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Lee WJ, Tsai MH, Hsu JF, Chu SM, Chen CC, Yang PH, Huang HR, Chi MC, Lee CW, Ou-Yang MC. The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis. Antibiotics (Basel) 2024; 13:377. [PMID: 38667053 PMCID: PMC11047628 DOI: 10.3390/antibiotics13040377] [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] [Received: 03/21/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
Background: Subdural empyema is one of the more serious complications of bacterial meningitis and therapeutic challenges to clinicians. We aimed to evaluate the clinical characteristics, treatment, and outcome of subdural empyema in neonates with bacterial meningitis. Methods: A retrospective cohort study was conducted in two medical centers in Taiwan that enrolled all cases of neonates with subdural empyema after bacterial meningitis between 2003 and 2020. Results: Subdural empyema was diagnosed in 27 of 153 (17.6%) neonates with acute bacterial meningitis compared with cases of meningitis without subdural empyema. The demographics and pathogen distributions were comparable between the study group and the controls, but neonates with subdural empyema were significantly more likely to have clinical manifestations of fever (85.2%) and seizure (81.5%) (both p values < 0.05). The cerebrospinal fluid results of neonates with subdural empyema showed significantly higher white blood cell counts, lower glucose levels and higher protein levels (p = 0.011, 0.003 and 0.006, respectively). Neonates with subdural empyema had a significantly higher rate of neurological complications, especially subdural effusions and periventricular leukomalacia. Although the final mortality rate was not increased in neonates with subdural empyema when compared with the controls, they were often treated much longer and had a high rate of long-term neurological sequelae. Conclusions: Subdural empyema is not uncommon in neonates with acute bacterial meningitis and was associated with a high risk of neurological complications, although it does not significantly increase the final mortality rate. Close monitoring of the occurrence of subdural empyema is required, and appropriate long-term antibiotic treatment after surgical intervention may lead to optimized outcomes.
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Affiliation(s)
- Wei-Ju Lee
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Shih-Ming Chu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chih-Chen Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Peng-Hong Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan; (M.-C.C.); (C.-W.L.)
| | - Hsuan-Rong Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Miao-Ching Chi
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan; (M.-C.C.); (C.-W.L.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Chiang-Wen Lee
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan; (M.-C.C.); (C.-W.L.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Mei-Chen Ou-Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
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Alnaami I. Surgical Indications and Outcomes of Postmeningitis Subdural Collection in Infants: Single Tertiary Care Center Experience. J Neurol Surg A Cent Eur Neurosurg 2023; 84:542-547. [PMID: 36539204 DOI: 10.1055/s-0042-1758675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Postmeningitis subdural collection (PMSC) is a complication in infants with bacterial meningitis. Clinical and radiologic findings enable treating teams to gain more insights into diagnosing and managing PMSC. This study aims to establish the indications for surgical management of PMSC in infants based on a single pediatric tertiary care center experience. METHODS We reviewed the hospital records of infants diagnosed with PMSC between January 2015 and December 2021. They were diagnosed based on clinical suspicion that was confirmed through imaging using computed tomography (CT) scanning or magnetic resonance imaging (MRI). All patients received antibiotic treatment, and surgical interventions using subdural drain placement or craniotomy were performed. The patients were followed up for outcomes and prognosis for 1 to 5 years. RESULTS A total of 17 infants were included in the study. Infants younger than 4 months represented most cases of PMSC (64.7%). Initially, bacterial growth was seen in the cerebrospinal fluid (CSF) of 15 (88.2%) patients. The causative agents included Streptococcus pneumoniae (58.8%), Salmonella spp. (11.7%), Streptococcus agalactiae (5.9%), Escherichia coli (5.9%), and Micrococcus luteus (5.9%). Growth in subdural fluid revealed the presence of E. coli (5.9%) and Staphylococcus hominis (5.9%). All the patients received treatments including combinations of antibiotics regimens. Major indications predisposing patients with PMSC to surgery included persistent fever, seizures, and bulging fontanel in the presence of PMSC on CT or MRI. All the patients underwent surgical operations, including subdural drain placement (76.5%) and craniotomy (23.5%). CONCLUSIONS Persistent fever, seizures, and bulging fontanel, in the presence of PMSC, were found to be the indications for surgical intervention in PMSC. Drainage of PMSC and continuation of antibiotics is a safe and effective modality for treatment in PMSC, with a reasonable outcome and acceptable rate of morbidity and mortality. Craniotomy should be reserved for those with thick pus collection, as burr hole surgery can be used to achieve the goal in the majority of patients.
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Affiliation(s)
- Ibrahim Alnaami
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Pediatric subdural empyema as a complication of meningitis: could CSF protein/CSF glucose ratio be used to screen for subdural empyema? Eur J Pediatr 2021; 180:415-423. [PMID: 32875444 DOI: 10.1007/s00431-020-03791-5] [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: 02/05/2020] [Revised: 07/02/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
Subdural empyema (SDE) is a rare condition which can appear secondary to meningitis in childhood, especially in infants. This study was planned to evaluate and compare clinical and laboratory features, treatment, and outcome of children with SDE to those with acute bacterial meningitis (ABM) without SDE. The electronic medical files of 266 patients diagnosed with ABM between January 2009 and December 2019 were evaluated. Patients' demographic and clinical features, laboratory results, cranial imaging findings, treatment, and outcomes were recorded. SDE was identified in 10 patients, 3.7% of all diagnosed with meningitis. The etiology of SDE was identified in eight (80%). The most common responsible pathogen was Streptococcus pneumoniae. Cranial imaging was performed between the 2nd and 13th days of admission, and the most common reason of performing cranial imaging was persistence of fever. Two patients were healed with 4-6 weeks of antibiotic treatment without surgery, eight (80%) needed surgical intervention.Conclusion: The clinical signs and symptoms of SDE may be subtle. If the fever persists or focal neurological findings are seen during the treatment of bacterial meningitis, SDE should be suspected. Furthermore, patients with ABM who are determined to have a protein-to-glucose ratio in the cerebrospinal fluid above 4.65 should be carefully monitored for SDE development. What is known: • Subdural empyema may develop subsequently to meningitis, especially in the infant age group in whom very little is known in terms of disease characteristics. • Delay in diagnosis and treatment can cause long-term neurologic sequelae and mortality. What is new: • Persistence or relapse of fever during the treatment of acute meningitis is an important warning sign for SDE even if there are no other symptoms. • Children with subdural empyema secondary to bacterial meningitis have higher protein-to-glucose ratio in the CSF, and a threshold of ˃ 4.65 was determined to demonstrate 100% sensitivity and 50.7% specificity.
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Yoon J, Redmond M. Check the Ear. The Importance of Ear Examinations in Assessment of Intracranial Subdural Empyema. Trop Med Infect Dis 2019; 4:tropicalmed4030120. [PMID: 31540395 PMCID: PMC6789478 DOI: 10.3390/tropicalmed4030120] [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: 08/04/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022] Open
Abstract
Intracranial subdural empyema (ISE) is an uncommon condition previously associated with almost 100% morbidity and mortality. Since the introduction of antibiotics and advancements in diagnosis the complication rates have significantly improved. We report an unusual case of a 32-year-old Aboriginal male diagnosed with ISE. On closer inspection the ISE was found to be a complication of otitis media with a cotton bud lodged in the external acoustic meatus. The report provides a literature review on the relationships of ISE, otitis media and foreign bodies. We conclude that although rare, all patients with suspected ISE should undergo an ear examination as it is at no cost to the patient or health service but may be the difference between life and death.
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Affiliation(s)
- Joseph Yoon
- Department of Neurosurgery, Royal Darwin Hospital, Darwin Northern Territory, Tiwi 0810, Australia.
| | - Michael Redmond
- Department of Neurosurgery, Royal Darwin Hospital, Darwin Northern Territory, Tiwi 0810, Australia.
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Kanu OO, Esezobor CI, Ojo OA, Asoegwu CN, Nnoli C, Dawang Y, Temiye E. Infantile supratentorial subdural empyema managed by percutaneous aspiration: an outcome study in a Nigerian city. Sudan J Paediatr 2019; 19:37-43. [PMID: 31384087 DOI: 10.24911/sjp.106-1520470056] [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] [Indexed: 11/11/2022]
Abstract
Subdural empyema (SDE), a common neurosurgical emergency in the developing countries, accounts for 15%-20% of localised paediatric intracranial infections. In regions where modern diagnostic tools are scarce and inaccessible, detection of SDE may be delayed with subsequent poor outcome. Percutaneous subdural aspiration in patients with open anterior fontanel may be the only surgical option in resource-poor regions of the world. This review focuses on the management outcome, including neurological outcome of these children. Clinical charts of children with SDE and treated by percutaneous subdural tap between February 2006 and August 2014 were reviewed. Demographic, clinical, radiological, bacteriological parameters and outcome data were analysed. Forty-five children with a mean age of 10.6 ± 6.2 months (range: 2-17 months) and followed up for a median duration of 16.4 months were included. The most frequent clinical features were enlarged head circumference, fever, focal neurologic deficits and altered level of consciousness. Diagnosis of SDE was confirmed using trans-fontanel ultrasound scan in 32 (71.1%) children, computerised tomography in 12 (26.7%) children and magnetic resonance imaging in one (2.2%) child. SDE was unilateral in 73.3% and bilateral in 26.7%. In 23 (51.1%) children with a positive culture, Staphylococcus aureus (n = 10), anaerobes (n = 7), Escherishia coli and Haemophilus influenza (n = 6 each) were the most common organisms. Forty-three children (95.6%) survived, 36 of which had good Glasgow outcome score. Seven children still had moderate deficits at 3 months. Treatment of SDE in young children with patent fontanel using percutaneous subdural tap has good therapeutic and neurological outcome.
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Affiliation(s)
- Okezie Obasi Kanu
- Neurosurgery Division, Department of Surgery, College of Medicine University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Christopher I Esezobor
- Department of Pediatrics, College of Medicine University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Omotayo A Ojo
- Neurosurgery Division, Department of Surgery, College of Medicine University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Chinyere N Asoegwu
- Department of Otorhinolaryngology, College of Medicine University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Chinenye Nnoli
- Department of Pediatrics, College of Medicine University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Yusuf Dawang
- Neurosurgery Division, Department of Surgery, College of Medicine University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Edamisan Temiye
- Department of Pediatrics, College of Medicine University of Lagos & Lagos University Teaching Hospital, Idi-Araba, Nigeria
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Konar S, Gohil D, Shukla D, Sadashiva N, Uppar A, Bhat DI, Srinivas D, Arimappamagan A, Devi BI. Predictors of outcome of subdural empyema in children. Neurosurg Focus 2019; 47:E17. [PMID: 31370020 DOI: 10.3171/2019.5.focus19268] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to report the etiology, clinical features, microbiology, surgical outcome, and predictors of outcome of spontaneous subdural empyema (SDE). METHODS The authors conducted a retrospective study in a tertiary hospital. Children up to 18 years of age, with a diagnosis of SDE with infective etiology, were included in the present cohort. Patients with posttraumatic, postsurgery, and tubercular origin of SDE were excluded from the study. The Glasgow Outcome Scale was used for outcome assessment at the end of 3 months. For analysis purposes, the demographic data, clinical features, radiological data, microbiology, type of surgery, and complication data were categorized, and univariate and multivariable logistic regression analyses were performed to identify the factors associated with outcome. RESULTS Ninety-eight children were included in the study and the mean age was 10.9 years. Otogenic origin (34.7%) was the most common source of infection, followed by meningitis (14.3%). The mean duration of symptoms was 12 days. Seventy-six children presented with Glasgow Coma Scale (GCS) score > 8 and the supratentorial location was the most common location. Almost 75% of the children underwent craniotomy or craniectomy and the rest had burr-hole evacuation. Beta-hemolytic Streptococcus (10%) was the most common organism isolated. Cerebral venous thrombosis (CVT; 10.2%) was the most frequent complication in this cohort. The other complications were infarction (6.1%), new-onset seizure (4.1%), and bone flap osteomyelitis (4.1%). Thirteen cases had a recurrence of pus collection, which was more common in the craniotomy group than in the burr-hole group. Age (p = 0.02), GCS score ≤ 8 (OR 8.15, p = 0.001), CVT (OR 15.17, p = 0.001), and presence of infarction (OR 7, p = 0.05) were strongly associated with unfavorable outcome. In multivariable logistic regression analysis, only GCS score ≤ 8 (p = 0.01), CVT (p = 0.02), and presence of infarction (p = 0.04) had a significant impact on unfavorable outcome. CONCLUSIONS Prompt diagnosis and immediate intervention is the goal of management of SDE, especially in children as a delay in diagnosis can result in unconsciousness and secondary complications such as CVT and infarction, which adversely affect outcome.
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Lundy P, Kaufman C, Garcia D, Partington MD, Grabb PA. Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr 2019; 24:14-21. [PMID: 31553545 DOI: 10.3171/2019.1.peds18434] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a retrospective analysis of a consecutive series of children with intracranial subdural empyemas (SEs) and epidural abscesses (EAs) to highlight the important clinical difference between these two entities. They describe the delays and pitfalls in achieving accurate diagnoses and make treatment recommendations based on clinical and imaging findings. METHODS They reviewed their experience with children who had presented with intracranial SE and/or EA in the period from January 2013 to May 2018. They recorded presenting complaint, date of presentation, age, neurological examination findings, time from presentation to diagnosis, any errors in initial image interpretation, timing from diagnosis to surgical intervention, type of surgical intervention, neurological outcome, and microbiology data. They aimed to assess possible causes of any delay in diagnosis or surgical intervention. RESULTS Sixteen children with SE and/or EA had undergone evaluation by the authors’ neurosurgical service since 2013. Children with SE (n = 14) presented with unmistakable evidence of CNS involvement with only one exception. Children with EA alone (n = 2) had no evidence of CNS dysfunction. All children older than 1 year of age had sinusitis. The time from initial presentation to a physician to diagnosis ranged from 0 to 21 days with a mean and median of 4.5 and 6 days, respectively. The time from diagnosis to neurosurgical intervention ranged from 0 to 14 days with a mean and median of 3 and 1 day, respectively. Delay in treatment was due to misinterpretation of images, a failure to perform timely imaging, progression on imaging as an indication for surgical intervention, or the managing clinician’s preference. Among the 14 cases with SE, initial imaging studies in 6 were not interpreted as showing SE. Four SE collections were dictated as epidural even on MRI. The only fatality was associated with no surgical intervention. Endoscopic sinus surgery was not associated with reducing the need for repeat craniotomy. CONCLUSIONS Regardless of the initial imaging interpretation, any child presenting with focal neurological deficit or seizures and sinusitis should be assumed to have an SE or meningitis, and a careful review of high-resolution imaging, ideally MRI with contrast, should be performed. If an extraaxial collection is identified, surgical drainage should be performed expeditiously. Neurosurgical involvement and evaluation are imperative to achieve timely diagnoses and to guide management in these critically ill children. ABBREVIATIONS EA = epidural abscess; SE = subdural empyema.
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Affiliation(s)
| | - Christian Kaufman
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - David Garcia
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - Michael D Partington
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - Paul A Grabb
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,2Children's Mercy Hospital and.,3University of Missouri at Kansas City, Kansas City, Missouri
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Abou-Hanna J, Panning K, Mehta H. Haemophilus influenzae Type f Meningitis Complicated by Bilateral Subdural Empyema, Central Venous Thrombosis, and Bilateral Sensorineural Hearing Loss in an Immunocompetent 12-month-old. Cureus 2019; 11:e4850. [PMID: 31410333 PMCID: PMC6684117 DOI: 10.7759/cureus.4850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Haemophilus influenzae is a gram-negative coccobacillus that colonizes the nasopharyngeal surface and upper respiratory tract of healthy individuals and includes six encapsulated serotypes as well as non-encapsulated, non-typeable strains. Since the widespread use of the Haemophilus influenzae type b (Hib) conjugate vaccine implemented in 1990, the majority of invasive illness now seen in the United States is secondary to capsular serotypes other than type b and non-typeable strains with the largest burden of disease affecting the extremes of age-infants and the elderly. We report a case of acute Haemophilus influenzae type f meningitis in a 12-month-old female who was previously healthy and had been fully immunized. She demonstrated clinical improvement on ceftriaxone, but persistent fever and ear-tugging resulted in obtaining an MRI that displayed bilateral subdural empyemas requiring burr-hole craniotomy, central venous thrombosis requiring anticoagulation, and bilateral sensorineural hearing loss requiring cochlear implants. Immunological studies confirmed immunocompetency and appropriate response to her previous Hib vaccination, suggesting a significant impact of bacterial virulence. These complications, with the exception of sensorineural hearing loss, have not been reported in the literature for Haemophilus influenzae type f and should be considered in the care of these patients despite clinical appearance given the severity of complications and potential for acute decompensation. Despite the success of vaccination in reducing invasive disease, cases of H. influenzae meningitis continue to occur via less common encapsulated serotypes with unknown complications, making the management and treatment of these infections more difficult for practitioners.
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Affiliation(s)
- Jacob Abou-Hanna
- Pediatrics, University of Michigan Medical School, Ann Arbor, USA
| | | | - Hiral Mehta
- Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, USA
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Chen JA, Mathios D, Hidalgo J, Cohen AR. Treatment-refractory Escherichia coli subdural empyema caused by infection of a chronic subdural hematoma in an infant. Childs Nerv Syst 2019; 35:719-723. [PMID: 30446813 DOI: 10.1007/s00381-018-4003-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/07/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Subdural empyema (SDE) is a neurosurgical emergency that is typically treated with surgical drainage, either by burr hole or by craniotomy. Escherichia coli is an uncommon cause of SDE and is associated with infection of a pre-existing subdural hematoma. CASE REPORT We report the case of an otherwise healthy, immunocompetent 4-month-old infant girl with an E. coli-infected subdural hematoma. The infection persisted despite aggressive neurosurgical treatment that included drainage of the subdural space through burr holes and, subsequently, a wide craniotomy was performed. Ultimately, after 30 days, the SDE resolved with good neurological outcome. A review of prior literature indicates that infected subdural hematomas (including those caused by E. coli) are typically less aggressive and respond to burr hole drainage. CONCLUSION We illustrate the fulminant progression of the SDE in the face of neurosurgical treatment. Our experience suggests lowering the threshold for wide craniotomy in these incompletely understood cases.
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Affiliation(s)
- Jason A Chen
- Department of Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Dimitrios Mathios
- Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joaquin Hidalgo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan R Cohen
- Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Williams V, Lakshmikantha KM, Nallasamy K, Sudeep KC, Baranwal AK, Jayashree M. Subdural empyema due to Salmonella paratyphi B in an infant: a case report and review of literature. Childs Nerv Syst 2018; 34:2317-2320. [PMID: 29748704 DOI: 10.1007/s00381-018-3825-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
Abstract
Intracranial infection due to Salmonella is uncommon in children. Subdural empyema (SDE) is described with Salmonella typhi as a complication of meningitis. We report a 6-month-old infant with SDE secondary to Salmonella paratyphi B who had presented with prolonged fever and enlarging head. A literature review of Salmonella SDE in infants with respect to clinical course and outcome is presented.
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Affiliation(s)
- Vijai Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India
| | | | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India.
| | - K C Sudeep
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India
| | - Arun Kumar Baranwal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India
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Hsu MH, Hsu JF, Kuo HC, Lai MY, Chiang MC, Lin YJ, Huang HR, Chu SM, Tsai MH. Neurological Complications in Young Infants With Acute Bacterial Meningitis. Front Neurol 2018; 9:903. [PMID: 30405525 PMCID: PMC6207629 DOI: 10.3389/fneur.2018.00903] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/05/2018] [Indexed: 01/27/2023] Open
Abstract
We aimed to evaluate the occurrence, treatment, and outcomes of neurological complications after bacterial meningitis in young infants. A case series study from a retrospective cohort from two tertiary-level medical centers in Taiwan between 2007 and 2016 was conducted. Eighty-five young infants aged < 90 days with bacterial meningitis were identified. 25 (29.4%) were born at preterm. Group B Streptococcus (GBS) and Escherichia coli caused 74.1% of identified cases. Despite the majority (90.6%) initially received microbiologically appropriate antibiotics, 65 (76.5%) had experienced at least one neurological complication identified at a median of 6 days (range: 1–173) after onset of bacterial meningitis. The most common neurological complication was seizure (58.8%), followed by subdural effusion (47.1%), ventriculomegaly (41.2%), subdural empyema (21.2%), hydrocephalus (18.8%), ventriculitis (15.3%), periventricular leukomalacia (11.8%), and encephalomalacia (10.6%). Nine patients (10.6%) died (including 4 had critical discharge on request) and 29/76 (38.2%) of the survivors had major neurological sequelae at discharge. Nighteen (22.4%) received surgical intervention due to these complications. After multivariate logistic regression, initial seizure (adjusted odds ratio [aOR]: 4.76, 95% confidence interval [CI]: 1.7–13.0, P = 0.002) and septic shock (aOR: 6.04; 95% CI: 1.35–27.0, P = 0.019) were independent predictors for final unfavorable outcomes. Conclusions: Neurological complications and sequelae are common in young infants after bacterial meningitis. Patients presented with early seizure or septic shock can be an early predictor of final unfavorable outcomes and require close monitoring. Further research regarding how to improve clinical management and outcomes is warranted.
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Affiliation(s)
- Mei-Hsin Hsu
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsuan-Chang Kuo
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Meiho University, Ping Tung, Taiwan
| | - Mei-Yin Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ying-Jui Lin
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Rong Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ming Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan
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Abstract
BACKGROUND Subdural empyema denotes the collection of purulent material in the subdural spaceand is commonly seen in infants and older children. In infants, the most common cause is bacterialmeningitis. In older children, sinusitis and otitis media are usually the source for subdural empyema. Theclinical symptomatology is varied and has a wide range including prolonged or recurrent fever, seizures,meningeal irritation, and raised intracranial pressure. It can mimic as well as complicate meningitis and aheightened clinical awareness is therefore paramount. AIMS AND OBJECTIVES The clinical profile, etiopathogenesis, imaging features and management of subdural empyema in children is discussed and the relevant literature is reviewed. CONCLUSION Subdural empyema is a neurosurgical emergency and rapid recognition and treatment canavoid life-threatening complications. In most cases, surgical decompression through burr hole or craniotomyis warranted. Near complete evacuation of the purulent material and appropriate long-term intravenous antibiotics are necessary for a gratifying outcome.
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Neurological complications after neonatal bacteremia: the clinical characteristics, risk factors, and outcomes. PLoS One 2014; 9:e105294. [PMID: 25364821 PMCID: PMC4217713 DOI: 10.1371/journal.pone.0105294] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 07/22/2014] [Indexed: 12/25/2022] Open
Abstract
Background Neonates with bacteremia are at risk of neurologic complications. Relevant information warrants further elucidation. Study Design This was a retrospective cohort study of neonates with bacteremia-related neurologic complications (BNCs) in a tertiary-level neonatal intensive care unit (NICU). A systemic chart review was performed conducted to identify clinical characteristics and outcomes. A cohort of related conditions was constructed as the control group. Logistic regression analysis was used to identify independent risk factors for BNC. Results Of 1037 bacteremia episodes, 36 (3.5%) had BNCs. Twenty-four cases of BNCs were related to meningitis, five were presumed meningitis, and seven occurred after septic shock. The most common causative pathogens were Group B streptococcus (41.7%) and E. coli (16.7%). The major BNCs consisted of seizures (28), hydrocephalus (20), encephalomalacia (11), cerebral infarction (7), subdural empyema (6), ventriculitis (8), and abscess (4). Eight (22.8%) neonates died and six (16.7%) were discharged in critical condition when the family withdrew life-sustaining treatment. Among the 22 survivors, eight had neurologic sequelae upon discharge. After multivariate logistic regression analysis, neonates with meningitis caused by Group B streptococcus (adjusted odds ratio [OR]: 8.90, 95% confidence interval [CI]: 2.20–36.08; p = 0.002) and combined meningitis and septic shock (OR, 5.94; 95% CI: 1.53–23.15; p = 0.010) were independently associated with BNCs. Conclusions Neonates with bacteremia-related neurologic complications are associated with adverse outcomes or sequelae. Better strategies aimed at early detection and reducing the emergence of neurologic complications and aggressive treatment of Group B streptococcus sepsis are needed in neonates with meningitis and septic shock.
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14
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Abstract
Subdural Empyema in infants and children might be life threatening if not managed properly. A search of the Pub Med database was carried out using a combination of the following terms: Subdural empyema, children, and management. Neurosurgical textbooks were reviewed as well. The prevalence, etiology, clinical features, investigations and management of SDE are reviewed in this article. Conservative management with antibiotics and follow up imaging is recommended if there are no focal deficits, change in mental status or if the patient is responding well to antibiotics. Alternatively, craniotomy is warranted in addition to antibiotics therapy. The surgeon might opt for burr holes in case the patient is frail or in septic shock.
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Madrid Gómez Tagle JA, Pacheco-Hernández P, Jiménez-Islas VG, Hernández López CA, Sánchez-Reyes BA, Ortiz MI. Brain empyema due to Escherichia coli in a 5 month-old infant: a case report and literature review. Medwave 2012. [DOI: 10.5867/medwave.2012.10.5555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Debroise A, Bosdure E, Bresson V, Scavarda D, Halbert C, Drancourt M, Chabrol B. Empyème sous-dural compliquant une méningite à méningocoque : une observation pédiatrique. Arch Pediatr 2012; 19:736-40. [DOI: 10.1016/j.arcped.2012.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 01/13/2012] [Accepted: 04/23/2012] [Indexed: 11/29/2022]
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