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Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Acute mastoiditis. Am J Emerg Med 2024; 79:63-69. [PMID: 38368849 DOI: 10.1016/j.ajem.2024.02.009] [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: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures. CONCLUSIONS An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Alshehri S, Alahmari KA. Pediatric Acute Mastoiditis in Saudi Arabia: Demographic Insights, Clinical Profiles, and Prognostic Factors. CHILDREN (BASEL, SWITZERLAND) 2024; 11:402. [PMID: 38671619 PMCID: PMC11048861 DOI: 10.3390/children11040402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
Acute mastoiditis, a complication of otitis media, poses significant challenges in diagnosis and treatment, particularly in pediatric populations. This study aims to comprehensively evaluate the demographic characteristics, clinical features, and prognostic factors associated with acute mastoiditis in pediatric patients in Saudi Arabia. Analysis of a multicenter dataset was conducted to assess demographic variables, symptomatology, disease course, and predictors of acute mastoiditis in pediatric patients. Significant associations were found between demographic variables (age group, gender, nationality) and acute mastoiditis risk. Symptomatology analysis revealed consistent frequencies of otalgia across age groups and genders. Disease course analysis highlighted a mean duration from symptom onset to diagnosis of 14.11 days, with frequent complications like mastoid abscess and meningitis. Predictor identification identified symptoms (otalgia, fever, otorrhea), duration of illness, and complications as significant predictors of disease severity. These findings contribute valuable insights into the epidemiology and clinical management of acute mastoiditis, informing targeted interventions to improve patient outcomes.
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Affiliation(s)
- Sarah Alshehri
- Otology and Neurotology, Department of Surgery, College of Medicine, King Khalid University, Abha 61423, Saudi Arabia
| | - Khalid A. Alahmari
- Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61423, Saudi Arabia;
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Häußler SM, Peichl J, Bauknecht C, Spierling K, Olze H, Betz C, Stölzel K. A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases. Otol Neurotol 2024; 45:e241-e247. [PMID: 38238923 DOI: 10.1097/mao.0000000000004089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Acute mastoiditis (AM) is a potentially life-threatening condition primarily affecting children. To date, there are no consistent criteria or valid guidelines for the diagnosis and treatment of pediatric AM. Therefore, this study evaluates the clinical course of AM in terms of clinical signs and treatment. In addition, a novel classification scheme for the disease and a treatment algorithm is being proposed. METHODS Patient records over a 12-year period from a single center were reviewed to identify confirmed cases of AM in children. Data collected included clinical signs, body temperature, and infection parameters during the disease, as well as radiological imaging, antibiotics, and surgical as well as conservative treatment. In addition, a classification of the AM stages was established in accordance with the findings described and practical experience, consisting of four stages (1, mastoidal irritation; 2, mild AM; 3, advanced AM; 4, advanced AM and additional complications) with corresponding treatment recommendations. In the retrospective cohort, those AM cases that were treated alongside the classification were compared with the rest concerning clinical course and outcome. RESULTS A total of 109 patients (mean age, 3.8 ± 3.8 years) were included. The main symptoms at hospital admission were auricular protrusion (n = 73; 67.0%), fever (n = 56; 51.4%) with a mean temperature of 38.3 ± 1.1°C, and otalgia (n = 28; 25.7%). The mean laboratory-tested levels of leukocytes and C-reactive protein at the time of hospital admission were 15.96 ± 8.7/nl and 59.6 ± 54.0 mg/L, respectively. During winter, there was a higher prevalence of AM, with peak hospital admissions in April (n = 22). The most common pathogen was Streptococcus pyogenes (32 cases). Treatment was purely conservative in four cases, whereas the remaining cases underwent surgery (41× grommet insertion, 64× plus mastoidectomy). The outcome was generally good, but in eight patients a second surgical procedure had to be performed as they showed signs of clinical deterioration. A total of 101 patients were treated according to the proposed algorithm, and all of which had a good outcome without the need for further interventions. CONCLUSION Based on clinical experience in a large cohort of pediatric AM patients, a novel diagnostic and treatment algorithm has been developed and successfully tested in a retrospective cohort for AM in children to prevent further complications and to ease its management by pediatricians and otorhinolaryngologists in the emergency setting.
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Affiliation(s)
| | - Jonathan Peichl
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - Christian Bauknecht
- Institute of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, Berlin 10117, Germany
| | - Katja Spierling
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Christian Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Wesson T, Sharma D, Rodman C, Tucker BJ, Romano DR, Chen J, Mulinaro L, Carroll AE, Illing EA, Bennett W, Burgin SJ. Evolving microbial patterns of acute mastoiditis in pediatric patients undergoing mastoidectomy. Int J Pediatr Otorhinolaryngol 2023; 172:111690. [PMID: 37544073 DOI: 10.1016/j.ijporl.2023.111690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To investigate the microbial patterns and clinical outcomes of pediatric patients undergoing mastoidectomy for acute coalescent mastoiditis and to identify factors associated with poor outcomes and/or prolonged treatment. STUDY DESIGN Monocentric retrospective cohort study. SETTING Tertiary referral pediatric hospital in Indiana. METHODS By cross-referencing database data from the Pediatric Health Information System (PHIS) querying for all inpatient stays (patients younger than eighteen) with a diagnostic code of mastoiditis between January 1st, 2010 and August 31, 2019, and the electronic health record (Cerner) for Riley Hospital for Children, 46 patients with mastoidectomy were included. A two-tailed T-test was used to evaluate continuous parametric data. Statistical significance was determined as P < 0.05. For continuous variables, data was analyzed using continuous logistic regression. A criteria of p > 0.1 was used for inclusion in the multivariate regression. RESULTS Inclusion criteria was met by 46 patients. From 2010 to 2019, S. pyogenes and S. pneumoniae were the most common bacteria, each isolated in 11 of 42 bacterial isolates (26.2%). There was no growth in 35.4% (17/48) of intra-operative wound cultures. On univariate analysis, patients with negative cultures had longer length of hospital stay (LOS) (7.7 days [6.5] vs. 4.3 [2.8]; p = 0.018) as well as higher rates of PICC (peripherally inserted central catheter) placement (53.3% vs. 19.4%; p = 0.021). There was a statistically significant difference in terms of gender (p = 0.021), with 15 males and 16 females in the positive culture cohort and 13 males and 2 females in the negative culture cohort. On multivariate analysis, which included gender, PICC placement, both intracranial and extracranial complications, duration of antibiotics, and LOS, female gender was the only significant predictor of positive culture status (p = 0.039). CONCLUSION S. pyogenes and S. pneumoniae were the predominant etiologic agents in acute coalescent mastoiditis between 2010 and 2019, and negative wound cultures were associated with worse clinical outcomes.
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Affiliation(s)
- Troy Wesson
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dhruv Sharma
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Cole Rodman
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Brady J Tucker
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel R Romano
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jerry Chen
- Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Lindsay Mulinaro
- Indiana University School of Medicine, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA
| | - Aaron E Carroll
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Pediatrics, Indianapolis, IN, USA
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA
| | - William Bennett
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Pediatrics, Indianapolis, IN, USA
| | - Sarah J Burgin
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA. http://sburgin.iupui.edu
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Saeed A, Maharjan R. A Child With Retroauricular Tenderness: Is It Really Mastoiditis? Cureus 2023; 15:e39394. [PMID: 37362478 PMCID: PMC10286815 DOI: 10.7759/cureus.39394] [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: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
The presence of retroauricular tenderness and erythema has always been closely linked to a diagnosis of acute mastoiditis (AM), a condition that has become less common over the years given the advent of antibiotics and pneumococcal vaccination. However, other etiologies such as retroauricular cellulitis can also present similarly. We present the case of a 10-year-old patient who presented with outward and downward protrusion of the left ear with retroauricular tenderness and erythema and was initially presumed to have a diagnosis of AM and admitted for intravenous antibiotic management. Imaging was negative for any evidence of AM, and in retrospect, the patient was diagnosed with retroauricular cellulitis secondary to acute otitis externa. Being familiar with this differential of retroauricular pain and tenderness can lead to more cost-effective patient care and a different approach with antibiotic management.
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Affiliation(s)
- Alaa Saeed
- Pediatrics, Woodhull Medical Center, Brooklyn, USA
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Purchase SL, Bazaliiskii VI, Lieverse AR. An innovative method to visualise mastoiditis using a hand-held X-ray system. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 26:22-26. [PMID: 31176196 DOI: 10.1016/j.ijpp.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 05/14/2019] [Accepted: 05/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We explore the utility of using a hand-held X-ray system to diagnose mastoiditis in archaeological populations. MATERIALS A sample (n = 56) of hunter-fisher-gatherers from the Early Neolithic (8,000-7,000/6,800 cal. BP) Cis-Baikal cemetery of Shamanka II (Russia) were examined. METHODS Images were taken medio-laterally, approximately 90° to a sensor temporarily affixed to the lateral surface of the mastoid process. Digital radiographs were analysed for signs of mastoiditis occurring pre- and/or post-puberty. RESULTS Two thirds of individuals (39/56) exhibited evidence of mastoiditis. Chronic mastoiditis and chronic sinusitis co-occurred in 61.5% (24/39) of observable individuals. CONCLUSIONS This method was found to be an effective, convenient, and versatile non-destructive alternative to sectioning and traditional radiographic imaging. SIGNIFICANCE This is the first project to adapt a hand-held X-ray system for imaging and diagnosis of mastoiditis and this approach encourages future analyses of this infection. LIMITATIONS The cost of the imaging system is limiting and there are few comparative images taken in the same plane. SUGGESTIONS FOR FURTHER RESEARCH Further research should create a larger catalogue of comparative radiographs and assess the diagnostic potential of imaging the mastoid process to rather than imaging the entire pneumatized portion of the temporal bone.
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Affiliation(s)
| | | | - Angela R Lieverse
- Department of Archaeology and Anthropology, University of Saskatchewan, Canada
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Orhan K, Aksoy S, Avsever IH, Gündüz K. Incidental Findings in TMJ Imaging. IMAGING OF THE TEMPOROMANDIBULAR JOINT 2019. [PMCID: PMC7115005 DOI: 10.1007/978-3-319-99468-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For years, the conventional imaging modalities are generally used in dental practice routine. They provide precious information about dentomaxillofacial region; they also have some limitations such as superimpositions, magnifications, distortions, and low-image quality. Because of these limitations, some pathologies, calcifications, and anatomical variations may be missed. Any findings on a radiographic image which are not related to the research areas of interest could be a description of “incidental findings.” Calcifications are one of these incidental findings. They are asymptomatic and also common in TMJ images. Although most of the calcifications require no treatment, correct identification will reduce further diagnostic assessments. Incidental findings on TMJ images were rare, while examining images for temporomandibular disorders and associated issues, it is important not only to examine the TMJ structures but also to look at the nearby anatomical features to check for evidence of incidental findings pathologies that may have mimicked signs and symptoms of TMJ disorders.
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Balsamo C, Biagi C, Mancini M, Corsini I, Bergamaschi R, Lanari M. Acute mastoiditis in an Italian pediatric tertiary medical center: a 15 - year retrospective study. Ital J Pediatr 2018; 44:71. [PMID: 29914542 PMCID: PMC6006960 DOI: 10.1186/s13052-018-0511-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 06/08/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute mastoiditis is the main suppurative complication of acute otitis media. Its incidence ranges from 1.2 to 4.2/100.000 children/year and a rise has been reported in the last years. There are controversial data regarding risk factors for mastoiditis and its complications. AIM OF THE STUDY to evaluate demographics and clinical characteristics of children with acute mastoiditis and to identify possible risk factors for complications. METHODS We retrospectively reviewed medical charts of all the children aged 1 month-14 years admitted to our Paediatric Emergency Department from January 2002 to December 2016. RESULTS One hundred forty-seven cases (97 males and 50 females) were included in the analysis, mean age was 4.8 ± 3.6 years and 28.2% of the patients were younger than 2 years. We found an increasing number of mastoiditis per year during the last 3 years of the study. Children younger than 2 years were less treated with antibiotics for acute otitis media or treated for a shorter period (p < 0.05), while they were treated at higher antibiotic's dosage for mastoiditis (p < 0.01). Older children presented more frequently with symptoms such as earache or retroauricular pain (p < 0.0001, p < 0.001). We didn't identify any risk factor for mastoiditis complications in our study. CONCLUSIONS Despite the introduction of pneumococcal vaccines, the incidence of acute mastoiditis in our population has not been reduced during the last years. We have to face all the reasons why this condition is still relevant, such as antibiotic resistance, new pathogens involved and a possible role played by the implementations of therapeutic acute otitis media guidelines restricting the use of antibiotics in this disease. A particular attention should be given to younger children where signs and symptoms may be less pronounced, therefore acute otitis media or mastoiditis may be misunderstood and appropriate treatment delayed.
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Affiliation(s)
- Claudia Balsamo
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Carlotta Biagi
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Margherita Mancini
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Ilaria Corsini
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Rosalba Bergamaschi
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, Azienda Ospedaliera – Universitaria di Bologna, Policlinico Sant’Orsola – Malpighi, via Massarenti 10, 40100 Bologna, Italy
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Sakaida H, Usui S, Matsuda Y, Masuda S, Takeuchi K. Sonographic diagnosis of acute mastoiditis and subsequent retroauricular abscess in a pediatric cochlear implant recipient: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:515-519. [PMID: 28369924 DOI: 10.1002/jcu.22442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/15/2016] [Accepted: 12/04/2016] [Indexed: 06/07/2023]
Abstract
When acute mastoiditis occurs in cochlear implant recipients, it can progress to subsequent retroauricular abscess due to the absence of the external mastoid cortex resulting from mastoidectomy performed for cochlear implantation. The management goal is to control infection while preserving the implanted device. A 2-year-old boy with cochlear implants developed acute mastoiditis and a subsequent retroauricular abscess. The patient underwent a surgical intervention based on the diagnosis made utilizing gray-scale and power Doppler sonography. This case illustrates the diagnostic usefulness of sonography in this rare situation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:515-519, 2017.
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Affiliation(s)
- Hiroshi Sakaida
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Satoko Usui
- Department of Otorhinolaryngology, National Mie Hospital, Tsu, Mie, Japan
| | - Yasunori Matsuda
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Sawako Masuda
- Department of Otorhinolaryngology, National Mie Hospital, Tsu, Mie, Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Taheri PA, Jafari M, Mehrazmai F. An unusual presentation of group A streptococcus infection in a newborn: with acute mastoiditis with no obvious clinical manifestation. CASE REPORTS IN PERINATAL MEDICINE 2017. [DOI: 10.1515/crpm-2017-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Acute mastoiditis (AM) is rarely seen in newborns. It is characterized by retroauricular pain, swelling, tenderness and protrusion of the auricle. This is the first report of the neonatal mastoiditis in a 17-day-old term neonate with no obvious clinical manifestation of mastoiditis and no associated malformation of the ears and mastoids. A computed tomography (CT) scan of the temporal bones revealed right mastoiditis without osteitis, destruction of the mastoid bone or abscess formation. Discharge culture revealed streptococcus A colonies sensitive to ampicillin, ceftriaxone, vancomycin and chloramphenicol. She was successfully treated with intravenous ampicillin and ceftizoxime. No complication or recurrence was reported.
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Affiliation(s)
- Peymaneh Alizadeh Taheri
- Full Professor of Pediatrics, Neonatologist , Bahrami Children Hospital , Tehran University of Medical Sciences , Shahid Kiai St., Damavand Ave. , Tehran 1641744991, Iran , Phone: +982173013420, Fax: +982177568809
| | - Mohsen Jafari
- Department of Pediatric Infectious diseases , Bahrami Children Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Fouzieh Mehrazmai
- Department of Pediatrics , Bahrami Children Hospital , Tehran University of Medical Sciences , Tehran , Iran
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Javali M, Acharya P, Mehta A, John AA, Mahale R, Srinivasa R. Use of multiplex PCR based molecular diagnostics in diagnosis of suspected CNS infections in tertiary care setting-A retrospective study. Clin Neurol Neurosurg 2017; 161:110-116. [PMID: 28866263 DOI: 10.1016/j.clineuro.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/22/2017] [Accepted: 08/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES CNS infections like meningitis and encephalitis pose enormous healthcare challenges due to mortality, sequelae and socioeconomic burden. In tertiary setting, clinical, microbiological, cytological and radiological investigations are not distinctive enough for diagnosing microbial etiology. Molecular diagnostics is filling this gap. We evaluated the clinical impact of a commercially available multiplex molecular diagnostic system - SES for diagnosing suspected CNS infections. PATIENTS AND METHODS This study was conducted in our tertiary level Neurology ICU. 110 patients admitted during Nov-2010 to April-2014 were included. CSF samples of patients clinically suspected of having CNS infections were subjected to routine investigation in our laboratory and SES test at XCyton Diagnostics. We studied the impact of SES in diagnosis of CNS infections and its efficacy in helping therapeutic management. RESULTS SES showed detection rate of 42.18% and clinical specificity of 100%. It had 10 times higher detection rate than conventional tests. Streptococcus pneumoniae and Mycobacterium tuberculosis were two top bacterial pathogens. VZV was most detected viral pathogen. SES results elicited changes in therapy in both positive and negative cases. We observed superior patient outcomes as measured by GCS scale. 75% and 82.14% of the patients positive and negative on SES respectively, recovered fully. CONCLUSION Detecting causative organism and ruling out infectious etiology remain the most critical aspect for management and prognosis of patients with suspected CNS infections. In this study, we observed higher detection rate of pathogens, target specific escalation and evidence based de-escalation of antimicrobials using SES. Institution of appropriate therapy helped reduce unnecessary use of antimicrobials.
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Affiliation(s)
| | | | - Aneesh Mehta
- Dept. of Neurology, MS Ramaiah Memorial Hospital, India
| | | | - Rohan Mahale
- Dept. of Neurology, MS Ramaiah Memorial Hospital, India
| | - R Srinivasa
- Dept. of Neurology, MS Ramaiah Memorial Hospital, India
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Schilder AGM, Marom T, Bhutta MF, Casselbrant ML, Coates H, Gisselsson-Solén M, Hall AJ, Marchisio P, Ruohola A, Venekamp RP, Mandel EM. Panel 7: Otitis Media: Treatment and Complications. Otolaryngol Head Neck Surg 2017; 156:S88-S105. [PMID: 28372534 DOI: 10.1177/0194599816633697] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
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Affiliation(s)
- Anne G M Schilder
- 1 evidENT, Ear Institute, University College London, London, United Kingdom.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tal Marom
- 3 Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Mahmood F Bhutta
- 4 Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Margaretha L Casselbrant
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harvey Coates
- 6 Department of Otolaryngology, School of Paediatrics and Child Health, The University of Western Australia, Nedlands, WA, Australia
| | - Marie Gisselsson-Solén
- 7 Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Amanda J Hall
- 8 University Hospitals Bristol NHS Foundation Trust and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Paola Marchisio
- 9 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aino Ruohola
- 10 Department of Pediatrics, University of Turku, Turku, Finland
| | - Roderick P Venekamp
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen M Mandel
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Abstract
BACKGROUND Acute mastoiditis (AM) can be clinically diagnosed, with an option for supplemental imaging: computed tomography (CT) scan and magnetic resonance imaging (MRI). Debate widely exists whether clinical diagnosis alone is sufficient, in view of the risk of missing undetected complications. We sought to study the reasons leading to the performance of an imaging study during AM course. METHODS Medical records of children younger than 8 years who were admitted from 2005 to 2014 with AM were retrospectively reviewed. Data included medical history, signs and symptoms, laboratory results, imaging studies, treatment methods and final outcomes. RESULTS Eighty-six children were diagnosed with 88 AM episodes. Of the AM episodes, 55 (63%) were in boys and 46 (52%) were in children younger than 2 years. All children were treated with parenteral antibiotics, and 82 (95%) underwent myringotomy on admission. Only 20 (23%) children underwent imaging studies, on the 6th median day. Of those, 20 (100%) children underwent CT scans, and 3 (15%) underwent additional MRI studies. The reasons for imaging studies included suspected subperiosteal abscess (9 of 20, 45%), lack of improvement despite adequate medical therapy (7, 35%) and focal neurological signs (4, 20%). Sixteen (16%) children underwent surgery for these pathologies: subperiosteal abscesses (n = 12,), jugular vein thrombosis (n = 2), perisinus empyema (n = 2), epidural abscess (n = 2) and Luc abscess (n = 1). CONCLUSIONS Most children presenting with AM can be diagnosed clinically and do well with intravenous antibiotics and myringotomy. CT and MRI imaging should be reserved for children with suspected AM-related intracranial complications.
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Kordeluk S, Kraus M, Leibovitz E. Challenges in the Management of Acute Mastoiditis in Children. Curr Infect Dis Rep 2015; 17:479. [DOI: 10.1007/s11908-015-0479-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Antibiothérapie des infections ORL sévères du nourrisson et de l’enfant : Mastoïdites aiguës. Arch Pediatr 2013; 20 Suppl 3:e10-3. [DOI: 10.1016/s0929-693x(13)71421-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Facial palsy complicated by masked otomastoiditis in a 3-month-old infant. J Emerg Med 2013; 46:e47-50. [PMID: 24113482 DOI: 10.1016/j.jemermed.2013.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 05/03/2013] [Accepted: 08/14/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The most common cause of facial palsy is idiopathic or Bell's palsy. Although uncommon in the postantibiotic era, otomastoiditis should receive more attention as a cause of facial palsy, especially in young children. Delay of identification and treatment may result in permanent neurological sequelae. OBJECTIVES To describe a 3-month-old infant eventually diagnosed with masked otomastoiditis with initial presentation of facial palsy. CASE REPORT We report a case of facial palsy complicated by masked otomastoiditis in a 3-month-old male infant. The facial palsy completely recovered after parenteral antibiotics and myringotomy. CONCLUSION We use this case to emphasize that otomastoiditis should be considered in the differential diagnosis of young children with facial palsy. Diagnosis may be difficult as signs and symptoms of otitis media in young children are often nonspecific and subtle, particularly in infants. Early diagnosis and careful investigation of middle ear regions should be performed to avoid permanent sequelae.
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Ear pain and fever. JAAPA 2013; 26:63-4. [PMID: 23805598 DOI: 10.1097/01.jaa.0000430436.95036.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mastoiditis in adults: a 19-year retrospective study. Eur Arch Otorhinolaryngol 2013; 271:925-31. [DOI: 10.1007/s00405-013-2454-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/15/2013] [Indexed: 10/27/2022]
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