A case of Clival Tuberculosis and associated meningitis

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Mycobacterium tuberculosis is infamous for its ability to mimic other pathology and manifest in unusual locations.

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The clivus is an extremely rare site for manifestation of MTB.

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A high index of suspicion and empirical approach is vital for successful management, as obtaining a definitive diagnosis of intracranial MTB may take weeks or months.

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Intracranial MTB can cause potentially lethal complications including meningitis, hydrocephalus and infectious vasculitis, however appropriate and timely management may lead to good outcomes.

Herein we report a 30-year-old man presenting with fevers, headaches and weight loss. On admission he was disorientated and demonstrated no focal signs of neurological deficit. Magnetic resonance imaging revealed a large area of abnormal bone marrow signal centred within the clivus with extension into the sphenoid sinus and signs of associated basal meningitis. A sphenoid sinus biopsy was performed and proved non diagnostic. The patient was treated empirically with antitubercular therapy (ATT). Lumbar puncture provided cerebrospinal fluid from which Mycobacterium tuberculosis (MTB) was isolated 35 days later. His clinical course was complicated by development of communicating hydrocephalus requiring placement of a ventriculoperitoneal shunt and addition of thalidomide. The patient was discharged following a ten-week admission with complete resolution of symptoms and remains well two years later.

The role of antibiotics in the surgical management of paediatric obstructive sleep apnoea (OSA): a cohort study

PURPOSE

Obstructive sleep apnoea (OSA) describes an irregular night-time breathing pattern that is present in approximately 1.8% of children and can have a negative impact on quality of life. The use of antibiotics postoperatively is controversial. They are commonly prescribed; however, they can also be associated with side effects and resistance. This study explores the role of antibiotics in the post-operative management of children with OSA in a cohort of children.

METHODS

We conducted a retrospective cohort study of children undergoing surgery for OSA or sleep disordered breathing (SDB) at a tertiary paediatric ENT referral centre from November 2018 to November 2019.

RESULTS

This study identified 382 children who had undergone surgical treatment for OSA or sleep disordered breathing (SDB); 319 underwent adenotonsillectomy, 53 adenoidectomy and 10 tonsillectomies. Antibiotics were given post-operatively to 158 (41%) patients and 18 (11%) of these patients presented to hospital with post-operative complications. A higher number of patients re-presented to hospital from the group who did not receive antibiotics (p = 0.982). Bleeding (p = 0.886) and infection (p = 0.823) were also more common in those children who did not receive antibiotics.

CONCLUSION

Antibiotics led to fewer complications and re-presentations to hospital in children undergoing operative management of OSA; however, this trend was not found to be statistically significant.