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Brenner DA, Valdivia DJ, Ginalis EE, Dadario NB, Mashiach E, Gupta G, Sundararajan S, Nourollah-Zadeh E, Lazar E, Roychowdhury S, Sun H. Brain abscesses following carotid blowout syndrome: a case report. Radiol Case Rep 2024; 19:1319-1324. [PMID: 38292792 PMCID: PMC10825556 DOI: 10.1016/j.radcr.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 02/01/2024] Open
Abstract
We report a case of intracranial abscesses development in a patient with head and neck cancer after emergent treatment of carotid blowout syndrome with coil embolization. Our patient is a 60-year-old male who presented with hemoptysis and hematemesis, which raised concerns for impending carotid blowout syndrome. Endovascular occlusion was successfully achieved, and the patient was discharged in stable condition. Ten days later, the patient reported headaches and right facial pain, and magnetic resonance imaging revealed multiple intracranial abscesses. Broad-spectrum intravenous antibiotics were administered, leading to a variable response with some abscesses decreasing in size and others increasing. Seven weeks from discharge, the patient had no neurological deficits, and all abscesses had decreased in size.
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Affiliation(s)
- Daniel A. Brenner
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Daniel J. Valdivia
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | | | - Nicholas B. Dadario
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Elad Mashiach
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Srihari Sundararajan
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Emad Nourollah-Zadeh
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Eric Lazar
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hai Sun
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
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Liu W, Feng R, Song X, Zhao H. Rare post-operative intracranial abscess due to Serratia marcescens: what we can learn from it? BMC Infect Dis 2024; 24:61. [PMID: 38191337 PMCID: PMC10775496 DOI: 10.1186/s12879-023-08966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Nosocomial infections caused by Serratia marcescens mostly occurred in pediatrics and it was very rarely reported after adult surgery. Here, an intracranial abscess caused by Serratia marcescens was reported. We report a rare case of a postoperative intracranial abscess caused by Serratia marcescens in a 63-year-old male patient with a left parietal mass. The patient underwent resection of the mass on June 1, 2022, and the postoperative pathology revealed an angiomatous meningioma, WHO I. He then experienced recurrent worsening of right limb movements, and repeated cranial CT scans showed oozing blood and obvious low-density shadows around the operation area. Delayed wound healing was considered. Subsequently, a large amount of pus was extracted from the wound. The etiological test showed that Serratia marcescens infection occurred before the removal of the artificial titanium mesh. Antibiotics were initiated based on the results of drug susceptibility tests. At present, the patient is recovering well and is still closely monitored during follow-up. CONCLUSION It is rare for Serratia marcescens to cause brain abscesses without any obvious signs of infection. This report provided in detail our experience of a warning postoperative asymptomatic brain abscess caused by an uncommon pathogen.
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Affiliation(s)
- Wenzheng Liu
- Department of Neurology, the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong, 266005, China
| | - Ridong Feng
- Department of Neurosurgery, the First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China
| | - Xiaolin Song
- Department of Neurology, the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong, 266005, China
| | - Hai Zhao
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong, 266005, China.
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Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30:66-89. [PMID: 37648062 DOI: 10.1016/j.cmi.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
SCOPE These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. METHODS Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mildred A Iro
- Department of Paediatric Infectious diseases and Immunology, The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Matthias Klein
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Hospital of the Ludwig-Maximilians University, Munich, Germany; Emergency Department, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Katharina Last
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Inmaculada López Montesinos
- Infectious Disease Service, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pasquale Pagliano
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Unit of Infectious Diseases, University of Salerno, Baronissi, Italy; UOC Clinica Infettivologica AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Oğuz Reşat Sipahi
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey; Infectious Diseases Department, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Rafael San-Juan
- CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rogelio de J Treviño-Rangel
- Faculty of Medicine, Department of Microbiology, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group (EFISG), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Makwana M, Merola JP, Bhatti I, Patel CK, Leach PA. Towards improved outcome in children treated surgically for spontaneous intracranial suppuration in South Wales. Br J Neurosurg 2023; 37:45-48. [PMID: 33428472 DOI: 10.1080/02688697.2020.1868403] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Spontaneous central nervous system (CNS) infections in children are rare. Treatment involves surgical intervention and antibiotic therapy. We describe a single centre experience of managing this condition in South Wales. METHODS We performed a retrospective review of surgically managed cases in our unit for patients under 18 years of age between 2008 and 2018. Data were collected regarding aetiology, location, microbiology examination, treatment and outcomes. RESULTS Twenty-six patients were identified of which 25 case notes were available. Fifteen were male and 10 were female. Median age was 12 years (age range 0.3-17 years). Seven patients (28%) had a burr-hole aspiration and 18 (72%) underwent craniotomy. A second procedure was performed in 10 (40%) and a third procedure in two (8%). Fourteen (56%) had a brain abscess, 10 (40%) had subdural empyema (one was bilateral) and one (4%) had an extradural empyema. Fifteen (60%) had a raised WCC (>11.5 × 109/L) and 22 (88%) had a CRP of >10 mg/L at presentation. Three (12%) patients had a normal WCC and CRP at presentation. Overall, 12 (48%) were secondary to sinus infection, with the most common organism being Streptococcus. Seven (28%) were due to otitis media or mastoiditis, six (24%) had no cause identified. The mean number of CT/MRI scans was 6.7 (range 3-13). The mean follow-up period was 16.7 months (range 1-117 months). At last follow up, 19 (76%) had a GOS of 5, five (20%) had a GOS of 4 and one (12%) had GOS of 3. There were no deaths. CONCLUSIONS In Wales, outcomes have improved over time in keeping with other paediatric neurosurgical units in England. Increased availability of imaging resources in our hospital and use of neuro-navigation for all cases in our unit as well as earlier identification of sepsis, communication with microbiologists with dedicated ward rounds and, enhanced identification of causative organisms and contemporary anti-microbials have also contributed towards the improved management of this condition.
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Affiliation(s)
- Milan Makwana
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
| | - Joseph P Merola
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
| | - Imran Bhatti
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
| | - Chirag K Patel
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
| | - Paul A Leach
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
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Roy H, Bescos R, McColl E, Rehman U, Cray E, Belfield LA, Nweze KD, Tsang K, Singleton W, Whitfield P, Brookes Z. Oral microbes and the formation of cerebral abscesses: A single-centre retrospective study. J Dent 2023; 128:104366. [PMID: 36402257 DOI: 10.1016/j.jdent.2022.104366] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/02/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Intracranial abscesses are relatively uncommon, but can result in significant mortality and morbidity. Whilst many potential causes of brain abscesses are recognised, in many cases the origin of infection remains clinically unidentified. Our objective was to investigate the role of bacteria found in the oral cavity in the development of brain abscesses. METHODS A retrospective analysis was performed using data from 87 patients admitted to a single UK neurosurgical unit with brain abscesses over a 16-year period. Using microbiological data obtained from abscess sampling and peripheral cultures, species of bacteria were categorised in patients where no primary source of infection was identified (NSI) for their brain abscess (n = 52), or where an infective source (ISI) was identified. The microbiological data was then screened to identify common oral bacteria in each group. RESULTS Brain abscesses from the ISI group (n = 35) demonstrated a significantly lower preponderance of oral bacteria (n = 8), than the NSI group (n = 29) (p < 0.05). Brain abscesses from the NSI group also had significantly higher counts of Streptococcus anginosus compared to ISI (p < 0.05), with brain abscesses being most common in the frontal and parietal lobes for both ISI and NSI. CONCLUSIONS These findings suggest that the oral cavity could be considered as a source of occult infection in cases of brain abscess where no clear cause has been identified. Future studies should include oral screening and microbiome analysis to better understand the mechanisms involved and develop approaches for prevention. CLINICAL SIGNIFICANCE STATEMENT Oral bacteria may be an under-recognised cause of brain abscesses. Careful review of oral health in brain abscess patients may help establish causation, particularly in patients with no cause for their abscess identified. Good levels of oral health may help prevent the development of brain abscesses in some individuals.
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Affiliation(s)
- Holly Roy
- Department of Neurosurgery, University Hospitals Plymouth NHS Trust, UK; Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Raul Bescos
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK.
| | - Ewen McColl
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Umar Rehman
- Department of Surgery, Northwick Park Hospital, London, HA1 3UJ, UK
| | - Elizabeth Cray
- Department of Neurosurgery, University Hospitals Plymouth NHS Trust, UK
| | - Louise A Belfield
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - King-David Nweze
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Kevin Tsang
- Neurosurgery Department, Charing Cross Hospital, London W6 8RF, UK
| | - William Singleton
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Peter Whitfield
- Department of Neurosurgery, University Hospitals Plymouth NHS Trust, UK; Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Zoe Brookes
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
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Yazar U, Aydın ZGG, Özkaya AK, Kırımlı K, Güvercin AR. Subdural empyema in immunocompetent pediatric patients with recent SARS-CoV-2 positivity: case report. Childs Nerv Syst 2022; 39:1335-1339. [PMID: 36534133 PMCID: PMC9762647 DOI: 10.1007/s00381-022-05803-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Subdural empyema refers to the collection of purulent material in the subdural space and the most source of it is bacterial meningitis in infants while sinusitis and otitis media in older children. It has been very recently reported that coronaviruses (CoV) exhibit neurotropic properties and may also cause neurological diseases. CoV-related complications as hypercoagulability with thrombosis and associated inflammation, catastrophic cerebral venous sinus thrombose sand bacterial-fungal superinfections have been well documented in adult patients. Hereby, we describe 15-year-old and 12-year-old female children with subdural empyema after SARS-CoV2. The patients presented limitation of eye in the outward gaze, impaired speech, drowsiness, fever, vomiting and they also were tested positive for COVID-19. MRI indicated subdural empyema and surgical interventions were needed to relieve intracranial pressure and drain pus after receiving broad spectrum antibiotics treatments. The microbiological analysis of abscess material revealed Streptococcus constellatus which is extremely rare in an immunocompetent child and the patients received appropriate IV antibiotic therapy. Eventually, patients became neurologically intact. Pediatric patients with CoV infections should be closely monitored for neurological symptoms. Further research and more data on the correlation between CoV infections would provide better recognition and treatment options in an efficient manner in children.
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Affiliation(s)
- Uğur Yazar
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Zeynep Gökçe Gayretli Aydın
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Kağan Özkaya
- Department of Pediatrics and Department of Pediatric Emergency, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Kaan Kırımlı
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ali Rıza Güvercin
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Guy K, Lelegren M, Shomaker K, Han J, Lam K. Management of complicated acute sinusitis in the setting of concurrent COVID-19. Am J Otolaryngol 2022; 43:103603. [PMID: 35985081 DOI: 10.1016/j.amjoto.2022.103603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Intraorbital and intracranial complications of acute bacterial rhinosinusitis require timely medical and surgical treatment to prevent the development of long-term neurologic sequelae. The era of Coronavirus Disease-2019 (COVID-19) has complicated the management of complicated acute rhinosinusitis, especially when patients have concurrent acute sinusitis and COVID-19 infection. This case series aims to highlight the clinical course of pediatric patients at a single tertiary pediatric hospital with concurrent complicated bacterial rhinosinusitis and COVID-19. MATERIALS AND METHODS A search of pediatric patients treated for COVID-19 and complications from acute sinusitis was performed using billing records for the year 2020-2021 at a single pediatric tertiary hospital. Data regarding presentation, management, microbiology, and hospital course was collected for review. RESULTS A total of 6 patients with complicated bacterial sinusitis in the setting of COVID-19 infection were included. All patients were initially managed with medical therapy, consisting of systemic antibiotics, but 3 of these patients ultimately required surgical intervention. Cultures from the cohort grew Staphylococcus aureus, streptococcus intermedius, streptococcus constellatus or Prevotella species. All patients experienced clinical improvements and were eventually discharged home with oral antibiotics. CONCLUSION COVID-19 continues to be an unusual disease especially for the pediatric population. Concurrent complicated acute rhinosinusitis and COVID-19 appear to have higher rates of surgical requirement in the pediatric population. COVID-19 safety precautions have influenced management practices for patients with severe bacterial rhinologic infections. While there may be an association between complicated bacterial rhinosinusitis and COVID-19 infection, further research is necessary to determine a true correlation.
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Malinvaud D, Shenouda K, Laccourreye L, Guiquerro S, Rubin F, Laccourreye O. Aural tuberculosis at the start of the 21st century. Literature review according to SWiM guidelines. Part 1: Clinical and diagnostic data. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139:343-349. [PMID: 35701295 DOI: 10.1016/j.anorl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Review of the scientific literature dedicated to clinical data and diagnosis modalities for aural tuberculosis published since the start of the 21st century. MATERIAL AND METHODS Search of the Medline, Cochrane and Embase databases for the period 2000-2020. Selection of articles in English, French and Spanish devoted to clinical cases and series documenting clinical data and diagnosis for aural tuberculosis of articles by two authors. Analysis performed according to SWiM guidelines. Extraction of data on pre-established files documenting clinical and diagnostic data. RESULTS In total, 173 articles: 163 case reports (228 patients) and 10 cohorts (177 patients) from 49 countries were analyzed. Female/male sex ratio was 1.05, with ages ranging from less than 1 month to 87 years. Tuberculosis involved another site in 35.1% of cases. Aural involvement was bilateral in 19.7% of cases. Clinical presentation corresponded to otitis media (prior antibiotic treatment and auricular surgery in 41.4% and 10.1% of cases, respectively) without any pathognomonic symptoms or signs. Associated severe locoregional complications were seen in 32% of cases, with 23.2% and 13% incidence of peripheral facial palsy and severe intracranial complications, respectively. Time to diagnosis ranged from less than 1 month to 384 months, and was longer than 12 months in 26.5% of case reports, without significant correlation (P=0.29) with severe revelatory locoregional complications. Incidence of Mycobacterium tuberculosis detection ranged from 33.4% of documented cases in auricular secretions to 64.6% in polyps, granulomas, and/or biopsies. In the case reports, diagnosis with certainty was done in 58.3% of cases, while it was based on involvement of another site and on indirect criteria or positive clinical progression after treatment in the other 10.1% and 31.6%, respectively. CONCLUSION Aural tuberculous must always be considered in case of unfavorable progression of otitis. Definitive diagnosis is based on multiple auricular sample sites, polymerase chain reaction, and γ interferon blood assay.
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Affiliation(s)
- D Malinvaud
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - K Shenouda
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - L Laccourreye
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, institut Arthur-Vernes, 36, rue d'Assas, 75006 Paris, France
| | - S Guiquerro
- Bibliothèque universitaire Necker, université Paris Cité, 160, rue de Vaugirard, 75015 Paris, France
| | - F Rubin
- Clinique Saint-Vincent, 8, rue de Paris, CS 71027, 97404 Saint-Denis cedex, France
| | - O Laccourreye
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
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Charlton M, Nair R, Gupta N. Subdural empyema in adult with recent SARS-CoV-2 positivity case report. Radiol Case Rep 2021; 16:3659-3661. [PMID: 34630795 PMCID: PMC8486433 DOI: 10.1016/j.radcr.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022] Open
Abstract
Intracranial abscess, including subdural empyema, is a rare central nervous system infectious disease and diagnosis is often delayed due to patient presentation with non-specific neurologic findings. Here we report a 65-year-old male with a recent past medical history of SARS-CoV-2 infection who presented with three weeks of escalating headache in whom MRI imaging revealed a subdural empyema. He subsequently underwent two craniectomies, which resulted in eradication of the abscess and clinical improvement. This report highlights a potential link between SARS-CoV-2 infection and this patient's development of subdural empyema, which has not been documented elsewhere in the literature.
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Affiliation(s)
- Megan Charlton
- Pacific Northwest University of Health Sciences, 200 University Parkway, Yakima, WA, 98901, USA
| | - Rathan Nair
- MultiCare Good Samaritan Hospital, 401 15th SE Avenue, Puyallup, WA, 98372, USA
| | - Nidhi Gupta
- MultiCare Good Samaritan Hospital, 401 15th SE Avenue, Puyallup, WA, 98372, USA
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Din-Lovinescu C, Mir G, Blanco C, Zhao K, Mazzoni T, Fried A, El Khashab M, Lin G. Intracranial complications of pediatric rhinosinusitis: Identifying risk factors and interventions affecting length of hospitalization. Int J Pediatr Otorhinolaryngol 2020; 131:109841. [PMID: 31901485 DOI: 10.1016/j.ijporl.2019.109841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify risk factors and interventions affecting length of hospitalization (LOH) and clinical outcome in children with intracranial complications of rhinosinusitis. METHODS Retrospective chart review of 12 children hospitalized at 2 academic medical centers for intracranial complications of rhinosinusitis over the past 5 years. RESULTS 12 patients were identified with an average age at presentation of 13 years old. 92% were male and 75% were African American. The most common presenting symptoms were fever and headache. Localizing neurological symptoms including hemiparesis and aphasia, in addition to seizures occurred in 33% of patients and increased LOH significantly (33 versus 15 days, p = 0.03). Epidural (EA) and subdural abscesses (SA) were the most common intracranial complications. 58% of patients were initially treated with a combination of open neurosurgical (ON) intervention and endoscopic sinus surgery (ESS) and LOH was significantly shorter for these patients compared to those treated otherwise (14 versus 31 days, p = 0.02). Streptococcus species were the most common group of bacteria identified in 75% of cases, with S. anginosus accounting for 42% of cases. The overall average LOH was 21 days with 92% of patients having complete resolution of symptoms by time of discharge. CONCLUSIONS Treatment of intracranial complications of acute rhinosinusitis can have favorable outcomes after appropriate surgical management. Localizing neurologic symptoms and seizures portend longer hospital stay and recovery time. Shorter hospital stay was seen in those undergoing early combined ON and ESS interventions.
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Affiliation(s)
- Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Ghayoour Mir
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Conor Blanco
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kevin Zhao
- Department of Neurosurgery, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Thomas Mazzoni
- Department of Otolaryngology-Head and Neck Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Arno Fried
- Department of Neurosurgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mostafa El Khashab
- Department of Neurosurgery, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Giant Lin
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology-Head and Neck Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
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11
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Levy DA, Nguyen SA, Harvey R, Hopkins C, Schlosser RJ. Hospital utilization for orbital and intracranial complications of pediatric acute rhinosinusitis. Int J Pediatr Otorhinolaryngol 2020; 128:109696. [PMID: 31585355 DOI: 10.1016/j.ijporl.2019.109696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. METHODOLOGY Analysis of Kids' Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. RESULTS A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, p < 0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], p < 0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, p < 0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], p < 0.001) but similar LOS (12 [10] v 11 [9] days, p = 0.783). CONCLUSIONS Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.
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Affiliation(s)
- Dylan A Levy
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Richard Harvey
- Rhinology and Skull Base Surgery, University of New South Wales, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Claire Hopkins
- ENT Department, Guy's and St. Thomas Hospitals, London, United Kingdom
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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12
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Touchette CJ, Crevier L, Weil AG. Neuronavigation-Guided Endoscopic Endonasal Drainage of Pediatric Anterior Cranial Base Epidural and Subdural Empyema. Pediatr Neurosurg 2020; 55:67-71. [PMID: 31962318 DOI: 10.1159/000503055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
In children, epidural and/or subdural intracranial empyema can complicate frontal sinusitis or pansinusitis. The standard transcranial approach used to treat epidural or subdural empyema has many drawbacks, but these can be avoided with an endoscopic expanded endonasal approach (EEA). To support the feasibility and advantages of this approach, we report the successful drainage through endoscopic EEA of a bifrontal empyema caused by an intracranial extension of pansinusitis. Our case and the ones previously reported in the literature establish well that endoscopic EEA offers several advantages over the standard craniotomy. Hence, EEA should be considered as an alternative to the transcranial approach when surgically draining anterior skull base empyema resulting from pansinusitis in children.
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Affiliation(s)
- Charles J Touchette
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Louis Crevier
- Pediatric Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital Center, Montreal University, Montreal, Québec, Canada
| | - Alexander G Weil
- Pediatric Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital Center, Montreal University, Montreal, Québec, Canada,
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13
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Collier MG, Doshani M, Asher A. Using Population Based Hospitalization Data to Monitor Increases in Conditions Causing Morbidity Among Persons Who Inject Drugs. J Community Health 2019; 43:598-603. [PMID: 29305727 DOI: 10.1007/s10900-017-0458-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Epidemics of opioid use and injection drug use (IDU) are associated with an increase in HIV and viral hepatitis infections and overdose deaths in the United States. Persons who inject drugs (PWID) are also at risk for serious infections caused by skin organisms introduced via IDU. We examined National Inpatient Sample hospital discharge data to determine trends in three serious infectious disease-associated conditions that primarily affect PWID in addition to HIV and viral hepatitis: infective endocarditis (IE), central nervous system (CNS) abscesses, and osteomyelitis. We found an increase in the number of primary hospitalization discharge diagnoses for IE among persons aged ≤39 years from 2009 to 2013. Hospitalization rates for these diagnoses also increased over this study period for person with secondary diagnoses of hepatitis B, C, or D viruses and substance-related disorders for IE, CNS abscess and osteomyelitis. Policies that improve access to sterile injection equipment, improve education regarding IDU, and treatment for substance use disorder may help to reduce the impact of serious and often fatal infectious diseases among PWID.
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Affiliation(s)
- Melissa G Collier
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Mailstop G-37, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA.
| | - Mona Doshani
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Mailstop G-37, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Alice Asher
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Mailstop G-37, 1600 Clifton Rd NE, Atlanta, GA, 30329, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Schupper AJ, Jiang W, Coulter MJ, Brigger M, Nation J. Intracranial complications of pediatric sinusitis: Identifying risk factors associated with prolonged clinical course. Int J Pediatr Otorhinolaryngol 2018; 112:10-15. [PMID: 30055716 DOI: 10.1016/j.ijporl.2018.06.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/09/2018] [Accepted: 06/09/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Intracranial extension is one of the most serious and morbid complications of pediatric sinusitis. Managing this complication continues to be challenging even after widespread pneumococcal vaccination adoption. We aim to identify risk factors associated with complicated clinical courses, and to assess for altering microbial communities and increased antibiotic resistance. METHODS A retrospective review was conducted of sinus procedures performed at a single institution for acute sinusitis with intracranial extension, and 16 cases were identified. Variables collected included patient demographics, vaccination status, laboratory results, imaging data, antibiotic therapy, sinus and intracranial cultures, perioperative and surgical reports, and hospital course. RESULTS The average patient age was 11.9 years, and 75% were male. The dominant microbial organisms were gram positive in 93.8% (15/16) of cases and 37.5% (6/16) were anaerobic. There were no cases of resistant bacterial growth, and only one case of Streptococcus pneumoniae. Increased antibiotic therapy duration was associated with anaerobic and polymicrobial sinus cultures. A significant increase in length of hospital stay was identified in polymicrobial sinus cultures and frontal sinus involvement. Intracranial abscess re-accumulation was associated with sinus cultures positive for fusobacterium (p = 0.036), polymicrobial infections (p = 0.034), and involvement of brain parenchyma (p = 0.036). Patients with frontal sinus involvement required a greater number of surgical procedures for abscess drainage (p = 0.046). An anaerobic intracranial culture was associated with an increased number of revision craniotomies (p < 0.001). Parenchymal involvement of the infection was associated with an increased number of surgical complications. CONCLUSIONS Frontal sinus involvement, and anaerobic and polymicrobial sinus cultures were predictive of a more severe infection requiring more surgical interventions, prolonged intravenous antibiotic treatment and overall hospital length of stay. Streptococcus pneumoniae was not prevalent in our series, and there seems to be a shift in the microbial profile of this patient subset, compared to previous studies, which can likely be attributed to the adoption of pneumococcal vaccinations. Sinus cultures were more predictive of a complicated clinical course compared to intracranial cultures, suggesting the importance of a thorough sinus debridement and obtaining directed sinus cultures.
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Affiliation(s)
| | - Wen Jiang
- Rady Children's Hospital San Diego, Otolaryngology, San Diego, CA, USA; Department of Surgery, University of California San Diego, San Diego, CA, USA
| | | | - Matthew Brigger
- Rady Children's Hospital San Diego, Otolaryngology, San Diego, CA, USA; Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Javan Nation
- Rady Children's Hospital San Diego, Otolaryngology, San Diego, CA, USA; Department of Surgery, University of California San Diego, San Diego, CA, USA
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16
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Kou YF, Killeen D, Whittemore B, Farzal Z, Booth T, Swift D, Berg E, Mitchell R, Shah G. Intracranial complications of acute sinusitis in children: The role of endoscopic sinus surgery. Int J Pediatr Otorhinolaryngol 2018; 110:147-151. [PMID: 29859578 DOI: 10.1016/j.ijporl.2018.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the role of endoscopic sinus surgery (ESS) in the management of intracranial complications of children with acute rhinosinusitis METHODS: Retrospective chart review at a tertiary care pediatric hospital MAIN OUTCOMES: Demographics, intracranial complications, length of hospital stay (LOS), neurological sequelae, ESS, neurosurgical procedures RESULTS: Twenty-four children with a mean age (SD) of 12.9 years (+/-3.2) with an intracranial complication(s) of acute rhinosinusitis were identified between 2005-2016. A total of 22 were included and 15 (68%) of these were males. The most common complications were: subdural abscess (n=10), epidural abscess (n=10), meningitis (n=5), intraparenchymal abscess (n=5), and cavernous sinus thrombosis (n= 2). Neurologic symptoms included headache (n=12), hemiparesis (n=5) and aphasia (n=3). Average length of stay was 16 (+/- 9.2) days. Average follow up was 7 (+/-5.6) months. One patient had residual seizures and 1 had recurrent rhinosinusitis. Aphasia and hemiparesis resolved in all patients within 1 year. Nineteen (86%) patients had ESS within 4 days of admission. Fourteen patients (63%) had a neurosurgical procedure, 6 (27%) required more than 1 neurosurgical procedure. Six patients (27%) had concurrent neurosurgical drainage and ESS. Four patients (17%) had neurosurgical procedure followed by ESS and 3 patients (13%) were treated only by a neurosurgical procedure. Patients who underwent ESS prior to a neurosurgical procedure had significantly less risk of needing a neurosurgical intervention (OR = .02, p < .01). There was a significantly higher proportion of neurosurgical patients with positive Strep anginosus cultures compared to the ESS only group (85.7% vs 37.5%, p = .02). Studies with larger patient populations are needed to determine the role of ESS in the management of intracranial complications of children with acute rhinosinusitis. DISCUSSION Early ESS may be associated with less need for neurosurgical procedures.
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Affiliation(s)
- Yann-Fuu Kou
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States.
| | - Daniel Killeen
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States
| | - Brett Whittemore
- Children's Medical Center Dallas, United States; University of Texas Southwestern Medical Center Department of Neurosurgery, United States
| | - Zainab Farzal
- University of North Carolina at Chapel Hill Department of Otolaryngology, Head and Neck Surgery, United States
| | - Tim Booth
- Children's Medical Center Dallas, United States; Children's Medical Center Dallas Department of Neurosurgery, United States
| | - Dale Swift
- Children's Medical Center Dallas, United States; University of Texas Southwestern Medical Center Department of Neurosurgery, United States
| | - Eric Berg
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
| | - Ron Mitchell
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
| | - Gopi Shah
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
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17
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Laulajainen-Hongisto A, Lempinen L, Färkkilä E, Saat R, Markkola A, Leskinen K, Blomstedt G, Aarnisalo AA, Jero J. Intracranial abscesses over the last four decades; changes in aetiology, diagnostics, treatment and outcome. Infect Dis (Lond) 2015; 48:310-316. [PMID: 26592421 DOI: 10.3109/23744235.2015.1113557] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The development of modern medicine has resulted in changes in the predisposing conditions, clinical picture, treatment and results of treatment of intracranial abscesses. This study sought to evaluate these changes in a hospital district. Methods A retrospective analysis of the clinical data of all patients treated due to intracranial abscesses at a tertiary referral centre, between 1970-2012. Results The total number of intracranial abscesses was 166. The incidence of intracranial abscesses was 0.33/100 000/year (2000-2012). The most common predisposing conditions were infection of the ear-, nose- and throat region (22%), odontogenic infection (15%) and cardiac anomaly (13%). Lately (2000-2012), infections of the ear-, nose- and throat region (15%) and cardiac anomalies (5%) have become less common, whereas odontogenic infections (32%) have become more common. The most common pathogens belong to Streptococcus spp (42%), Fusobacteriae (14%), Actinomycetales (8%) and Staphylococcus spp (8%). Most patients (66%) experienced a favourable recovery; the proportion of patients with favourable outcome enabling return to prior occupation rose over time, from 12% in 1970-1989 to 24% in 1990-2012. Conclusions The predisposing conditions for intracranial abscesses have changed markedly within the study period. Odontogenic infections have become a common predisposing condition, whereas infections of the ear-, nose- and throat region and cardiac malformations are nowadays less common as predisposing conditions compared to at the beginning of the study period. The proportion of patients with favourable outcome enabling return to prior occupation seems to have increased with time.
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Affiliation(s)
- Anu Laulajainen-Hongisto
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,b Department of Allergy , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Laura Lempinen
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Esa Färkkilä
- c Department of Oral and Maxillofacial Diseases , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Riste Saat
- d Department of Radiology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Antti Markkola
- d Department of Radiology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kimmo Leskinen
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,e Pikkujätti Medical Centre for Children and Youth , Helsinki , Finland
| | - Göran Blomstedt
- f Department of Neurosurgery , University of Helsinki and Helsinki University Hospital, Töölö Hospital , Helsinki , Finland
| | - Antti A Aarnisalo
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Jussi Jero
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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18
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Patel AP, Masterson L, Deutsch CJ, Scoffings DJ, Fish BM. Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol 2015; 79:868-873. [PMID: 25887135 DOI: 10.1016/j.ijporl.2015.03.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. METHODS All children with sinogenic intracranial abscesses presenting to a large university teaching hospital over a five-year period were included in the study. Data on clinical presentation, radiological findings, microbiology, medical and surgical management and follow-up were recorded and analysed. RESULTS We identified 27 children aged 12.9 ± 3.4 years of which 56% were male. Fourteen (52%) children had extradural abscesses, nine (33%) subdural abscesses and four (15%) parenchymal abscesses. Early sinus drainage procedures were performed on 24 (89%) patients, and the same number required neurosurgical drainage. Streptococcus milleri was isolated in 18 (67%) cases. An initial conservative neurosurgical approach failed in 50% of cases where trialled, and was associated with longer length of stay (p = 0.025). In comparison to extradural abscesses, subdural abscesses were more likely to present with neurological deficits (p < 0.001) and reduced consciousness (p = 0.018), and required multiple neurosurgical procedures (p < 0.001), longer stays (p = 0.017), and had greater morbidity at six months (p = 0.017). A third of children had significant morbidity at six months, which included cognitive and behavioural problems (25%), residual hemiparesis (19%) and expressive dysphasia (7%). There were no mortalities. CONCLUSION Sinusitis complicated by intracranial abscess remains a contemporary problem. We demonstrate good outcomes with an early combined rhinological and neurosurgical approach. S. milleri is identified as the causative organism in the majority of cases, and empirical antimicrobial treatments should reflect this.
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Affiliation(s)
- Anant P Patel
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Liam Masterson
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christopher J Deutsch
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daniel J Scoffings
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brian M Fish
- Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Wang J, Fraser JF. An Intracranial Petri Dish? Formation of Abscess in Prior Large Stroke After Decompressive Hemicraniectomy. World Neurosurg 2015; 84:1495.e5-9. [PMID: 25988538 DOI: 10.1016/j.wneu.2015.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/10/2015] [Accepted: 05/13/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Development of brain abscess after an infarction is a rare clinical condition. There have been 11 cases in the literature. Many patients were treated with potent antibiotics only and did not survive. We present 2 cases in which patients received aggressive surgical resection of brain abscess and survived. The analysis of the literature confirmed our finding that surgical intervention of brain abscess in patients after stroke is advisable. METHODS A 58-year-old man was transferred to our institution with left hemiparesis, hemisensory loss, neglect, and hemianopsia. The computed tomography angiography demonstrated large volume right hemispheric infarct. He underwent decompressive hemicraniectomy but developed fevers and swollen fontanelle 6 weeks later, which did not improve with antibiotics. The magnetic resonance imaging demonstrated progression of ring-enhancement of the old infarct and abscess formation was suspected. In another case, a 42-year-old woman was admitted to our institution with aphasia and weakness on the right side. The computed tomography angiography showed left middle cerebral artery territory infarction and decompressive hemicraniectomy was performed. Patient recovered well but a brain abscess was suspected during a routine preoperative computed tomography before cranioplasty. RESULTS In the first case, patient was then taken to the operating room for resection of the infarcted brain tissue involved. The patient's consciousness improved, and he was discharged with antibiotic treatment. The patient subsequently underwent cranioplasty with synthetic graft with no complications. In the second case, the suspected abscess was resected surgically and culture of abscess grew Pantoea agglomerans and Bacillus macerans. The patient underwent synthetic cranioplasty 1 month later and remained in good condition. CONCLUSIONS Secondary abscess formation after significant ischemic stroke is a rare condition that carries potential for high morbidity/mortality. The limited body of literature with the addition of our 2 cases supports aggressive management with surgical evacuation of brain abscess to increase survival.
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Abstract
Intracranial infections in children are a relatively rare, but potentially severe condition. Because of the potential for rapid deterioration, timely diagnosis and treatment are necessary. These infections are categorized based on their intracranial location: epidural abscess, subdural empyema, and brain abscess. They largely arise from direct extension of adjacent infection, hematogenous seeding, or trauma. Clinical presentations of intracranial infections also vary. However, common signs and symptoms include headache, fever, nausea and vomiting, altered mental status, focal neurologic deficits, and seizures. In general, MRI demonstrates a peripherally enhancing lesion with high signal on diffusion weighted imaging (DWI). Bacterial isolates vary, but most commonly are a single pathogen. Successful treatment requires a multidisciplinary team approach including such modalities as antibiotic therapy and surgical drainage. When possible, open surgical evacuation of the abscess is preferred, however, in cases of deep-seated lesions, or in unstable patients, aspiration has also been performed with good results.
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Affiliation(s)
- Christopher M Bonfield
- Division of Neurosurgery, Department of Surgery, BC Children's Hospital, Vancouver, Canada.
| | - Julia Sharma
- Division of Neurosurgery, Department of Surgery, BC Children's Hospital, Vancouver, Canada.
| | - Simon Dobson
- Division of Infectious Diseases, Department of Pediatrics, BC Children's Hospital, Vancouver, Canada.
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21
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Moazzam AA, Rajagopal SM, Sedghizadeh PP, Zada G, Habibian M. Intracranial bacterial infections of oral origin. J Clin Neurosci 2015; 22:800-6. [PMID: 25800939 DOI: 10.1016/j.jocn.2014.11.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/05/2014] [Accepted: 11/08/2014] [Indexed: 12/30/2022]
Abstract
Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as large-scale studies are difficult to perform. We compiled a total of 60 previously published cases of such a complication to investigate the predisposing factors, microbiology, and clinical outcomes of intracranial abscesses of odontogenic origin. A systematic review of the literature using the PubMed database was performed. Men accounted for 82.1% of cases, and the mean age was 42.1 years. Caries with periapical involvement and periodontitis were the two most common intra-oral sources, and wisdom tooth extraction was the most common preceding dental procedure. In 56.4% of cases, there were obvious signs of dental disease prior to development of intracranial infection. Commonly implicated microorganisms included Streptococcus viridans (especially the anginosus group), Actinomyces, Peptostreptococcus, Prevotella, Fusobacterium, Aggregatibacter actinomycetemcomitans and Eikenella corrodens. There was an 8.3% mortality rate. Intracranial abscesses can form anywhere within the brain, and appear unrelated to the side of dental involvement. This suggests that hematogenous spread is the most likely route of dissemination.
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Affiliation(s)
- Alan A Moazzam
- Department of General Internal Medicine, Keck Hospital of University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, USA.
| | - Sowmya M Rajagopal
- Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Parish P Sedghizadeh
- Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mina Habibian
- Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
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22
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Aryasinghe L, Sabbar S, Kazim Y, Awan LM, Khan HKN. Streptococcus pluranimalium: A novel human pathogen? Int J Surg Case Rep 2014; 5:1242-6. [PMID: 25437686 PMCID: PMC4275821 DOI: 10.1016/j.ijscr.2014.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/01/2014] [Accepted: 11/08/2014] [Indexed: 12/12/2022] Open
Abstract
Subdural empyema is difficult to differentiate from meningitis on clinical examination alone. CT or MRI imaging must be performed for definitive diagnosis. Prompt diagnosis, IV antibiotics and neurosurgical evacuation improve morbidity and mortality. Use of prophylactic anticonvulsants and wide-exposure craniotomy are recommended. Streptococcus pluranimalium needs to be further studied to assess for zoonotic potential.
INTRODUCTION We present the first case of a subdural empyema caused by Streptococcus pluranimalium, in a healthy adolescent male as a possible complication of subclinical frontal sinusitis. Clinical features, diagnostic approach and management of subdural empyema are discussed. PRESENTATION OF CASE A 17-year-old male with a 2 day history of headache and nausea was referred to our Emergency Department (ED) as a case of possible meningitis. He was afebrile, lethargic and drowsy with significant neck stiffness on examination. Computerized tomography (CT) revealed a large frontotemporoparietal subdural fluid collection with significant midline shift. Subsequent contrast-enhanced CT established the presence of intracranial empyema; the patient underwent immediate burr-hole evacuation of the pus and received 7 weeks of intravenous antibiotics, recovering with no residual neurological deficit. DISCUSSION The diagnosis of subdural empyema as a complication of asymptomatic sinusitis in an immunocompetent patient with no history of fever or upper respiratory symptoms was unanticipated. Furthermore, the organism Streptococcus pluranimalium that was cultured from the pus has only been documented twice previously in medical literature to cause infection in humans, as it is primarily a pathogen responsible for infection in bovine and avian species. CONCLUSION Subdural empyema represents a neurosurgical emergency and if left untreated is invariably fatal. Rapid diagnosis, surgical intervention and intensive antibiotic therapy improve both morbidity and mortality.
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Affiliation(s)
- Lasanthi Aryasinghe
- Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai, United Arab Emirates.
| | - Saweera Sabbar
- Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai, United Arab Emirates
| | - Yasmin Kazim
- Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai, United Arab Emirates
| | - Liaqat Mahmood Awan
- Department of Neurosurgery, Rashid Hospital Trauma Center, Dubai, United Arab Emirates
| | - Hammad Khan Nadir Khan
- Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai, United Arab Emirates
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Seto T, Takesada H, Matsushita N, Ishibashi K, Tsuyuguchi N, Shimono T, Hikita N, Hattori T, Tanaka K, Shintaku H. Twelve-year-old girl with intracranial epidural abscess and sphenoiditis. Brain Dev 2014; 36:359-61. [PMID: 23815969 DOI: 10.1016/j.braindev.2013.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
We report the case of a 12-year-old girl with an intracranial epidural abscess and sphenoiditis. Although she had no history of sinusitis, she developed acute severe headache, fever, and vomiting. Emergent CT and MRI showed a spherical space-occupying lesion of diameter 3 cm in the right cranial fossa with rim enhancement. The lesion was thought to be an epidural abscess adjacent to the right sphenoiditis. On the basis of the MRI findings, we performed emergent surgery to drain the abscess and sinusitis because of severe and rapidly worsening headaches. The patient showed great improvement the day after the operation. Intravenous antibiotics were administered for 8 days. She has completely recovered, with neither sequelae nor recurrence at 7 months after the operation. We believe that this report will be a useful reference for cases of acute onset headache and may be helpful in diagnosis and treatment decisions for severe sinusitis-related intracranial abscess in childhood.
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Affiliation(s)
- Toshiyuki Seto
- Department of Pediatrics, Graduate School of Medicine, Osaka City University, Japan.
| | - Hiroharu Takesada
- Department of Pediatrics, Graduate School of Medicine, Osaka City University, Japan
| | - Naoki Matsushita
- Department of Otolaryngology, Graduate School of Medicine, Osaka City University, Japan
| | - Kenichi Ishibashi
- Department of Neurosurgery, Graduate School of Medicine, Osaka City University, Japan
| | - Naohiro Tsuyuguchi
- Department of Neurosurgery, Graduate School of Medicine, Osaka City University, Japan
| | - Taro Shimono
- Department of Radiology, Graduate School of Medicine, Osaka City University, Japan
| | - Norikatsu Hikita
- Department of Pediatrics, Graduate School of Medicine, Osaka City University, Japan
| | - Taeka Hattori
- Department of Pediatrics, Graduate School of Medicine, Osaka City University, Japan
| | - Katsuji Tanaka
- Department of Pediatrics, Graduate School of Medicine, Osaka City University, Japan
| | - Haruo Shintaku
- Department of Pediatrics, Graduate School of Medicine, Osaka City University, Japan
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