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Eichorn FC, Kameda-Smith M, Fong C, Graham AK, Main C, Lu JQ. Polymicrobial brain abscesses: A complex condition with diagnostic and therapeutic challenges. J Neuropathol Exp Neurol 2024; 83:798-807. [PMID: 38874452 DOI: 10.1093/jnen/nlae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
Brain abscesses (BA) are focal parenchymal infections that remain life-threatening conditions. Polymicrobial BAs (PBAs) are complex coinfections of bacteria or bacterial and nonbacterial pathogens such as fungi or parasites, with diagnostic and therapeutic challenges. In this article, we comprehensively review the prevalence, pathogenesis, clinical manifestations, and microbiological, histopathological, and radiological features of PBAs, as well as treatment and prognosis. While PBAs and monomicrobial BAs have some similarities such as nonspecific clinical presentations, PBAs are more complex in their pathogenesis, pathological, and imaging presentations. The diagnostic challenges of PBAs include nonspecific imaging features at early stages and difficulties in identification of some pathogens by routine techniques without the use of molecular analysis. Imaging of late-stage PBAs demonstrates increased heterogeneity within lesions, which corresponds to variable histopathological features depending on the dominant pathogen-induced changes in different areas. This heterogeneity is particularly marked in cases of coinfections with nonbacterial pathogens such as Toxoplasma gondii. Therapeutic challenges in the management of PBAs include initial medical therapy for possibly underrecognized coinfections prior to identification of multiple pathogens and subsequent broad-spectrum antimicrobial therapy to eradicate identified pathogens. PBAs deserve more awareness to facilitate prompt and appropriate treatment.
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Affiliation(s)
- Frances-Claire Eichorn
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
| | | | - Crystal Fong
- Department of Radiology/Neuroradiology, McMaster University, Hamilton, Canada
| | - Alice K Graham
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
| | - Cheryl Main
- Department of Pathology and Molecular Medicine/Microbiology, McMaster University, Hamilton, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
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2
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Cress VJ, Green KJ, Jain A, Viaud-Murat EM, Patel PA, Wiedermann JP. A Scoping Review of the Intracranial Complications of Pediatric Sinusitis. Otolaryngol Head Neck Surg 2024; 171:937-945. [PMID: 38895865 DOI: 10.1002/ohn.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/25/2024] [Accepted: 04/19/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Intracranial complications of pediatric sinusitis are uncommon but are often associated with significant morbidity, especially when appropriate care is delayed. The present study aimed to identify commonalities for the development and progression of these complications in the pediatric population. DATA SOURCES CENTRAL, CINAHL, Citation searching, ClinicalTrials.gov, Embase, Google Scholar, MEDLINE, PsycINFO, PubMed, Scopus, Web of Science, and World Health Organization. REVIEW METHODS A comprehensive literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses scoping review guidelines. Studies describing intracranial infections secondary to sinusitis in the pediatric population (age <18 years) were included. Studies in which adult and pediatric data were not separated and studies in which the pediatric cohort was fewer than 10 cases were excluded. Ultimately, 33 studies describing 1149 unique patient cases were included for data collection and analysis. RESULTS Our analysis revealed intracranial complications were more common in adolescent males. Most children presented with over 1 week of vague symptoms, such as headache and fever. The majority of complications were diagnosed radiographically with computed tomography. Subdural empyema and epidural abscess were the most common intracranial complications reported. On average, patients were admitted for over 2 weeks. Most children were treated with a combination of antibiotics and surgical intervention. Complications were rare, but when present, were often associated with significant morbidity. CONCLUSION This scoping review of the available literature has provided insight into commonalities among pediatric patients who develop intracranial complications of sinusitis, providing a foundation for further study to inform medical and surgical decision-making in this population.
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Affiliation(s)
- Victoria J Cress
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katerina J Green
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amiti Jain
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Punam A Patel
- Department of Pediatric Otolaryngology, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Joshua P Wiedermann
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatric Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Madan A, Wilson M, Garcia A, Hamam F, Rhandhawa R. Subdural Empyema as a Sequela of Severe Erosive Sinusitis: A Case Report. Cureus 2024; 16:e67690. [PMID: 39314621 PMCID: PMC11419590 DOI: 10.7759/cureus.67690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/25/2024] Open
Abstract
Intracranial subdural empyema is a rare but critical neurosurgical emergency marked by pus accumulation between the brain and the dura mater. It typically arises from bacterial or fungal infections, often secondary to sinusitis, otitis media, or head trauma. Symptoms can range from mild headaches to significant neurological deficits and altered mental status. Diagnosis is confirmed through advanced imaging techniques such as MRI and CT scans. Timely intervention is essential to prevent neurological damage and systemic complications, usually involving surgical drainage and antimicrobial therapy. We present the case of a 45-year-old male who visited the emergency room several times with progressive lethargy and altered mental status. He was admitted and later transferred to our trauma center for a suspected subdural hematoma. An emergent right-sided craniotomy was performed, and a subdural empyema was found. The patient improved following subdural drainage and antibiotic treatment, including 600 mg linezolid every 12 hours, 2 g cefepime every eight hours, and 500 mg metronidazole every eight hours. This case highlights the effectiveness of prompt medical and surgical intervention in managing this rare condition and offers valuable insights for improving future patient outcomes.
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Affiliation(s)
- Ahmed Madan
- General Surgery, Larkin Community Hospital, South Miami, USA
| | - Madison Wilson
- Biomedical Sciences, Barry University, Miami, USA
- General Surgery, St. George's University School of Medicine, St. George's, GRD
| | - Andy Garcia
- Emergency Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Feisal Hamam
- General Surgery, Larkin Community Hospital, South Miami, USA
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Servos Li MM, Hamersley ERS, Baldassari C. Nasal Disorders. Pediatr Rev 2024; 45:188-200. [PMID: 38556515 DOI: 10.1542/pir.2023-006012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.
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Affiliation(s)
- Mariah M Servos Li
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Erin R S Hamersley
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Cristina Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
- Department of Pediatric Sleep Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
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Colomba C, Garbo V, Boncori G, Albano C, Bagarello S, Condemi A, Giordano S, Canduscio LA, Gallo C, Parrinello G, Cascio A. Streptococcus mitis as a New Emerging Pathogen in Pediatric Age: Case Report and Systematic Review. Antibiotics (Basel) 2023; 12:1222. [PMID: 37508318 PMCID: PMC10376791 DOI: 10.3390/antibiotics12071222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Streptococcus mitis, a normal inhabitant of the oral cavity, is a member of Viridans Group Streptococci (VGS). Generally recognized as a causative agent of invasive diseases in immunocompromised patients, S. mitis is considered to have low pathogenic potential in immunocompetent individuals. We present a rare case of sinusitis complicated by meningitis and cerebral sino-venous thrombosis (CSVT) caused by S. mitis in a previously healthy 12-year-old boy with poor oral health status. With the aim of understanding the real pathogenic role of this microorganism, an extensive review of the literature about invasive diseases due to S. mitis in pediatric patients was performed. Our data define the critical role of this microorganism in invasive infections, especially in immunocompetent children and in the presence of apparently harmful conditions such as sinusitis and caries. Attention should be paid to the choice of therapy because of VGS's emerging antimicrobial resistance patterns.
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Affiliation(s)
- Claudia Colomba
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
- Division of Pediatric Infectious Diseases, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Valeria Garbo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Giovanni Boncori
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Chiara Albano
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Sara Bagarello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Anna Condemi
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Salvatore Giordano
- Division of Pediatric Infectious Diseases, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Laura A Canduscio
- Division of Pediatric Infectious Diseases, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Cristina Gallo
- Division of Radiology, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Gaspare Parrinello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
- Infectious and Tropical Diseases Unit, AOU Policlinico "P. Giaccone", 90100 Palermo, Italy
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Kameda-Smith MM, Duda T, Duncan DB, Ragulojan M, Jung Y, Farrokhyar F, Main C, Reddy K. Retrospective Review of the Clinical Outcomes of Surgically Managed Patients with Intracranial Abscesses: A Single-Center Review. World Neurosurg 2022; 165:e697-e711. [PMID: 35798293 DOI: 10.1016/j.wneu.2022.06.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study analyzed patient, radiologic, and clinical factors associated with operative brain abscesses and patients' functional outcomes. METHODS A retrospective analysis was conducted of neurosurgical cases of brain abscesses from 2009 to 2019 at a Canadian center. Functional outcome was recorded as Modified Rankin Scale score and Extended Glasgow Outcome Scale score. Multivariate analysis was conducted to identify relevant prognostic factors. RESULTS We identified 139 patients managed surgically for brain abscesses. Resection alone was performed in 64% of patients, whereas 26.6% underwent aspiration alone. Most were adults (93.2%) and male (68.3%). Immunocompromise risk factors included diabetes (24.5%), cancer (23.7%), and immunosuppressive therapy (11.5%). Likely sources were postoperative (17.3%), systemic spread (16.5%), and poor dentition (12.9%). Microorganisms cultured from abscess samples were mixed growth (28%), Streptococcus anginosus (24.5%), and Staphylococcus aureus (7.9%). Disposition was home (42.4%) or repatriation to a home hospital (50.4%). By Extended Glasgow Outcome Scale, 25.2% had an unfavorable outcome including a mortality of 11.5%. Factors on multivariate analysis associated with poor outcome included diabetes (odds ratio, 2.8; 95% confidence interval [CI], 1.2-5.0) and ventricular rupture (odds ratio, 5.0; 95% CI, 1.7-13.5; hazard ratio, 12; 95% CI, 3.9-37.0). Supratentorial superficial eloquently located abscess was also associated with poor outcome (hazard ratio, 5.5; 95% CI, 1.8-16.7). Outcomes were similar with surgical excision and aspiration. CONCLUSIONS Ventricular rupture and diabetes are significant risk factors for poor outcomes in intraparenchymal brain abscesses. No clear difference in outcomes was found between surgical excision or aspiration in our retrospective cohort.
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Affiliation(s)
| | - Taylor Duda
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Donald B Duncan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malavan Ragulojan
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Yongkyung Jung
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Main
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Laaidi A, Makhchoune M, Tahrir Y, Haouas MY, Naja A, Lakhdar A. Simultaneous frontal and orbital abscess rare complications of otogenic origin: Case report and literature review. Ann Med Surg (Lond) 2022; 75:103458. [PMID: 35386769 PMCID: PMC8977935 DOI: 10.1016/j.amsu.2022.103458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022] Open
Abstract
Otogenic frontal abscess is an uncommon location of otogenic abscess of the brain and constitutes less than 5%. And the orbital extension is even more exceptional. An 11-year-old child, presenting with a two-week-long history of an acute otitis badly treated. Admitted for headaches, fever, vomiting and left eyelid swelling. The preoperative CT scan revealed a left frontal epidural abscess associated to a sub-periosteal Abscess. The patient was operated on. A supraorbital incision through the eyebrows allowed the evacuation of the periorbital abscess and the cerebral empyema through a trephine hole. The patient received probabilistic intravenous antibiotic therapy with ceftriaxon, aminoglycoside and metronidazole. Then relay per os. Postoperative recovery was marked by disappearance of headaches at postoperative Day two and the periorbital edema at day six. The patient was discharged home at postoperative week four with oral antibiotic therapy. Three months postoperative months follow-up CT scan revealed a total radiological cleaning. Otogenic frontal abscess associated to orbital Abscess is extremely rare and should be considered in front of ophthalmological signs. The management is multidisciplinary, and the entry point treatment mustn't be forgotten.
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Affiliation(s)
- Abdelkouddous Laaidi
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Marouane Makhchoune
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Yassin Tahrir
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | | | - Abdessamad Naja
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
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8
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Almomen A, Alshuhayb Z, Alsheef H, Alhammad S, Alawami B, Aldhurais A, Almulla H, Almoumen Z, Alkishi S. The Endoscopic Management of Different Pediatric Frontal Sinus Pathologies. Int J Otolaryngol 2022; 2022:1078178. [PMID: 35186090 PMCID: PMC8853819 DOI: 10.1155/2022/1078178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The paranasal sinuses in pediatrics can harbor a wide variety of pathologies. With the present literature being composed of case studies only, this entity is quite understudied. OBJECTIVES This article aims to study the clinical presentation, diagnosis, and endoscopic management of six different rare frontal sinus pathologies in pediatrics, which include extensive allergic fungal sinusitis, mucoceles, osteoma, superior sagittal sinus thrombosis, CSF leak, and subdural empyema. METHODS We retrospectively studied all pediatric patients with frontal sinus pathologies presenting to our center, King Fahad Specialist Hospital, Dammam, Saudi Arabia, from the period of 2006 to 2020. RESULTS A total of 8 patients presented to our hospital with different frontal sinus pathologies. 5 of them were males, and 3 were females with an age of presentation ranging from 7 to 17 years. The diagnosis and localization were performed through computerized tomography without contrast and magnetic resonance imaging, when indicated. All cases were primarily managed with endonasal endoscopic approaches successfully without complications and with no recurrence evident upon follow-up. CONCLUSION In this case series, six different frontal sinus pathologies were managed by an endoscopic approach, with excellent recovery and no recurrence upon follow-up demonstrated. This approach enabled excellent visualization of the pathologies, accurate localization, adequate drainage, and repair or grafting when needed.
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Affiliation(s)
- Ali Almomen
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Hallak B, Bouayed S, Ghika JA, Teiga PS, Alvarez V. Management Strategy of Intracranial Complications of Sinusitis: Our Experience and Review of the Literature. ALLERGY & RHINOLOGY 2022; 13:21526575221125031. [PMID: 36177149 PMCID: PMC9513574 DOI: 10.1177/21526575221125031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Sinusitis or rhinosinusitis is a very common disease worldwide, and in some
cases, it leads to intracranial complications (ICS). These are more common
in immunocompromised patients or with underlying comorbidities, but even
healthy individuals, can be affected. Nowadays, ICS have become less common
thanks to improved antibiotic therapies, radiological diagnostic methods,
surgical techniques and skills. Nonetheless, they can still cause
significant morbidity and mortality. For this reason, management of these
complications requires a multidisciplinary approach to plan and customize
treatment options. This paper presents our strategy in the management of a
series of intracranial complications induced by acute sinusitis and compares
our experience and outcomes with the literature. Study design Single institute experience, retrospective analysis of cases series and
literature review. Methods Adult and child patients who were treated for ICS in the Department of
Otorhinolaryngology at Sion Hospital, in Switzerland from 2016 to 2020 were
included. Their symptoms, medical history, clinical and radiological
findings, treatment, and outcome were documented. Results Eight patients (6 males- 2 females) aged from 14 to 88 y.o., were enrolled.
None had any previous history of chronic, or recurrent sinusitis. Moreover,
very few presented specific rhinological symptoms, but with neurological or
other symptoms. Computed tomography (CT) and Magnetic Resonance Imaging
(MRI) were used to confirm the diagnosis of all ICS. All types of known
intracranial complications were observed in our cohort with a wide range of
extension and severity of sinusitis. A multidisciplinary approach with
individual treatments was tailored to each patient. Outcomes were favorable
in almost all patients with neither recurrence, nor neurological sequels
being observed in the follow-up. Only one patient was lost due to fatal
complications of advanced lung cancer. Conclusion ICS remain a challenging clinical problem due to substantial associated
morbidity and mortality. The incidence of these complications is relatively
low. Therapeutical management guidelines are lacking. Early detection and
multidisciplinary approach are key to successful treatment.
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Affiliation(s)
- Bassel Hallak
- Department of Otorhinolaryngology, Head and Neck Surgery, Sion Hospital, Sion, Switzerland
| | - Salim Bouayed
- Department of Otorhinolaryngology, Head and Neck Surgery, Sion Hospital, Sion, Switzerland
| | | | - Pedro S. Teiga
- Department of Otorhinolaryngology, Head and Neck Surgery, Sion Hospital, Sion, Switzerland
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Hultman Dennison S, Hertting O, Bennet R, Eriksson M, Holmström M, Schollin Ask L, Lindstrand A, Dimitriou P, Stjärne P, Granath A. A Swedish population-based study of complications due to acute rhinosinusitis in children 5-18 years old. Int J Pediatr Otorhinolaryngol 2021; 150:110866. [PMID: 34416439 DOI: 10.1016/j.ijporl.2021.110866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND There are few population-based studies of complications due to acute rhinosinusitis in children. The aim was to clarify the admission and complication rate and analyze bacterial cultures in children five to 18 years old in Stockholm, Sweden. METHODS This was a population-based observational cohort study with retrospectively collected data from individual medical records, from 1 July 2003 to 30 June 2016 in Stockholm, Sweden. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed. RESULTS Incidence of admission due to acute rhinosinusitis was 7.8 per 100 000 children per year (boys 9.2, girls 6.2) and 61% of the admitted children were boys. A severe - postseptal orbital, intracranial or osseous - complication, was present in 34% of admissions (postseptal orbital 28%, intracranial 6%, osseous 4%), resulting in an incidence of 2.6 severe complications per 100 000 children per year (boys 3.6, girls 1.6). Orbital preseptal cellulitis was present in 88% of admissions. Incidence of surgery was 1.3 per 100 000 per year (boys 1.8, girls 0.8) and the percentage of admitted children that had surgery increased with age. S. pyogenes was the most common pathogen found in the whole cohort (29 admissions), while S. milleri was the most common pathogen found among the children with severe complication and surgery. CONCLUSIONS There is a relative high risk of severe complications in children between five to 18 years that are admitted due to acute rhinosinusitis. There is a need for prospective studies to further analyze the pathogens involved in complications due to acute rhinosinusitis.
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Affiliation(s)
- S Hultman Dennison
- Department of otorhinolaryngology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden.
| | - Olof Hertting
- Section for Pediatric Infectious Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Anna Steckséns gata 35, 171 64, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Rutger Bennet
- Section for Pediatric Infectious Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Anna Steckséns gata 35, 171 64, Stockholm, Sweden
| | - Margareta Eriksson
- Section for Pediatric Infectious Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Anna Steckséns gata 35, 171 64, Stockholm, Sweden
| | - Mats Holmström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Lina Schollin Ask
- Public Health Agency of Sweden, Nobels väg 18, 171 65, Stockholm, Sweden; Sach's Children and Youth Hospital, South General Hospital, Sjukhusbacken 10, 118 83, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Ann Lindstrand
- WHO Department of Immunization, vaccines and Biologicals, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Praxitelis Dimitriou
- Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden
| | - Pär Stjärne
- Department of otorhinolaryngology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Anna Granath
- Department of otorhinolaryngology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
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11
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Milinis K, Thompson N, Atsmoni SC, Sharma SD. Sinogenic Intracranial Suppuration in Children: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2021; 167:215-223. [PMID: 34491863 DOI: 10.1177/01945998211043847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate temporal trends in the management of sinogenic intracranial suppuration and its outcomes in children. DATA SOURCES A systematic search of databases was performed (Medline, Embase, Cochrane, ClinicalTrials.gov). REVIEW METHODS Studies in children (age <18 years) with sinogenic subdural empyema, extradural abscess, and intraparenchymal abscess were included. Data on treatment strategies were extracted. Primary outcome was death <90 days. Secondary outcomes were return to theater, neurologic disability at 6 months, and length of stay. Random effects meta-analysis and meta-regression were performed to investigate the effect of time and endoscopic sinus surgery (ESS) on these outcomes. RESULTS A total of 32 retrospective observational studies involving 533 patients recruited across a 45-year period (1975-2020) were included. The pooled estimates for 90-day mortality, permanent neurologic disability, and return to theater were 2.3% (95% CI, 1.1%-3.6%; I2 = 0, P > .99), 21.3% (95% CI, 15.3%-27.3%; I2 = 75.2%, P < .001), and 37.3% (95% CI, 29.5%-45%; I2 = 71.2%, P < .001), respectively, with no significant differences found across the study period. The pooled estimate for ESS was 58.4% (95% CI, 44.2%-72.6%; I2 = 97.1%, P < .001) with a significantly increasing trend in its use in the more recent years. ESS was not associated with improved mortality, reduced need for revision surgery, or neurologic disability. CONCLUSION The outcomes of sinogenic intracranial complications have not changed over the last 45 years, and ESS was not associated with improved patient outcomes. Further high-quality studies are required to determine the most appropriate treatment modalities to improve the burden of morbidity associated with sinogenic intracranial suppuration in children.
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Otto WR, Paden WZ, Connors M, Joerger T, Buzi A, Rizzi M, Huh J, Storm P, Heuer G, Kennedy B, McGuire J, Swami S, Lang SS. Suppurative Intracranial Complications of Pediatric Sinusitis: A Single-Center Experience. J Pediatric Infect Dis Soc 2021; 10:309-316. [PMID: 32955086 PMCID: PMC8023312 DOI: 10.1093/jpids/piaa101] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Suppurative intracranial complications of sinusitis are rare events in children and can lead to harmful neurologic sequelae and significant morbidity. We sought to review the presentation and management of patients admitted at our hospital with these conditions. METHODS This was a retrospective study of pediatric patients admitted to a quaternary children's hospital from 2007 to 2019 for operative management of sinusitis with intracranial extension. Clinical characteristics, including surgical and microbiological data, were collected and analyzed. RESULTS Fifty-four patients were included; the median age was 11.0 years, and there was a male predominance. Eighty-nine percent of patients had prior healthcare visits for the current episode of sinusitis; 46% of patients had an abnormal neurologic exam on admission. Epidural abscess and subdural empyema were the most common complications, and subdural empyema was associated with repeat surgical intervention. The dominant pathogens were Streptococcus anginosus group organisms (74%). The majority of patients completed treatment parenterally, with a median duration of therapy of 35 days. Neurological sequelae, including epilepsy or ongoing focal deficits, occurred in 22% of patients. History of seizure or an abnormal neurological exam at admission were associated with neurological sequelae. CONCLUSIONS Clinicians should consider intracranial complications of sinusitis in patients with symptoms of sinusitis for >1 week. Patients should undergo urgent neuroimaging, as neurosurgical intervention is essential for these patients. Subdural empyema was associated with repeat neurosurgical intervention. Neurological sequelae occurred in 22% of patients, and new onset seizure or an abnormal neurological exam at admission were associated with neurological sequelae.
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Affiliation(s)
- William R Otto
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - William Z Paden
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Meghan Connors
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Torsten Joerger
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adva Buzi
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Department of Otolaryngology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark Rizzi
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Department of Otolaryngology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jimmy Huh
- Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Phillip Storm
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gregory Heuer
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Benjamin Kennedy
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer McGuire
- Division of Neurology, Children’s Hospital of Philadelphia, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sanjeev Swami
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shih-Shan Lang
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Olzowy B, Al-Nawas B, Havel M, Karbach J, Müller R. Calculated parenteral initial treatment of bacterial infections: Infections in the ear, nose, throat and mouth and jaw area. GMS INFECTIOUS DISEASES 2020; 8:Doc14. [PMID: 32373439 PMCID: PMC7186809 DOI: 10.3205/id000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the sixth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter deals with the antibacterial treatment of more severe infections of the ear, the nose, the throat and the maxillofacial region, including odontogenic and salivary gland infections.
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Affiliation(s)
| | - Bilal Al-Nawas
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Miriam Havel
- Klinik und Poliklinik für HNO-Heilkunde, Klinikum der Universität München, Munich, Germany
| | - Julia Karbach
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Rainer Müller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus Dresden, Germany
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Touchette CJ, Crevier L, Weil AG. Neuronavigation-Guided Endoscopic Endonasal Drainage of Pediatric Anterior Cranial Base Epidural and Subdural Empyema. Pediatr Neurosurg 2020; 55:67-71. [PMID: 31962318 DOI: 10.1159/000503055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
In children, epidural and/or subdural intracranial empyema can complicate frontal sinusitis or pansinusitis. The standard transcranial approach used to treat epidural or subdural empyema has many drawbacks, but these can be avoided with an endoscopic expanded endonasal approach (EEA). To support the feasibility and advantages of this approach, we report the successful drainage through endoscopic EEA of a bifrontal empyema caused by an intracranial extension of pansinusitis. Our case and the ones previously reported in the literature establish well that endoscopic EEA offers several advantages over the standard craniotomy. Hence, EEA should be considered as an alternative to the transcranial approach when surgically draining anterior skull base empyema resulting from pansinusitis in children.
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Affiliation(s)
- Charles J Touchette
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Louis Crevier
- Pediatric Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital Center, Montreal University, Montreal, Québec, Canada
| | - Alexander G Weil
- Pediatric Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital Center, Montreal University, Montreal, Québec, Canada,
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Torretta S, Drago L, Marchisio P, Gaini L, Guastella C, Moffa A, Rinaldi V, Casale M, Pignataro L. Review of Systemic Antibiotic Treatments in Children with Rhinosinusitis. J Clin Med 2019; 8:E1162. [PMID: 31382570 PMCID: PMC6723210 DOI: 10.3390/jcm8081162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/02/2023] Open
Abstract
Antibiotic treatment in paediatric rhinosinusitis is still a matter of debate, as the current guidelines have been drafted mainly based on clinical studies published before 2013. Recent modifications in the epidemiological basis of the disease might mean that current treatments are not completely adequate considering the evolving microbiological profile of the disease. The present paper reviews the role of systemic antibiotics in children with acute (ARS), chronic (CRS), recurrent (RARS), and complicated acute (CoARS) rhinosinusitis. A total of 14 studies (including 3 prospective non-randomised studies, 8 retrospective studies, and 3 prospective randomised studies) of the 115 initially identified papers were included in this review, corresponding to 13,425 patients. Five papers dealt with ARS, four papers with RARS or CRS, and five papers with CoARS; the remaining papers included patients with either ARS or CRS. Data about the effectiveness of antibiotic treatment in children with ARC, CRS, and CoARS is scarce, as only three randomised controlled trials have been published in the last decade, with contrasting results. There is an urgent need for dedicated controlled trials not only to test the actual clinical benefits deriving from the routine use of systemic antibiotics in different categories of patients but also to compare the effectiveness of various therapeutic protocols in terms of the type of antibacterial molecules and the duration of treatment.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20100, Italy.
| | - Lorenzo Drago
- Department of Biomedical Sciences for Health, University of Milan, Milan 20100, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20100, Italy
| | - Lorenzo Gaini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
| | - Claudio Guastella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
| | - Antonio Moffa
- Unit of Otolaryngology, University of Foggia, Foggia 71121, Italy
| | - Vittorio Rinaldi
- Unit of Otolaryngology, UOS ORL TI, Campus Bio-medico University, Rome 00128, Italy
| | - Manuel Casale
- Unit of Otolaryngology, UOS ORL TI, Campus Bio-medico University, Rome 00128, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20100, Italy
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Scullen T, Hanna J, Carr C, Mathkour M, Aslam R, Amenta P, Dallapiazza RF. Surgical Approaches in the Treatment of Intracranial Complications of Paranasal Sinus Disease: A Review of the Literature. World Neurosurg 2019; 130:24-29. [PMID: 31254711 DOI: 10.1016/j.wneu.2019.06.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intracranial extension of frontal or ethmoid sinusitis carries a high morbidity and mortality if not treated aggressively. With the emergence of endoscopic sinus surgery (ESS), we questioned whether these approaches have supplanted traditional transcranial procedures for intracranial extension of sinus disease, and whether ESS approaches had a difference in patient outcomes. METHODS Studies reporting surgical management and outcomes of frontal sinus disease with intracranial extension were queried using the United States National Library of Medicine at the National Institutes of Health PubMed database. We also queried common internet search engines. We included studies regarding sinogenic intracranial suppurative infections treated surgically with ESS and neurosurgical approaches. Studies with insufficient data regarding specific treatment methods and studies that included populations of medically treated infections were excluded. RESULTS A total of 108 cases were identified in which patients with intracranial sinogenic disease were treated via ESS alone (morbidity: 43.5%, mortality: 0.9%), 47 cases via transcranial intervention alone (morbidity: 33.2%, mortality: 7.8%), and 43 cases via simultaneous neurosurgical and ESS approaches (morbidity: 16.3%, mortality: 6.4%). Complex sinus disease with posterior table compromise in the absence of intracranial extension treated via ESS alone was reported in 164 cases with a morbidity and mortality of 3.8% and 0%, respectively. CONCLUSIONS Combined ESS and transcranial approaches achieve definitive control of sinogenic and intracranial disease, whereas either modality alone carries a potential risk for higher morbidity and mortality. The use of ESS alone may have use in the treatment of sinusitis with posterior table erosion prior to intracranial extension.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Joshua Hanna
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Christopher Carr
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Rizwan Aslam
- Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA
| | - Peter Amenta
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Robert F Dallapiazza
- Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA.
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17
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Dennison SH, Ask LS, Eriksson M, Granath A, Hertting O, Bennet R, Lindstrand A, Masaba P, Dimitriou P, Stjärne P. Serious complications due to acute rhinosinusitis in children up to five years old in Stockholm, Sweden - Still a challenge in the pneumococcal conjugate vaccine era. Int J Pediatr Otorhinolaryngol 2019; 121:50-54. [PMID: 30861428 DOI: 10.1016/j.ijporl.2019.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. METHODS This was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003-2007. RESULTS A total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. CONCLUSIONS Complications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.
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Affiliation(s)
- S Hultman Dennison
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - L Schollin Ask
- South General Hospital, Sachs' Children and Youth Hospital, Sjukhusbacken 10, 118 83, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - M Eriksson
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - A Granath
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - O Hertting
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - R Bennet
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - A Lindstrand
- Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, 171 77, Stockholm, Sweden; Public Health Agency of Sweden, Nobels väg 18, 171 65, Solna, Sweden
| | - P Masaba
- Department of Radiology, Karolinska University Hospital, Karolinska Vägen, 171 76, Solna, Stockholm, Sweden
| | - P Dimitriou
- Department of Radiology, Karolinska University Hospital, Karolinska Vägen, 171 76, Solna, Stockholm, Sweden
| | - P Stjärne
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden
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18
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El Mograbi A, Ritter A, Najjar E, Soudry E. Orbital Complications of Rhinosinusitis in the Adult Population: Analysis of Cases Presenting to a Tertiary Medical Center Over a 13-Year Period. Ann Otol Rhinol Laryngol 2019; 128:563-568. [PMID: 30788974 DOI: 10.1177/0003489419832624] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature. OBJECTIVE To review our experience with the management of orbital complications of rhinosinusitis in the adult patient population and identify key factors in the characteristics and management of these patients. DESIGN Retrospective case series during the years 2004 to 2016 in a tertiary referral center including all patients with rhinosinusitis and orbital complications. MAIN OUTCOMES AND MEASURES Severity of complications, risk factors, clinical, imaging and microbiological data, treatment outcomes. RESULTS Seventy patients were identified. Median age at diagnosis was 38 years. In 57%, complications were associated with acute rhinosinusitis and in 43% with chronic rhinosinusitis, most of whom had a history of previous sinus surgery. Thirty-five percent of patients received antibiotics prior to admission. The majority of the previously operated patients (61%) had some form of orbital wall dehiscence noted on imaging. Preseptal cellulitis was the most common complication (61.5%) encountered, followed by orbital cellulitis (23%), sub-periosteal abscess (11.5%), orbital abscess (3%), and cavernous sinus thrombosis (1.5%). Gram-positive bacteria were more commonly isolated from acute rhinosinusitis patients and gram-negative bacteria from chronic rhinosinusitis (CRS) patients. Complete recovery was noted in all patients, of whom 85% were managed conservatively. All, but 1 patient, with an abscess or cavernous sinus thrombosis required surgical drainage. Older age was the only risk factor identified for severe complications. CONCLUSIONS In contrast to the pediatric population, CRS is very common in adults with orbital complications of rhinosinusitis, with previous sinus surgery and orbital wall dehiscence being noticeably common. Older patients are at risk for more severe complications. Conservative treatment suffices in patients with preseptal and orbital cellulitis. In more advanced stages, surgical drainage is advocated with excellent results. Larger cohort studies are needed to further investigate this patient group.
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Affiliation(s)
- Aiman El Mograbi
- 1 Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah-Tikva.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Ritter
- 1 Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah-Tikva.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esmat Najjar
- 1 Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah-Tikva.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ethan Soudry
- 1 Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah-Tikva.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
"Headache and fever" is a common presentation to the urgent care and emergency department setting and can have many etiologies. We present a case of a 10-year-old girl who presented with headache and fever and was found to have intracranial extension of sinusitis despite lack of typical sinus or chronic upper respiratory tract infection symptoms. This case illustrates the need in the emergency department or urgent care to keep a broad differential diagnosis for pediatric headache, especially when initial interventions are unsuccessful. We also review the epidemiology of pediatric sinusitis, age at sinus development, and associated intracranial complications.
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Kou YF, Killeen D, Whittemore B, Farzal Z, Booth T, Swift D, Berg E, Mitchell R, Shah G. Intracranial complications of acute sinusitis in children: The role of endoscopic sinus surgery. Int J Pediatr Otorhinolaryngol 2018; 110:147-151. [PMID: 29859578 DOI: 10.1016/j.ijporl.2018.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the role of endoscopic sinus surgery (ESS) in the management of intracranial complications of children with acute rhinosinusitis METHODS: Retrospective chart review at a tertiary care pediatric hospital MAIN OUTCOMES: Demographics, intracranial complications, length of hospital stay (LOS), neurological sequelae, ESS, neurosurgical procedures RESULTS: Twenty-four children with a mean age (SD) of 12.9 years (+/-3.2) with an intracranial complication(s) of acute rhinosinusitis were identified between 2005-2016. A total of 22 were included and 15 (68%) of these were males. The most common complications were: subdural abscess (n=10), epidural abscess (n=10), meningitis (n=5), intraparenchymal abscess (n=5), and cavernous sinus thrombosis (n= 2). Neurologic symptoms included headache (n=12), hemiparesis (n=5) and aphasia (n=3). Average length of stay was 16 (+/- 9.2) days. Average follow up was 7 (+/-5.6) months. One patient had residual seizures and 1 had recurrent rhinosinusitis. Aphasia and hemiparesis resolved in all patients within 1 year. Nineteen (86%) patients had ESS within 4 days of admission. Fourteen patients (63%) had a neurosurgical procedure, 6 (27%) required more than 1 neurosurgical procedure. Six patients (27%) had concurrent neurosurgical drainage and ESS. Four patients (17%) had neurosurgical procedure followed by ESS and 3 patients (13%) were treated only by a neurosurgical procedure. Patients who underwent ESS prior to a neurosurgical procedure had significantly less risk of needing a neurosurgical intervention (OR = .02, p < .01). There was a significantly higher proportion of neurosurgical patients with positive Strep anginosus cultures compared to the ESS only group (85.7% vs 37.5%, p = .02). Studies with larger patient populations are needed to determine the role of ESS in the management of intracranial complications of children with acute rhinosinusitis. DISCUSSION Early ESS may be associated with less need for neurosurgical procedures.
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Affiliation(s)
- Yann-Fuu Kou
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States.
| | - Daniel Killeen
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States
| | - Brett Whittemore
- Children's Medical Center Dallas, United States; University of Texas Southwestern Medical Center Department of Neurosurgery, United States
| | - Zainab Farzal
- University of North Carolina at Chapel Hill Department of Otolaryngology, Head and Neck Surgery, United States
| | - Tim Booth
- Children's Medical Center Dallas, United States; Children's Medical Center Dallas Department of Neurosurgery, United States
| | - Dale Swift
- Children's Medical Center Dallas, United States; University of Texas Southwestern Medical Center Department of Neurosurgery, United States
| | - Eric Berg
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
| | - Ron Mitchell
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
| | - Gopi Shah
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
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21
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Chokkappan K, Lohan R. Rapidly Developing Subdural Empyema in an Adult with Sinusitis: A Neurosurgical Threat Alert. Asian J Neurosurg 2018; 13:458-461. [PMID: 29682060 PMCID: PMC5898131 DOI: 10.4103/ajns.ajns_97_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Subdural empyema (SDE) is collection of pus in the potential space between the dura and arachnoid layers of the meninges. Leading causes of SDE are sinonasal and otomastoid infections. Commonly affecting patients in the second and third decades, SDE could have a fulminant course with immediate complications and delayed morbidities including hydrocephalus, focal deficits, and epilepsy.
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Affiliation(s)
| | - Rahul Lohan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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23
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Nicoli TK, Oinas M, Niemelä M, Mäkitie AA, Atula T. Intracranial Suppurative Complications of Sinusitis. Scand J Surg 2016; 105:254-262. [PMID: 26929294 DOI: 10.1177/1457496915622129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intracranial complications of paranasal sinusitis have become rare due to widespread and early use of antibiotics. Potentially life-threatening intracranial complications of sinusitis include subdural empyema, epidural and intracerebral abscess, meningitis, and sinus thrombosis. Patients with intracranial complication of sinusitis can present without neurological signs, which may delay diagnosis and correct treatment. AIMS Our aim was to evaluate the diagnostics, treatment, and outcome of sinusitis-related intracranial infections at our tertiary referral hospital with a catchment area of 1.9 million people. MATERIALS AND METHODS We retrospectively collected data on all patients diagnosed and treated with an intracranial infection at the Helsinki University Hospital, Helsinki, Finland, during a 10-year period between 2003 and 2013. RESULTS Six patients were diagnosed to have a sinusitis-related intracranial infection. Four patients had an epidural abscess, one both an epidural abscess and a subdural empyema and one a subdural empyema. The most common presenting complaint was headache (100%) followed by fever (83%), vomiting (50%), nasal congestion (50%), forehead lump (34%), and neck stiffness (17%). All patients were managed surgically. Most (83%) patients recovered to premorbid state without neurological sequelae. One patient died intraoperatively. CONCLUSION Patients with a sinusitis-related intracranial suppuration typically present with signs of raised intracranial pressure rather than signs of sinusitis. Most are likely to need neurosurgical intervention and evacuation of the abscess without delay.
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Affiliation(s)
- T K Nicoli
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M Oinas
- 2 Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M Niemelä
- 2 Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A A Mäkitie
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,3 Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T Atula
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Intracranial Abscess Presenting as Periorbital Edema of Graves Disease. J Craniofac Surg 2016; 27:817. [DOI: 10.1097/scs.0000000000002426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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Soudry E, Hwang PH. Acute Frontal Sinusitis. THE FRONTAL SINUS 2016. [PMCID: PMC7178852 DOI: 10.1007/978-3-662-48523-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Uncomplicated acute frontal sinusitis (AFS) is most often associated with an antecedent viral upper respiratory tract infection. Bacterial infection is suspected if symptoms are persistent for at least 10 days.
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Benevides GN, Salgado GA, Ferreira CR, Felipe-Silva A, Gilio AE. Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome. AUTOPSY AND CASE REPORTS 2015; 5:19-26. [PMID: 26894042 PMCID: PMC4757916 DOI: 10.4322/acr.2015.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/07/2015] [Indexed: 12/28/2022] Open
Abstract
The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate case.
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Affiliation(s)
| | - German Alcoba Salgado
- Department of Pathology - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
| | - Cristiane Rúbia Ferreira
- Anatomic Pathology Division - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil
| | - Aloísio Felipe-Silva
- Department of Pathology - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil.; Anatomic Pathology Division - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil
| | - Alfredo Elias Gilio
- Department of Pediatrics - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil.; Division of Pediatrics - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil
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Abstract
Acute bacterial sinusitis (ABS) is a common complication of a simple upper respiratory infection. Acute bacterial sinusitis and an upper respiratory infection, however, have different management plans. This article will help clinicians establish when a diagnosis of ABS can be made based on the latest guidelines from the American Academy of Pediatrics. Also covered will be the pathophysiology of ABS, the role of diagnostic imaging, the recognition of complications of ABS, and treatment options.
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Garin A, Thierry B, Leboulanger N, Blauwblomme T, Grevent D, Blanot S, Garabedian N, Couloigner V. Pediatric sinogenic epidural and subdural empyema: The role of endoscopic sinus surgery. Int J Pediatr Otorhinolaryngol 2015; 79:1752-60. [PMID: 26304070 DOI: 10.1016/j.ijporl.2015.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
AIM To analyze the indications and outcomes of open neurosurgical approaches (ONA) and endoscopic transnasal approaches (ETA) in the surgical management of pediatric sinogenic subdural and epidural empyema. MATERIAL AND METHODS Retrospective single-center study design within a tertiary care referral center setting. Children less than 18 years of age consecutively operated on between January 2012 and February 2014 for drainage of a sinogenic subdural empyema (SE) or epidural (EE) empyema were included. MAIN OUTCOME MEASURES success of first surgical procedure, persistent symptoms and sequelae at the end of the follow-up period. RESULTS Nine SE (53%) and 8 EE (47%) were observed. Neurological symptoms, especially seizures, were more frequent in the SE group. Perioperative pus samples were positive in 67% of the SE group and in 75% of the EE group. The most frequently isolated bacteria belonged to the Streptococcus anginosus group. CT or MR imaging showed that most empyema probably originated from the frontal sinus. However, two cases resulted from an ethmoiditis and one case from a Pott's puffy tumor, without any direct contact with the paranasal sinus. In cases of SE, the most effective surgical technique was ONA with craniotomy. Associated endoscopic sinus drainage was useful for the purpose of bacteriological diagnosis. In cases of EE, effectiveness was noted in both ONA and ETA techniques. In two cases of EE, the ETA procedure encompassed direct drainage of the empyema through the posterior wall of the frontal sinus (Draf III approach). The number of patients successfully treated after a single surgical procedure was higher in the EE group (p=0.05). Regarding outcomes, no mortalities were observed. Persistent disorders at the end of the follow-up period, especially headaches, cognitive, concentration or schooling problems, tended to be more frequent in the SE group than in the EE group (67% vs 29%), and were more commonly observed in cases requiring several surgical procedures (75% vs 12.5%) (p=0.05). DISCUSSION Endoscopic sinus surgery plays a critical role in the surgical management of pediatric sinogenic SE and EE. In cases of small volume EE, the endoscopic approach associated with antibiotherapy may be sufficient to treat the infectious process.
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Affiliation(s)
- A Garin
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - B Thierry
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - N Leboulanger
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - T Blauwblomme
- Pediatric Neurosurgery Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - D Grevent
- Pediatric Radiology Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - S Blanot
- Department of Anesthesiology, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - N Garabedian
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - V Couloigner
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
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Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging 2015; 6:509-18. [PMID: 26253983 PMCID: PMC4569601 DOI: 10.1007/s13244-015-0424-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 10/26/2022] Open
Abstract
UNLABELLED In patients with acute bacterial rhinosinusitis severe orbital and intracranial complications can occur. This review will illustrate the anatomic relationship between the paranasal sinuses and the orbital and intracranial compartments. Subsequently, the spectrum of orbital and intracranial complications of rhinosinusitis and related imaging findings will be discussed and illustrated by case material from daily practice. TEACHING POINTS • Acute bacterial rhinosinusitis can cause severe orbital and intracranial complications. • If orbital or intracranial complications are suspected, cross-sectional imaging is mandatory. • Infection can spread from the ethmoid sinus to the orbit through the lamina papyracea. • Frontal sinusitis can spread intracranially through dehiscences or osteomyelitis. • Radiologists must recognize imaging findings of complications of acute bacterial rhinosinusitis.
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Nieto Gámiz I, Varona García A, Vilaplana López A, Ortíz Flores A, García Rubio R. Absceso epidural y sinusitis frontal. An Pediatr (Barc) 2015; 82:274-5. [DOI: 10.1016/j.anpedi.2014.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022] Open
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Stokken J, Gupta A, Krakovitz P, Anne S. Rhinosinusitis in children: a comparison of patients requiring surgery for acute complications versus chronic disease. Am J Otolaryngol 2014; 35:641-6. [PMID: 25069389 DOI: 10.1016/j.amjoto.2014.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/31/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patient characteristics, risk factors, and microbiology are important to consider in the management of complications of acute bacterial sinusitis (ABS) in pediatric patients. This study evaluates this subset of patients and compares them to patients that undergo surgery for chronic rhinosinusitis (CRS). METHODS This study is a retrospective review of all pediatric patients from 2002 to 2011, who underwent sinus surgery at a tertiary hospital. Patients who underwent surgery for ABS complication were compared to patients who underwent surgery for CRS. Statistical analysis was completed using chi-square test or Fisher's exact test with a statistical significance set at p<0.05. RESULTS Twenty-seven patients with a complication of ABS and 77 patients with CRS were analyzed. The groups did not differ demographically. Patients with a complication were statistically less likely to have seasonal allergies, prior sinusitis, prior nasal steroid use, or adenoidectomy (p<0.05). In addition, they had more frequent involvement of ethmoid and frontal sinuses (p<0.05). The most common cultures results were no growth (30.8%), Streptococcus milleri (30.8%), and normal flora (19.2%) in ABS for the with a complication group, and normal flora (41.5%), coagulase negative Staphylococcus (22%), and Propionobacterium (19.5%) for the CRS group. Most prevalent complications were preseptal cellulitis (55.5%), orbital subperiosteal abscess (29.6%), subgaleal abscess (22%), and epidural abscess (22%). Five patients had simultaneous orbital and intracranial complications. CONCLUSIONS Patients who present with complications of ABS vary significantly from the CRS patients. Location of most commonly affected sinuses and microbiology also differ and is crucial for understanding the management of this disease process.
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Chang CC, Incaudo GA, Gershwin ME. Microbiology of Acute, Subacute, and Chronic Rhinosinusitis in Children. DISEASES OF THE SINUSES 2014. [PMCID: PMC7120624 DOI: 10.1007/978-1-4939-0265-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Christopher C. Chang
- Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, Wilmington, Delaware USA
| | - Gary A. Incaudo
- Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
| | - M. Eric Gershwin
- The Jack and Donald Chia Distinguished Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
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Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics 2013; 132:e262-80. [PMID: 23796742 DOI: 10.1542/peds.2013-1071] [Citation(s) in RCA: 292] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To update the American Academy of Pediatrics clinical practice guideline regarding the diagnosis and management of acute bacterial sinusitis in children and adolescents. METHODS Analysis of the medical literature published since the last version of the guideline (2001). RESULTS The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with (1) persistent illness (nasal discharge [of any quality] or daytime cough or both lasting more than 10 days without improvement), (2) a worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement), or (3) severe onset (concurrent fever[temperature ≥39°C/102.2°F] and purulent nasal discharge for at least 3 consecutive days). Clinicians should not obtain imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI, because they do not contribute to the diagnosis; however, a contrast-enhanced computed tomography scan of the paranasal sinuses should be obtained whenever a child is suspected of having orbital or central nervous system complications. The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course. The clinician should either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness. Amoxicillin with or without clavulanate is the firstline treatment of acute bacterial sinusitis. Clinicians should reassess initial management if there is either a caregiver report of worsening(progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours of initial management.If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially managed with observation. CONCLUSIONS Changes in this revision include the addition of a clinical presentation designated as “worsening course,” an option to treat immediately or observe children with persistent symptoms for 3 days before treating, and a review of evidence indicating that imaging is not necessary in children with uncomplicated acute bacterial sinusitis.
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Complicated sinusitis in a developing country, a retrospective review. Int J Pediatr Otorhinolaryngol 2013; 77:1174-8. [PMID: 23688379 DOI: 10.1016/j.ijporl.2013.04.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/18/2013] [Accepted: 04/20/2013] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of our study was to assess the incidence rate, mode of presentation, treatment and outcome measures associated with complicated sinusitis in our developing world setting. Additionally we had hope to identify possible patterns or predisposing factors that may assist us in decreasing the significant morbidity and mortality associated with this serious disease. METHOD A retrospective chart review was performed on all patients treated for complicated sinusitis at 3 referral hospitals in Durban South Africa between January 2006 and September 2009. RESULTS A total of 220 patients were identified including 138 patients with orbital complications only and 82 with intracranial complications with or without orbital manifestations. We report on the demographics, mode of presentation, microbiology, impact on resources, management and mortality of the study group. The incidence rate was found to be 5.83 per million, the most common risk factors associated with intracranial complications, a persistent headache beyond 1 week and referral from a rural rather than urban area (OR 3.24). We found a high mortality rate of 20.7% in those patients with intracranial complications of their sinusitis. CONCLUSIONS Complicated sinusitis is still far too common in the developing world with young adolescent males most at risk. A high index of suspicion must be maintained in detecting orbital as well as intracranial extension of disease and appropriate referral for investigation and management swift and aggressive in preventing extensive morbidity and mortality.
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Smith SS, Kern RC, Chandra RK, Tan BK, Evans CT. Variations in antibiotic prescribing of acute rhinosinusitis in United States ambulatory settings. Otolaryngol Head Neck Surg 2013; 148:852-9. [PMID: 23462657 PMCID: PMC5514556 DOI: 10.1177/0194599813479768] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/31/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify variations in antibiotic treatment of acute rhinosinusitis (ARS) on a national level. STUDY DESIGN Cross-sectional study of a national database. SETTING Otolaryngology and primary care ambulatory settings. SUBJECTS AND METHODS A nationally representative sample of adult outpatient visits was extracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey data for 2006 to 2009. Antibiotic prescriptions associated with ARS were tabulated. Statistical analyses were conducted to identify variations in antibiotic prescribing by patient and physician characteristics. RESULTS Antibiotics were prescribed in 82.3% ± 2.6% of 18.7 million visits for ARS (mean age, 46.2 years; 65.9% female). The ratio of primary care physician (PCP) to otolaryngologist (ENT) ARS visits was 18.6:1. Antibiotic prescription rates were inversely related to increasing age groups of 18 to 39, 40 to 64, and ≥ 65 years (87.8%, 81.2%, and 71.0%, respectively; P = .02). Physicians in general medicine outpatient departments, internal medicine, and family medicine were more likely to prescribe antibiotics compared with ENTs (adjusted odds ratio [OR], 7.9 [95% confidence interval (CI), 3.5-17.8]; 6.9 [2.5-19.2]; and 3.9 [2.0-7.7], respectively). The most commonly prescribed antibiotics were azithromycin, amoxicillin, and amoxicillin/clavulanate acid (27.5%, 15.5%, and 14.6%, respectively). The ENTs selected broad-spectrum antibiotics more often than PCPs (94.3% vs 75.7% of visits with antibiotics were broad-spectrum agents; P = .01). CONCLUSION Antibiotics were prescribed frequently despite recent consensus guidelines that discourage antibiotic use in mild cases. Furthermore, antibiotic prescription was more likely for younger patients and in primary care settings. This highlights the need to promote awareness of practice guidelines.
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Affiliation(s)
- Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Bruner DI, Littlejohn L, Pritchard A. Subdural empyema presenting with seizure, confusion, and focal weakness. West J Emerg Med 2013; 13:509-11. [PMID: 23358438 PMCID: PMC3555596 DOI: 10.5811/westjem.2012.5.11727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 04/17/2012] [Accepted: 05/14/2012] [Indexed: 11/11/2022] Open
Abstract
While sinusitis is a common ailment, intracranial suppurative complications of sinusitis are rare and difficult to diagnose and treat. The morbidity and mortality of intracranial complications of sinusitis have decreased significantly since the advent of antibiotics, but diseases such as subdural empyemas and intracranial abscesses still occur, and they require prompt diagnosis, treatment, and often surgical drainage to prevent death or long-term neurologic sequelae. We present a case of an immunocompetent adolescent male with a subdural empyema who presented with seizures, confusion, and focal arm weakness after a bout of sinusitis.
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Affiliation(s)
- David I Bruner
- Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia
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Holland AA, Morriss M, Glasier PC, Stavinoha PL. Complicated subdural empyema in an adolescent. Arch Clin Neuropsychol 2012; 28:81-91. [PMID: 23232862 DOI: 10.1093/arclin/acs104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Little is known regarding typical neuropsychological outcomes of intracranial empyema, a rare complication of sinusitis marked by accumulation of purulent material adjacent to the brain. A 15-year-old, right-handed male presented with a 3-day history of congestion, lethargy, fever, headache, dizziness, unequal pupil dilation, and right-sided facial droop. Computed tomography revealed right-sided subdural empyema causing subfalcine, central, foraminal uncal, and tonsillar herniation. Postoperative inpatient neuropsychological consultation was requested 17 days postsurgery due to language deficits. Through comparison of neuropsychological and radiological findings, this case of subdural empyema demonstrates the anatomical and functional impact of mass effect on the brainstem and the vasculature of the contralateral hemisphere. Deficits were observed in expressive language, processing speed, and fine motor functioning, all of which lingered 6 months postacute. This case study reviews the pathophysiology of subdural empyema and illustrates its potential neuropsychological impact to inform clinicians encountering this rare condition.
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Affiliation(s)
- Alice Ann Holland
- Department of Psychology, Children's Medical Center, Dallas, TX 75235, USA.
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Cole TS, Clark ME, Jenkins AJ, Clark JE. Pediatric focal intracranial suppuration: a UK single-center experience. Childs Nerv Syst 2012; 28:2109-14. [PMID: 22864509 DOI: 10.1007/s00381-012-1877-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Brain abscess (BA) and subdural empyema (SDE) are uncommon but clinically important conditions in childhood. Treatment involves surgery and prolonged courses of antibiotics. There is no consensus on the optimal approach. The objective was to review management and outcome of BA and SDE in a single UK center. METHODS This retrospective case notes review of children with brain abscess or subdural empyema admitted to a tertiary pediatric infectious diseases and neurosurgical center from 2001 to 2009. RESULTS Forty-two children were included in the study; 17 children were with BA, 23 with SDE, and two both with BA and SDE. The causative factors found in 88 % of the patients were most commonly sinusitis and meningitis with congenital heart disease and immunocompromise unusual. Streptococcus anginosus group organisms were most common; 10 % of the children had a resistant pathogen and 86 % had surgical intervention. Fifteen patients with BA underwent surgery; nine of these patients underwent burrhole aspiration, three had craniotomy, two had stereotactic surgery, and one had endoscopic aspiration. Remaining 19 patients with SDE underwent surgery: seven had burrhole aspiration, 11 underwent craniotomy, and one had aspiration via the anterior fontanel. The most common antibiotic regime was cefotaxime, metronidazole, and amoxicillin. Mean duration of treatment was 14.4 weeks. Mean time until normalization of C reactive protein was 23 days. Survival was 95 % and 20 % had ongoing neurological sequelae. CONCLUSIONS BA and SDE remain important childhood infections in the UK. Antibiotics are essential in the management of these cases. Empiric antibiotic choices require knowledge of likely pathogens and local resistance. Selected infections can be treated without surgical intervention. Long courses of antibiotics were administered. Outcome is good, and neurological sequelae were less common than found in previous series.
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Affiliation(s)
- Theresa S Cole
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
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Acute Sinusitis Resulting in a Craniotomy: An Uncommon Complication of a Common Infection. Case Rep Infect Dis 2012; 2012:979836. [PMID: 22953085 PMCID: PMC3431045 DOI: 10.1155/2012/979836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 07/05/2012] [Indexed: 11/18/2022] Open
Abstract
Acute bacterial sinusitis is a common infectious condition. Patients may initially present with an uncomplicated infection and later, despite appropriate initial antibiotic therapy, develop a potentially life-threatening complication. Interventions aimed at alleviating such unexpected events need be prompt and adequate. We describe a case of a patient who initially presented with signs and symptoms of acute sinusitis later to be diagnosed with a frontal epidural abscess.
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Piatt JH. Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study. J Neurosurg Pediatr 2011; 7:567-74. [PMID: 21631191 DOI: 10.3171/2011.3.peds10504] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intracranial abscess is a very infrequent complication of sinusitis among children. Case series, mostly small and focusing on surgical treatment, have appeared in the literature, but there has been no study on the epidemiology of this condition, nor has there been any large-scale study on the intensity of therapy or outcomes. METHODS Data were drawn from the Kids' Inpatient Databases for 1997, 2000, 2003, and 2006 and the National Inpatient Sample for 2001. Cases were defined by the conjunction between the diagnostic codes for intracranial abscess and those for acute or chronic sinusitis or mastoiditis. RESULTS Eight hundred forty-seven hospital admissions were captured. Over the 10 years of the study, admission rates ranged between 2.74 and 4.38 per million children per year. Boys were affected much more commonly than girls. Black children were affected out of proportion to their presence in the population. The overall incidence seemed to peak in early adolescence. Sinogenic cases had a marked seasonal pattern peaking in winter, but no seasonal variation was seen for otogenic cases. Asthma comorbidity was more prevalent among sinogenic cases. The mortality rate was 2%, and death occurred only among sinogenic cases. Moreover, sinogenic cases tended to require more intensive therapy, as measured by the number of procedures, and there was a trend toward less favorable discharge dispositions. Older patients and black patients were less likely to be discharged directly to home. At least a quarter of the cases were managed without neurosurgical intervention. White patients were treated without neurosurgery more often than others. CONCLUSIONS Analysis of administrative data sets has yielded a descriptive picture of intracranial abscess complicating sinusitis among children, but the very low incidence of this condition impedes prospective clinical research directed at practical management issues.
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Affiliation(s)
- Joseph H Piatt
- Division of Neurosurgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
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Gupta S, Vachhrajani S, Kulkarni AV, Taylor MD, Dirks P, Drake JM, Rutka JT. Neurosurgical management of extraaxial central nervous system infections in children. J Neurosurg Pediatr 2011; 7:441-51. [PMID: 21529183 DOI: 10.3171/2011.2.peds09500] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Extraaxial infections of the CNS, including subdural empyema and epidural abscess, are rare but potentially life-threatening conditions. Symptoms are usually progressive, and early diagnosis is therefore important. Early intervention with appropriate treatment offers the best opportunity for eradicating the infection and promoting maximal neurological recovery. METHODS The medical records of children with extraaxial CNS infection over the last 24 years at the Hospital for Sick Children were analyzed. Only those patients with radiological and/or operative confirmation of the diagnosis of subdural empyema or epidural abscess were included in the study. Demographic and clinical data were collected to determine the outcomes after such infections and factors that predict for such outcomes. RESULTS The authors identified 70 children who fulfilled the inclusion criteria. Sinusitis was the most common etiology and was seen in 38 patients. All of these patients were older than 7 years of age at diagnosis. Subdural empyemas were diagnosed in 13 patients following bacterial meningitis, and they were found primarily in infants within the 1st year of life. Other etiological factors included otogenic infection (4 cases), postneurosurgical infection (7 cases), and hematogenous spread of infection (7 cases including 6 cases of spinal epidural abscess). Streptococcus anginosus and Staphylococcus aureus were the most common pathogens identified. Sixty-four patients (91.4%) underwent at least 1 neurosurgical procedure. Seizures and cerebral edema from cortical vein thrombosis were the most common complications. CONCLUSIONS Due to variable etiology, identification of the responsible microorganism through neurosurgical drainage followed by long-term intravenous antibiotics remains the mainstay in treating extraaxial CNS infections. Optimal outcome is achieved with early diagnosis and therapy.
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Affiliation(s)
- Sanjay Gupta
- Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada
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Przypadek mnogich powikłań zatokopochodnych w ostrym jednostronnym zapaleniu zatok przynosowych. Otolaryngol Pol 2011; 65:228-32. [DOI: 10.1016/s0030-6657(11)70680-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Identifying and managing intracranial complications of sinusitis in children: a retrospective series. Pediatr Infect Dis J 2011; 30:222-6. [PMID: 21416657 DOI: 10.1097/inf.0b013e3181f86398] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Of patients admitted to hospital with sinusitis, about 3% have an intracranial complication. We describe the clinical features, laboratory data, imaging findings, and outcomes of pediatric patients with intracranial complications of sinusitis. METHODS A retrospective chart review of all pediatric patients < 21 years of age admitted for intracranial complications of sinusitis to a tertiary hospital over a 10-year period. RESULTS A total of 13 patients with a mean age of 13.3 ± 3.7 years presented with headache (92%), fever (85%), nausea/vomiting (62%), sinus tenderness (31%), and lethargy (23%). Physical examination findings included Pott puffy tumor (46%), orbital cellulitis (46%), altered level of consciousness (46%), new-onset seizure (31%), hemiparesis (23%), nuchal rigidity (23%), visual disturbance (23%), and slurred speech (15%). Computed tomography and magnetic resonance imaging demonstrated 16 instances of epidural and subdural empyema, and 1 brain abscess. One child had sagittal sinus thrombosis. CONCLUSIONS Our findings suggest that acute sinusitis in combination with severe intractable headache, varying degrees of altered level of consciousness, focal neurologic deficits, and/or signs of meningeal irritation should raise clinical suspicion for potential intracranial complications of sinusitis. These signs and symptoms should prompt early and aggressive evaluation and management, including neuroimaging studies, neurologic and otolaryngologic consultations, and intravenous antibiotics.
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Goytia VK, Giannoni CM, Edwards MS. Intraorbital and intracranial extension of sinusitis: comparative morbidity. J Pediatr 2011; 158:486-91. [PMID: 20970813 DOI: 10.1016/j.jpeds.2010.09.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 06/21/2010] [Accepted: 09/02/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We hypothesized that intracranial extension of sinusitis carries greater morbidity than extension confined to the orbit and that presenting features can raise suspicion for intracranial extension. STUDY DESIGN A retrospective review (1997 to 2006) identified 118 children with sinusitis complicated by intracranial extension or intraorbital extension. Presenting features and infecting organisms were compared using χ(2) or Fisher exact tests. Outcomes included duration of hospitalization, length of therapy and sequelae. RESULTS Thirty-three children had intracranial extension and 85 had intraorbital extension. Children with intracranial extension were older (11.4 versus 7.6 years; P ≤ .001), had more preadmission encounters (1.9 versus 1.3; P = .012), longer headache duration (9.5 versus 2.8 days; P = .009), and presented more often with vomiting (73% versus 28%; P < .001) than those with intraorbital extension. Children with intracranial extension also were hospitalized (26 versus 10 days; P < .001) and treated (36 versus 24 days; P = .001) longer. Four children (3%) had persistent sequelae. CONCLUSIONS Children with intracranial extension are hospitalized and treated longer than those with intraorbital extension of sinusitis but persistent sequelae are uncommon. Prolonged headache and protracted vomiting at presentation should alert caregivers to consider intracranial extension.
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Affiliation(s)
- Veronica K Goytia
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Greve T, Clemmensen D, Ridderberg W, Pedersen LN, Møller JK. Polymicrobial subdural empyema: involvement of Streptococcus pneumoniae revealed by lytA PCR and antigen detection. BMJ Case Rep 2011; 2011:2011/mar01_1/bcr0920103344. [PMID: 22707602 DOI: 10.1136/bcr.09.2010.3344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The authors report a case of a subdural empyema (SDE) caused by a coinfection with Streptococcus intermedius and Streptococcus pneumoniae, initially considered a S. intermedius infection only. An otherwise healthy 11-year-old female was admitted to the hospital after 5 days of illness. Symptoms were consistent with classical SDE symptoms and progressed rapidly with finally somnolence before the first neurosurgical procedure despite relevant antibiotic treatment. Primary MRI showed an interhemispheric SDE and a postoperative control CT scan showed progression of the empyema infratentorially. The empyema was evacuated twice, day 8 and 18, with good results. Primary samples showed growth of S. intermedius only. The severity of the clinical picture elicited supplementary samples, which were additionally positive for S. pneumoniae by an in-house specific lytA PCR and/or a commercial antigen test.
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Affiliation(s)
- Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Skejby, Denmark.
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Kanu OO, Ukponmwan E, Bankole O, Olatosi JO, Arigbabu SO. Intracranial epidural abscess of odontogenic origin. J Neurosurg Pediatr 2011; 7:311-5. [PMID: 21361773 DOI: 10.3171/2010.12.peds10242] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dental infection as a cause of epidural abscess is rare compared with other forms of intracranial suppurations. A 10-year-old boy was seen because of headaches and fever. There was no history of otitis media or sinusitis, but he had sought care for dental complaints. The patient was from an upper-middle-class family, was not immunocompromised, and had no other risk factor for a major infection. A CT brain scan confirmed a frontal epidural abscess. The patient underwent emergency surgery for evacuation of the epidural abscess, followed by antimicrobial therapy. His condition improved remarkably following surgery, with complete resolution of symptoms. He subsequently underwent extraction of 2 teeth following dental review. Dental infection as a cause of intracranial epidural abscess is rare, but should be considered when evaluating patients for intracranial infections. A review of the literature sheds light on the causal relationship and possible pathogenesis of this condition.
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Affiliation(s)
- Okezie Obasi Kanu
- Neurosurgery Division, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria.
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Hoxworth JM, Glastonbury CM. Orbital and Intracranial Complications of Acute Sinusitis. Neuroimaging Clin N Am 2010; 20:511-26. [DOI: 10.1016/j.nic.2010.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Passeron H, Sidy Ka A, Diakhaté I, Imbert P. Suppurations intracrâniennes à porte d’entrée otorhinolaryngologique chez l’enfant au Sénégal. Arch Pediatr 2010; 17:132-40. [DOI: 10.1016/j.arcped.2009.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Revised: 06/15/2009] [Accepted: 11/01/2009] [Indexed: 11/27/2022]
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