Clinical manifestations and lethality of descending necrotizing mediastinitis

Objective. To describe the clinical manifestations, treatment anal lethalit y of a series of,of patients with descending necrotizing mediastinitis (DNM ). Design. Retrospective study of a series of cases. Site of study. The Inf ectious Diseases Hospital (IDH) of the Mexican Social Security Institute, M exico City; a national reference Hospital. Patients and methods. From Janua ry 1996 through December 1998, 18 consecutive patients with diagnostic crit eria for DNM were treated in the IDH. Demographic variables, precedents, cl inical manifestations, characteristics of paraclinical studies, and treatme nt results were recollected from the chart of each patient. We made a compa rison between patients who survived and the patients who died. Results. The mean age of the patients was 48.8 +/- 19.1 years; 13 (72.5%) were men. Nin e (50%) had an underlying disease, being diabetes mellitus the most frequen t one. In 13 (72.5%) cases art odontogenic abscess was the original infecti on; three (16.6%) patients had retropharyngeal abscesses. The mean time bet ween the beginning of symptoms and admission to the hospital was 10.6 +/- 6 .7 days. The most frequent symptoms were fever, dyspnea, disphagia, and hyp otension. The treatment was medical and surgical in, all cases, with antibi otics, thoracotomy, drainage and debridement. The most frequent complicatio ns were septic shock, nosocomial pneumonia and ARDS. Nine patients died, th e lethality rate was 50%. Patients who died had, at admission lower leukocy tes and platelets counts; higher glycemia, and developed more frequently ca rdiovascular complications and septic shock. Conclusions. Odontogenic absce sses are the most frequent primary infections in patients with DNM. This is an infectious problem with high lethality. Septic shock is the principal c ause of death.