Infectious Disease Compendium

Mediastinitis

Diagnosis

Pus in the mediastinum.

Epidemiologic Risks

Usually trauma, post-surgical, or esophageal perforation for a variety of reasons including foreign body ingestion (PubMed). I had one guy who perforated his esophagus from a tortilla chip.

Neck infections can track down into the mediastinum aka descending mediastinitis (PubMed)(PubMed).

Microbiology

Trauma and post-operative tends to be S. aureus and S. epidermidis.

Esophageal perforation and head&neck infections tend towards mixed infections with viridans and other streptococci, Peptostreptococcus, Bacteroides, and oral anaerobes.

Occasionally actinomycosis will burrow into the mediastinum.

Fibrosing Mediastinitis, a complication of granulomatous mediastinal infection, can be from Histoplasmosis or Tuberculosis.

Empiric Therapy

Trauma and postoperative: anti-staphylococcal therapy.

Esophageal perforation or head&neck infection: (penicillin G OR ampicillin PLUS metronidazole) OR (third-generation cephalosporins PLUS metronidazole) OR (quinolone PLUS metronidazole) OR penicillin/beta-lactamase inhibitors OR clindamycin OR cefoxitin OR cefotetan.

Drain the pus, always drain the pus. It is often a surgical emergency.

Curious Cases

Relevant links to my Medscape blog

Lacs

Sympathetic Heart Ache

Last Update: 11/07/18.