Spinal epidural abscess in a neonate

Nejat, Farideh; Ardakani, Shahin Behjati; Khotaei, Ghamar Taj; Roodsari, Nahid Nasri

doi:10.1097/00006454-200208000-00024

Cited by 13 publications

(9 citation statements)

References 8 publications

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“…Spinal epidural abscesses are usually localised to the mid‐thoracic or lower lumbar areas. This is thought because of anatomical reasons, with the spinal cord naturally narrowing at these levels, giving rise to a relatively large epidural space containing soft tissue and a rich venous plexus, thus providing a suitable environment for infection 2,3 . Such extensive involvement as seen in our case is very rare 4–6 …”

Section: Discussionmentioning

confidence: 67%

“…In older children and adults, this is usually in the setting of predisposing factors such as diabetes mellitus, intravenous drug use or immunodeficiency. However, a proportion of reported cases have been in immunocompetent individuals with no identifiable source of infection 2,3 …”

Section: Discussionmentioning

confidence: 99%

“…However, a proportion of reported cases have been in immunocompetent individuals with no identifiable source of infection. 2,3 Spinal epidural abscesses are usually localised to the midthoracic or lower lumbar areas. This is thought because of anatomical reasons, with the spinal cord naturally narrowing at these levels, giving rise to a relatively large epidural space containing soft tissue and a rich venous plexus, thus providing a suitable environment for infection.…”

Section: Discussionmentioning

confidence: 99%

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Epidural abscess in a neonate

Hazelton¹,

Kesson

Prelog³

et al. 2011

J Paediatrics Child Health

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We report the case of a 16-day-old neonate who presented with fever and irritability. Blood and cerebrospinal fluid (CSF) samples collected on his admission grew methicillin sensitive Staphylococcus aureus on culture, prompting an urgent search for parameningeal collections or an occult sinus involving the central nervous system. Magnetic resonance imaging revealed a pyogenic collection within the epidural space extending from the upper cervical to lumbosacral level and multiple other deep tissue collections that required repeated surgical drainage. Central nervous system infections due to S. aureus are uncommon, particularly in the absence of an anatomical defect or prior neurosurgical instrumentation. This case demonstrates the importance of a timely and thorough search for parameningeal foci when CSF cultures are positive for unusual organisms such as S. aureus.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Epidural abscess in a neonate

Hazelton¹,

Kesson

Prelog³

et al. 2011

J Paediatrics Child Health

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“…Epidural abscesses presenting in infancy are even rarer, with the youngest patient reported being 20 days of age. 1 An epidural abscess complicating a congenital neuroenteric cyst appears not to have been reported previously.…”

mentioning

confidence: 80%

Presacral Neuroenteric Fistula in a Newborn Presenting With an Epidural Abscess: Case Report and Review of the Literature

Darwish

Stanley²,

Wickremesekera³

et al. 2004

Pediatrics

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ABSTRACT. We describe a newborn infant (<24 hours of age) who presented with mild swelling on the back and buttocks attributable to a neuroenteric fistula complicated by an epidural parasacral abscess infected with mixed coliforms. Epidural abscesses in infancy are extremely rare, and one has not been observed previously in the newborn period. The infant was surprisingly mildly affected. Prompt intervention led to an excellent outcome. Coliforms may colonize the infant gut in <24 hours, even in the developed world. Unexplained swellings on the backs of infants should lead to a search for underlying malformations and an early surgical review, which is best conducted with a combined pediatric surgical and neurosurgical approach. N euroenteric cysts (fistulas) are rare, with Ͻ30 cases being described in the pediatric literature. Epidural abscesses presenting in infancy are even rarer, with the youngest patient reported being 20 days of age. 1 An epidural abscess complicating a congenital neuroenteric cyst appears not to have been reported previously. CASE REPORTA Ͻ1-day-old boy was admitted to the neonatal unit at a peripheral hospital with irritability, lethargy, and poor feeding. He had been delivered at 42 weeks of gestation through normal vaginal delivery and weighed 3250 g. His mother had an older healthy child and had remained in good health during this pregnancy. She admitted to smoking cigarettes and occasionally drinking alcoholic drinks. Results of ultrasound scanning performed in the first trimester had been reported as normal and consistent with dates. The infant's condition at birth was excellent, and he was allowed home, breastfeeding successfully, at 12 hours of age. In the examination, the infant was mildly jaundiced and lethargic. He had cool extremities, with a capillary return of 4 seconds, a heart rate of 150 beats per minute, a respiratory rate of 68 breaths per minute, and a skin temperature of 36.6°C. There was no sign of respiratory difficulty. The patient's anterior fontanelle was not distended, and his posture was normal. His abdomen was soft, without organomegaly. Movements were normal in all limbs, with normal tone and reflexes. The patient's anus was in a normal position, and he passed stools without difficulty. His back was normal, with no sign of sinuses or fistulas. Blood and urine cultures were obtained. Blood tests showed a C-reactive protein level of 25 g/mL (normal: Ͻ10 g/mL) and a white blood cell count of 10 300 cells per mm 3 (neutrophils: 8000 cells per mm 3 ). Results of a chest radiograph were normal. Lumbar punctures were performed as part of the septic screening and on 2 occasions revealed frank yellow-green pus, which showed large numbers of pus cells and mixed flora with Gram-staining and subsequently showed heavy growth of Escherichia coli and enterococci. A provisional diagnosis of mixed-organism meningitis was made, and the infant began broad-spectrum antibiotic treatment and was transferred to the neonatal intensive care unit of Wellington Hospital for additional in...

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“…There are reports of cases managed with surgical drainage [15][16][17][18][19] but also with antibiotics alone. [20][21][22] Notably, many of the case reports describing surgical drainage of the abscess involve patients with neurologic compromise, whereas only 1 case series described patients treated with antibiotics alone who had neurologic compromise.…”

Section: Dr Stephanie Greene (Pediatric Neurosurgeon)mentioning

confidence: 99%

A 34-Day-Old With Fever, Cerebrospinal Fluid Pleocytosis, andStaphylococcus aureusBacteremia

Horner¹,

Yamada²,

Zuccoli³

et al. 2016

Pediatrics

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A 34-day-old previously healthy boy born full term presented to the emergency department with fever at home (38.1°C), fussiness, and decreased oral intake for 1 day. He was difficult to console at home. He had decreased oral intake without emesis, diarrhea, or a change in urine output. He did not have rhinorrhea, cough, or increased work of breathing noted by parents. He lived at home with his parents and 13-year-old brother, did not attend day care, and had no sick contacts. On examination, he was fussy but consolable. He was febrile to 39.3°C, tachycardic (180 beats per minute), and tachypneic (64 breaths per minute), with mottling and a capillary refill of 3 seconds. The remainder of his examination was normal, without an infectious focus for his fever. A complete blood cell count with differential revealed leukocytosis. A basic metabolic panel was normal. A catheter urinalysis was normal. Cerebrospinal fluid examination yielded pleocytosis, low glucose, and elevated protein. Blood cultures were persistently positive with methicillin-sensitive Staphylococcus aureus, but cerebrospinal fluid cultures remained negative. We present his case, management, and ultimate diagnosis.

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Spinal epidural abscess in a neonate

Cited by 13 publications

References 8 publications

Epidural abscess in a neonate

Epidural abscess in a neonate

Presacral Neuroenteric Fistula in a Newborn Presenting With an Epidural Abscess: Case Report and Review of the Literature

A 34-Day-Old With Fever, Cerebrospinal Fluid Pleocytosis, andStaphylococcus aureusBacteremia

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