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Samuel O, Saliba W, Stein N, Shiner Y, Cohen-Kerem R. Emerging Clinical Features of Acute Mastoiditis in Israel: A Registry Based Cohort. Pediatr Infect Dis J 2024; 43:620-625. [PMID: 38564738 DOI: 10.1097/inf.0000000000004325] [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: 04/04/2024]
Abstract
BACKGROUND AND OBJECTIVES Acute mastoiditis (AM) is a severe infection in the young population, with possible life-threatening complications. This study aimed to characterize AM presentation, symptoms and signs, complications, and management, over a period of 10 years. METHODS This large-scale population-based cohort studied "Clalit Health Care" records, to include patients <18 years diagnosed with AM, hospitalized between the years 2008-2018. After validation, we investigated clinical symptoms and signs, pneumococcal vaccination status, complications, laboratory and microbiological parameters, imaging, antibiotic treatment and surgical interventions. RESULTS AM was diagnosed in 1189 patients, mean age of 2.71 years and 591 (49.71%) were female. Most presented with protrusion of pinna (83.1%), retro auricular redness (73.5%) and fever (71.8%). Patients <2 years of age had more symptoms (3.8 ± 1.4, opposed to 3.6 ± 1.5, P = 0.006) and showed higher white blood cell count and C-reactive protein values. Local and intracranial complications occurred in 233 (20.8%) and 75 (6.5%) patients, respectively. Complications were associated with increased white blood cell count and C-reactive protein and related to bacterial type, specifically Fusobacterium necrophorum ( P < 0.0001), for which 50% had an intracranial complication. Between the years 2008-2018, Streptococcus pneumoniae -positive cultures decreased (30.9% to 10.3%, P > 0.0001) as opposed to group-A Streptococcus (10.9% to 30.9%, P = 0.002). CONCLUSIONS This study shows a difference in AM appearance in the <2 years population and the association between white blood cell count, C-reactive protein and microbiology results with the occurrence of a complication. This may play a role in the management process, such as imaging and intervention needs. Although performed during the pneumococcal vaccine era, the disease microbiology was shown to change significantly throughout the study.
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Affiliation(s)
- Orit Samuel
- From the Department of Otolaryngology-Head and Neck Surgery, Carmel Medical Center
- The Bruce Rappaport Faculty of Medicine, the Technion
- Unit of Otoneurology, Lin Medical Center, Haifa, Israel
- University of Melbourne, Melbourne, Australia
| | - Walid Saliba
- The Bruce Rappaport Faculty of Medicine, the Technion
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Yotam Shiner
- From the Department of Otolaryngology-Head and Neck Surgery, Carmel Medical Center
- The Bruce Rappaport Faculty of Medicine, the Technion
| | - Raanan Cohen-Kerem
- From the Department of Otolaryngology-Head and Neck Surgery, Carmel Medical Center
- The Bruce Rappaport Faculty of Medicine, the Technion
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
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Feenstra E, Van Roest A, Boes J, Spiritus T, Kenis S, Duval ELIM, Vanden Bossche S, Vanden Driessche K, Jorens PG. A Pediatric Case of Fusobacterium necrophorum Mastoiditis and Meningitis Case Report in a Healthy Child and Review of the Literature. Case Rep Pediatr 2024; 2024:6365796. [PMID: 38939326 PMCID: PMC11208823 DOI: 10.1155/2024/6365796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 11/02/2023] [Accepted: 04/12/2024] [Indexed: 06/29/2024] Open
Abstract
In infants and children, bacterial meningitis caused by anaerobic bacteria is rare. However, a serious infection with the anaerobe Fusobacterium necrophorum can occur in previously healthy children with a peak incidence in preschool children and in adolescents. As the clinical presentation can be very similar to meningitis caused by aerobic bacteria, one should consider Fusobacterium necrophorum as the causative agent when preceded by or associated with otitis media with purulent otorrhea or mastoiditis, in combination with minimal or no improvement on empiric antibiotic treatment. As this pathogen can be difficult to culture, anaerobic cultures should be obtained. Prompt treatment with a third-generation cephalosporin and metronidazole should be initiated once suspected or confirmed. Surgical source control is often necessary, but even with adequate and prompt treatment, the morbidity and mortality in children with a Fusobacterium necrophorum meningitis remains high. In this report, we describe a case of Fusobacterium necrophorum meningitis in a previously healthy child and review the available literature.
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Affiliation(s)
- Elizabeth Feenstra
- Pediatrics, (Pediatric) Critical Care, Pediatric Neurology, Radiology, General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Aalt Van Roest
- Pediatrics and Microbiology, AZ Turnhout, Turnhout, Belgium
| | - Juul Boes
- Pediatrics and Microbiology, AZ Turnhout, Turnhout, Belgium
| | - Tom Spiritus
- Pediatrics and Microbiology, AZ Turnhout, Turnhout, Belgium
| | - Sandra Kenis
- Pediatrics, (Pediatric) Critical Care, Pediatric Neurology, Radiology, General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Els L. I. M. Duval
- Pediatrics, (Pediatric) Critical Care, Pediatric Neurology, Radiology, General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Antwerp, Belgium
| | - Stephanie Vanden Bossche
- Pediatrics, (Pediatric) Critical Care, Pediatric Neurology, Radiology, General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Koen Vanden Driessche
- Pediatrics, (Pediatric) Critical Care, Pediatric Neurology, Radiology, General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Philippe G. Jorens
- Pediatrics, (Pediatric) Critical Care, Pediatric Neurology, Radiology, General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Antwerp, Belgium
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Duhan S, Keisham B, Gradon JD. Fusobacterium Necrophorum bacteremia involving multi-organ systems. J Natl Med Assoc 2023; 115:577-579. [PMID: 37867129 DOI: 10.1016/j.jnma.2023.09.008] [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: 01/29/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
A 62-year-old African American man with a history of avascular necrosis (AVN) of the right hip joint presented with severe right hip pain, dyspnea, fever, tachycardia, and hypertension. Computed tomography (CT) scan showed bilateral airspace opacities with a mild tree-in-bud nodularity in the left lower lobe. Ultrasonography of the lower extremities revealed a deep venous thrombus (DVT) in the right deep veins. Blood cultures grew Fusobacterium necrophorum. CT and magnetic resonance imaging showed right hip joint destruction and septic arthritis. The patient had a complicated hospital course leading to total hip arthroplasty with antibiotic-impregnated cementing.
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Affiliation(s)
- Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore, MD 21215, USA.
| | - Bijeta Keisham
- Department of Internal Medicine, Weifang Medical University, Weifang, China
| | - Jeremy D Gradon
- Department of Internal Medicine, Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore, MD 21215, USA
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Michelson-Farkash C, Ashkenazi-Hoffnung L, Yalek A, Shiran SI, Klivitsky A, Grisaru-Soen G. Skull Base Osteomyelitis in Children: Clinical Characteristics and Potential Implications. Pediatr Emerg Care 2023; 39:869-874. [PMID: 37857457 DOI: 10.1097/pec.0000000000003065] [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: 10/21/2023]
Abstract
OBJECTIVES We describe 10 new cases of otogenic (n = 8) and nonotogenic (n = 2) skull base osteomyelitis (SBO) in previously healthy children and review the literature on SBO in the pediatric population. METHODS We retrospectively analyzed the medical records of 10 children (age range 0.9-12.8 years) discharged with a diagnosis of SBO between 2015 and 2020 in 2 children's hospitals in central Israel. RESULTS Five patients presented with fever and 5 with otological signs and symptoms. All 10 children underwent a comprehensive clinical evaluation, imaging studies (computerized tomography or magnetic resonance imaging) and laboratory investigations. The physical examination revealed neurologic findings, including nuchal rigidity, papilledema, and apathy, in 4 patients. All 8 otogenic patients underwent surgical intervention and the 2 nonotogenic patients, who were diagnosed as having deep neck and throat infections, responded well to treatment consisting of antibiotics without surgery. CONCLUSIONS Early diagnosis of pediatric SBO can be challenging because the symptoms are often nonspecific. The final diagnosis relies mainly on imaging, preferably magnetic resonance imaging. Surgical intervention is usually mandatory in the otogenic patients, whereas the nonotogenic patients respond well to medical management alone.
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Affiliation(s)
- Carmela Michelson-Farkash
- From the Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv
| | | | - Alexander Yalek
- From the Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv
| | | | - Amir Klivitsky
- Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (both centers affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
| | - Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (both centers affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)
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Narcy L, Durand S, Grimaud M, Leboucq N, Grevent D, Cambonie G, Couloigner V, Rivier F, Meyer P, Kossorotoff M. Cerebral sinovenous thrombosis associated with head/neck infection in children: Clues for improved management. Dev Med Child Neurol 2023; 65:215-222. [PMID: 35765978 DOI: 10.1111/dmcn.15331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 01/06/2023]
Abstract
AIM To compare paediatric patients with cerebral sinovenous thrombosis (CSVT) with and without head/neck infection to improve management of the condition. METHOD We conducted a bicentric retrospective study of consecutive children (neonates excluded) with radiologically confirmed CSVT, comparing children with a concurrent head/neck infection and children with other causes. RESULTS A total of 84 consecutive patients (46 males and 38 females) with a median age of 4 years 6 months (range 3 months-17 years 5 months) were included. Associated head/neck infection was identified in 65.4% of cases and represented the main identified CSVT aetiology. Children in the head/neck infection group displayed a milder clinical presentation and less extensive CSVT. Median time to complete recanalization was significantly shorter in this group (89 days [interquartile range 35-101] vs 112.5 days [interquartile range 83-177], p = 0.005). These findings were even more pronounced in the subgroup of patients with otogenic infection and no neurological sign. INTERPRETATION As CSVT in the setting of an otogenic infection and no neurological sign seems to represent a milder condition with a shorter course, these results suggest adapting current recommendations: consider earlier control imaging in paediatric otogenic CSVT, and shorter anticoagulant treatment if recanalization is obtained. WHAT THIS PAPER ADDS Children with cerebral sinovenous thrombosis related to head/neck infections have a milder clinical presentation. They also have a shorter recanalization time, especially if there is otogenic infection without neurological symptoms.
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Affiliation(s)
- Lucie Narcy
- Paediatric Neurology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France.,Sorbonne Université, Paris, France
| | - Sabine Durand
- Paediatric and Neonatal Intensive Care Unit, CHU Arnaud de Villeneuve, Montpellier, France
| | - Marion Grimaud
- Paediatric Intensive Care Unit, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboucq
- Paediatric Imaging Department, CHU Arnaud de Villeneuve, Montpellier, France
| | - David Grevent
- Paediatric Imaging Department, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Gilles Cambonie
- Paediatric and Neonatal Intensive Care Unit, CHU Arnaud de Villeneuve, Montpellier, France
| | - Vincent Couloigner
- Paediatric Otorhinolaryngology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - François Rivier
- Paediatric Neurology Department, Phymedexp, Montpellier University, Inserm, CNRS, University Hospital Montpellier, Montpellier, France
| | - Pierre Meyer
- Paediatric Neurology Department, Phymedexp, Montpellier University, Inserm, CNRS, University Hospital Montpellier, Montpellier, France
| | - Manoelle Kossorotoff
- Paediatric Neurology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France.,French Centre for Paediatric Stroke, APHP, University Hospital Necker-Enfants Malades, Paris, France
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Yosefof E, Hilly O, Sokolov M, Raveh E, Yacobovich J, Ulanovski D. Paediatric otogenic sinus venous thrombosis: the role of Fusobacterium necrophorum. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:388-394. [PMID: 36254655 PMCID: PMC9577686 DOI: 10.14639/0392-100x-n1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/06/2022] [Indexed: 11/07/2022]
Abstract
Objectives Sinus venous thrombosis (SVT) is a rare complication of acute otitis media (AOM) with acute mastoiditis (AM), which during recent years has been associated with Fusobacterium necrophorum (Fn) infection. Our objective was to review clinical, microbiologic, and hematologic features of paediatric otogenic SVT, with a specific focus on the role of Fn. Methods A retrospective database review in a tertiary paediatric hospital between 2000-2019. Results Fifty children aged 6-155 months were treated for AM with SVT. Forty-seven (94%) underwent cortical mastoidectomy. Forty-six children received low-molecular-weight heparin (LMWH). Follow-up imaging revealed recanalisation in 92% of cases. No long-term neurologic or haematologic complications were observed. Since 2014, when anaerobic cultures and PCR were routinely used in our institute, Fn was isolated from 15/21 children with SVT. Their time to recanalisation was longer, and the rate of lupus anticoagulant antibodies (LAC) was higher than in the 6 non-Fn patients. Children positive for LAC also had a longer time to recanalisation. Conclusions Fn is a common pathogen in AM with SVT; its thrombogenic role was demonstrated by a higher prevalence of LAC and a longer time to recanalisation.
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Affiliation(s)
- Eyal Yosefof
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Aviv University, Aviv, Israel,Correspondence Eyal Yosefof Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva 4941492, Israel Tel. +972 3 9376456. Fax +972 3 9376467 E-mail:
| | - Ohad Hilly
- Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Meirav Sokolov
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel, Pediatric Otorhinolaryngology Unit, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Eyal Raveh
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel, Pediatric Otorhinolaryngology Unit, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Joanne Yacobovich
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel, Pediatric Hematology Unit, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - David Ulanovski
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel, Pediatric Otorhinolaryngology Unit, Schneider Children’s Medical Center, Petach Tikva, Israel
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7
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Hirschhorn A, Averbuch D, Michaan N, Adler A, Grisaru-Soen G. Invasive Fusobacterium Infections in Children: A Retrospective Multicenter Study. Pediatr Infect Dis J 2022; 41:517-523. [PMID: 35363651 DOI: 10.1097/inf.0000000000003514] [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: 11/25/2022]
Abstract
BACKGROUND The past decade has witnessed a rise in Fusobacterium infections. This study aimed to describe the epidemiology, clinical and demographic characteristics and outcomes associated with Fusobacterium infections in hospitalized children in central Israel. METHODS We retrospectively analyzed the medical records of children <18 years old who had been admitted with a diagnosis of invasive Fusobacterium infection (IFI) between January 2010 and April 2020. Clinical, laboratory and microbiologic data were retrieved. IFI diagnosis was based upon microbiological identification in any specimen by culture or by 16S ribosomal RNA polymerase chain reaction. RESULTS Fifty-one children (26 boys) with a median age of 3 years (range, 5-16 years) were included. Hospitalizations for IFI increased from 19 of 100,000 admissions between 2010 and 2015 to 50 of 100,000 between 2016 and 2020, representing a 2.5-fold increase. Most of the infections were from an otogenic source (n = 28, 55%) followed by an oropharyngeal/respiratory source (n = 21, 41%). The most common complications were subperiosteal and epidural abscesses (41% and 37%, respectively). Thrombosis was diagnosed in 11 children, 10 of whom had sinus vein thrombosis. All had an otogenic source. Children with otogenic compared with all other infection sources were significantly younger (median age of 1.9 vs. 3 years; P < 0.001). Forty-seven children (92%) underwent a surgical intervention. All patients survived, one with neurologic sequelae. CONCLUSIONS The admissions for IFI in children increased 2.5-fold during the last decade. The most common source is otogenic, especially among younger children, and it is associated with high complication rates. Current management, including combinations of antibiotics and surgical interventions, leads to favorable outcome.
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Affiliation(s)
- Adi Hirschhorn
- From the Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Diana Averbuch
- Paediatric Infectious Diseases, Paediatric Division, Hadassah Medical Center, Jerusalem, Israel, affiliated to the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadav Michaan
- Microbiology Laboratory
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Galia Grisaru-Soen
- From the Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Thevis M, Leow TYS, Bekkers S, Otten J, Waterval JJ, Derks J, Buil JB, Kunst DPM, Jansen TTG. Diagnosis, treatment and prognosis of otomastoiditis induced by Fusobacterium necrophorum: A retrospective multicentre cohort study. Anaerobe 2022; 76:102587. [PMID: 35595214 DOI: 10.1016/j.anaerobe.2022.102587] [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: 10/27/2021] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Otomastoiditis caused by the anaerobic Fusobacterium necrophorum (F. necrophorum) often induces severe complications, such as meningitis and sinus thrombosis. Early diagnosis is difficult, partly because little is known about specific early signs. Comprehensive research about clinically chosen antimicrobial therapy has not been done yet and prognostic information about otomastoiditis caused by F. necrophorum is scarce. More knowledge about this subject is required. METHODS In this retrospective cohort study, we included all cases of otomastoiditis caused by F. necrophorum treated in two university medical centres in the Netherlands during the past 10 years. Data was gathered from patient records and analysed using independent sample T-tests and Chi2-tests. RESULTS This study reveals that otomastoiditis caused by F. necrophorum potentially induces neurological sequelae. Thereby, 80% of all included patients (n = 16) needed readmission within six months due to recurrence or complications of otomastoiditis caused by F. necrophorum. Mean (range) of age, CRP and temperature were 4.5 years (0.9-29.3), 243 mg/L (113-423) and 40 °C (37-41). All patients were hospitalized and treated with antibiotics, mostly metronidazole (n = 13/16) and a β -lactam (n = 15/16). Additional treatment contained low molecular weight heparin (83%, n = 10/12), dexamethasone (78%, n = 7/9) and/or surgery (80%, n = 12/16, whereof 9/12 mastoidectomy). CONCLUSIONS Patients and/or their parents need to be informed about this potential unfortunate prognosis when otomastoiditis caused by F. necrophorum is diagnosed. To improve early diagnosis, otomastoiditis caused by F. necrophorum should be suspected and therefore immediately cultured when a) young children present with otomastoiditis, with b) high CRP values, and/or c) vomiting and decreased consciousness.
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Affiliation(s)
- Madelon Thevis
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Theresa Y S Leow
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Stijn Bekkers
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Josje Otten
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Jerome J Waterval
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Jolanda Derks
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - Jochem B Buil
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Dirk P M Kunst
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Thijs T G Jansen
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen/Maastricht, the Netherlands; Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
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Xiao J, Jiang J, He X, Zhang S, Wang Z, Wang F, Wang L, Guo D. Evaluation of Immunoprotective Effects of Fusobacterium necrophorum Outer Membrane Proteins 43K OMP, Leukotoxin and Hemolysin Multi-Component Recombinant Subunit Vaccine in Mice. Front Vet Sci 2021; 8:780377. [PMID: 34938794 PMCID: PMC8685265 DOI: 10.3389/fvets.2021.780377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 12/04/2022] Open
Abstract
We evaluated the efficacy of three vaccine formulations containing different combinations of proteins (43K OMP, leukotoxin recombinant protein PL4 and hemolysin recombinant protein H2) and killed whole cell Fusobacterium necrophorum in preventing liver abscess. Four subcutaneous vaccines were formulated: vaccine 1 (43K OMP), vaccine 2 (PL4 and H2), vaccine 3 (43K OMP, PL4 and H2), and vaccine 4 (killed whole bacterial cell). 43K OMP, PL4, and H2 proteins were produced by using recombinant protein expression. To evaluate vaccine efficacy, we randomly allocated 50 BALB/c female mice to one of five different treatment groups: PBS control group, vaccine 1, vaccine 2, vaccine 3, and vaccine 4. Mice were vaccinated three times, with 14 days between each immunization. After immunization, the mice were challenged with F. necrophorum. The three key findings of this study are as follows: (1) Vaccine 3 has enabled mice to produce higher antibody titer following bacterial challenge, (2) in the liver pathology of mice, the vaccine 3 liver showed the least pathology, and (3) all four vaccines produced high levels of antibodies and cytokines in mice, but the level of vaccine 3 was the highest. Based on our results, it has been demonstrated that a mixture of F. necrophorum 43K OMP, PL4, and H2 proteins inoculated with mice can achieve protection against liver abscess in mice. Our research may therefore provide the basis for the development of a vaccine against F. necrophorum bovine infections.
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10
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Paediatric otogenic cerebral venous sinus thrombosis: a multidisciplinary approach. The Journal of Laryngology & Otology 2021; 136:3-7. [PMID: 34698003 DOI: 10.1017/s0022215121003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paediatric otogenic cerebral venous sinus thrombosis is a rare, heterogeneous and life-threatening condition, with possible otological, neurological and ophthalmological sequelae. Its course and outcomes can be widely variable. The publications available often consider individual aspects of paediatric otogenic cerebral venous sinus thrombosis management. The condition itself and the nature of the currently available guidance can lead to uncertainties when holistically managing patients with paediatric otogenic cerebral venous sinus thrombosis. OBJECTIVES Clear recommendations for the comprehensive assessment and management of paediatric otogenic cerebral venous sinus thrombosis are presented, along with the literature review upon which they are based. Its clinical and radiological assessment are discussed. CONCLUSION A multidisciplinary approach to assessment and management is recommended, inclusive of infectious diseases, ENT surgery, neurology, ophthalmology and haematology. On balance, anticoagulation is recommended for three months. Follow-up imaging is not recommended in the absence of clinical concern. Follow up by ENT surgery, neurology and ophthalmology departments is recommended.
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Goggin KP, Beckmann N, Bettin K, Carrillo-Marquez M, Wood J, Arnold SR. Lemierre's Syndrome Due to the Zoonotic Anaerobe Bacteroides pyogenes: Case Report and Literature Review. J Pediatric Infect Dis Soc 2021; 10:886-888. [PMID: 34038561 DOI: 10.1093/jpids/piab001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 05/24/2021] [Indexed: 11/14/2022]
Abstract
Although Fusobacterium necrophorum is well described as an emerging pathogen of acute mastoiditis in young children, infection with other anaerobes can lead to similar severe sequelae including intracranial and extracranial suppurative thrombophlebitis and sepsis. We describe a patient whose unremarkable exposure history assumed increased significance upon obtaining the results of 16S next generation sequencing from a surgical specimen. The novel pathogen Bacteroides pyogenes is reviewed herein.
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Affiliation(s)
- Kathryn P Goggin
- Department of Pediatrics, Division of Infectious Diseases, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nicholas Beckmann
- Department of Otolaryngology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kristen Bettin
- Department of Pediatrics, Division of Academic Hospital Medicine, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Maria Carrillo-Marquez
- Department of Pediatrics, Division of Infectious Diseases, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joshua Wood
- Department of Otolaryngology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sandra R Arnold
- Department of Pediatrics, Division of Infectious Diseases, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Sapir A, Ziv O, Leibovitz E, Kordeluk S, Rinott E, El-Saied S, Greenberg D, Kaplan DM. Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis in children in southern Israel: A 12-year retrospective comparative study (2005-2016). Int J Pediatr Otorhinolaryngol 2021; 140:110485. [PMID: 33168224 DOI: 10.1016/j.ijporl.2020.110485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To define the trends in acute mastoiditis (AM) incidence, microbiology, complications and management in children, before and after the 13-valent pneumococcal conjugate vaccine (PVC13) introduction. METHODS Medical records of all AM patients <15 years of age diagnosed during 2005-2016 were reviewed. The study years were divided into three periods: pre-vaccination (2005-2008), interim (2009-2011) and post-PCV13 vaccination (2012-2016). RESULTS 238 patients (53.4% males) were enrolled, 81, 56 and 101 in the 3 time periods, respectively. Overall, 177/238 (75.2%) of children were <5 years of age. Mean AM incidence in the whole population was 10.32/100,000, with no changes during the study years. Ninety-three (45.6%) of 204 evaluable patients had positive middle ear fluid/mastoid cultures; S. pneumoniae (SP) was isolated in 47/93 (50.5%) cases. Mean incidence of SP-AM during the study years was 2.49 cases/100,000. A trend for decrease in mean incidence of SP-AM was recorded between the pre and the post-vaccination periods (3.05/100,000 vs. 1.82/100,000, P = 0.069). Among patients <5 years, SP-AM rates decreased from pre to post-vaccination period (19/50, 38% vs. 15/73, 20.6%, P = 0.034). No changes were reported in percentages of culture negative-AM and of AM complications in the post-PCV13 period compared with the pre-vaccine period. A significant decrease in distribution of PCV13 serotypes was recorded (17/19, 89.5% vs. 8/12, 66.6% and vs. 7/16, 43.75% during the 3 study periods, P = 0.015) accompanied by a complementary increase in non-vaccine serotypes. CONCLUSIONS The introduction of PCV13 was accompanied by a significant decrease in SP-AM cases among children <5 years of age. PCV13 serotypes decreased significantly as etiologic agents of SP-AM while non-vaccine serotypes and culture negative-AM became more common in the postvaccination period.
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Affiliation(s)
- Aviad Sapir
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Oren Ziv
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Eugene Leibovitz
- Pediatric Infectious Disease Unit, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel.
| | - Sophia Kordeluk
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Ehud Rinott
- Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
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Ulanovski D, Shavit SS, Scheuerman O, Sokolov M, Hilly O, Raveh E. Medical and surgical characteristics of fusobacterium necrophorum mastoiditis in children. Int J Pediatr Otorhinolaryngol 2020; 138:110324. [PMID: 32911237 DOI: 10.1016/j.ijporl.2020.110324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate and compare characteristics of Fusobacterium necrophorum mastoiditis (FnM) to characteristics of acute mastoiditis (AM) caused by other bacteria in tertiary children hospital Methods : Children with FnM (N=43) and non FnM (N=88). Assess medical, microbiologic and imaging characteristics, surgical findings and postoperative recovery. RESULTS Children with FnM had a positive history of otitis media, ear discharge and sub-periosteal abscess (p=0.0004, 0.09, 0.0003, respectively) at presentation. Their temperature, WBC and CRP were significantly higher (39.8 vs. 37.9, 19.4K vs. 16.1K, 21 vs. 8.7, p=0.0001). Positive culture was found in 46% of patients; 64% were diagnosed by PCR. CT scan was indicated in 95% and surgical intervention in 93% of children with FnM, compared to 15% and 9.7% of children in the non-FnM group (p=0.0001). Complex post-operative course was frequent for the FnM group: 88% of children had persistent fever, 46% had additional imaging and 14% additional surgical intervention. Children with FnM were treated with IV antibiotics for an average of 22 compared to seven days for non-FnM children (p=0.0001). CONCLUSIONS Fusobacterium should be suspect in a child presenting with AM, a septic appearance, high fever and increased inflammation markers. A regimen of two antibiotics should be empirically started, then proceed to imaging and early surgical intervention. A relatively slow post-operative recovery process should be expected; however, prognosis is good.
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Affiliation(s)
- David Ulanovski
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Stern Shavit
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Meirav Sokolov
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Raveh
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jung M, Mlynski R, Weiss NM. [Medical examination: Preparation for ENT specialisation : Part 51]. HNO 2020; 68:949-954. [PMID: 33021686 DOI: 10.1007/s00106-020-00943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Jung
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - R Mlynski
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - N M Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland.
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Rosenthal A, Gans H, Schwenk HT. A 10-Month-Old Female With Complicated Mastoiditis Due to Fusobacterium necrophorum: A Case Report and Literature Review. J Pediatric Infect Dis Soc 2020; 9:399-401. [PMID: 32531061 DOI: 10.1093/jpids/piaa059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/16/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Ayelet Rosenthal
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Hayley Gans
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Hayden T Schwenk
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Coudert A, Fanchette J, Regnier G, Delmas J, Truy E, Nicollas R, Akkari M, Couloignier V, Ayari-Khalfallah S. Fusobacterium necrophorum, a major provider of sinus thrombosis in acute mastoiditis: A retrospective multicentre paediatric study. Clin Otolaryngol 2019; 45:182-189. [PMID: 31746543 DOI: 10.1111/coa.13478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/22/2019] [Accepted: 11/09/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate in children the clinical severity and evolution of otogenic lateral sinus thrombosis (OLST) due to Fusobacterium necrophorum compared with other bacterial otogenic thrombosis and propose a specific management flowchart for Fusobacterium OLST. DESIGN A retrospective multicentre cohort study. SETTINGS Four French ENT paediatric departments. PARTICIPANTS A total of 260 under 18 years old admitted for acute mastoiditis were included. Initial imaging was reviewed to focus on complicated mastoiditis and 52 OLST were identified. Children were then divided into two groups according to bacteriological results: 28 in the "OLST Fusobacterium group" and 24 in the "OLST other bacteria group". RESULTS There was a significant association between F necrophorum and OLST (P < .001). When compared to the OLST other bacteria group, children in the OLST Fusobacterium group were significantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation: higher CRP (113 mg/L vs 175.7 mg/L, P = .02) and larger subperiosteal abscess (14 mm vs 21 mm, P < .01). Medical management was also more intensive in the OLST Fusobacterium group than in the OLST other bacteria group: increased number of conservative surgeries (66.7% vs 92.9%, P = .03) and longer hospital stay (13.7 days vs 19.8 days, P = .02). At the end of follow-up, the clinical course was good in both groups without any neurological sequelae. CONCLUSIONS Thrombotic complications are very frequent in case of Fusobacterium mastoiditis and clinicians should be aware of the initial severity of the clinical presentation. Under appropriate management, the clinical course of Fusobacterium OLST is as good as that of other bacterial otogenic thrombosis.
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Affiliation(s)
- Aurélie Coudert
- Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France
| | - Julia Fanchette
- Service d'ORL Pédiatrique, Hôpital Necker, Centre Hospitalier et Universitaire, Paris, France
| | - Gaëlle Regnier
- Service d'ORL Pédiatrique, Hôpital Gui de Chauliac, Centre Hospitalier et Universitaire, Montpellier, France
| | - Justine Delmas
- Service d'ORL Pédiatrique, Hôpital de la Timone, Centre Hospitalier et Universitaire, Marseille, France
| | - Eric Truy
- Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France
| | - Richard Nicollas
- Service d'ORL Pédiatrique, Hôpital de la Timone, Centre Hospitalier et Universitaire, Marseille, France
| | - Mohamed Akkari
- Service d'ORL Pédiatrique, Hôpital Gui de Chauliac, Centre Hospitalier et Universitaire, Montpellier, France
| | - Vincent Couloignier
- Service d'ORL Pédiatrique, Hôpital Necker, Centre Hospitalier et Universitaire, Paris, France
| | - Sonia Ayari-Khalfallah
- Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France
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