should have differential diagnosis the causes of  parotid abscess from Staphylococcus aureus and other bacterias by  investigation of  pus gram stain and culture from parotid  gland.

Keyword : Burkholderia pseudomallei, parotid abscess.