Subdural empyema in children

Muzumdar, Dattatraya; Biyani, Naresh; Deopujari, Chandrashekhar

doi:10.1007/s00381-018-3907-6

Cited by 29 publications

(50 citation statements)

References 41 publications

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“…Male children were more affected than female children in our study, which is also consistent with the published literature. 13 In our cohort, 34.7% of cases were due to otogenic origin and 14.3% were due to sequelae of meningitis. All infants (9 cases) had meningitis prior to development of SDE.…”

Section: Discussionmentioning

confidence: 58%

“…8 In an infant, the common source was secondary infection of a subdural collection following bacterial meningitis. 9 The otogenic source was the predominant origin in both the supratentorial and infratentorial compartment, although the paranasal sinus was the second most common source in the supratentorial compartment, 13 especially in older children. These findings are also similar to those in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…They also found that neurological deficit at the time of admission was one of the significant predictors of outcome. 8 In a literature review, 13 the occurrence of aerobic streptococci was found to be a good prognostication factor and the presence of sterile culture was the poor factor for outcome. However, in our study, outcome was not related to the isolated organisms in the culture.…”

Section: Predictors Of Outcomementioning

confidence: 99%

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Predictors of outcome of subdural empyema in children

Konar¹,

Gohil²,

Shukla³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe aim of this study was to report the etiology, clinical features, microbiology, surgical outcome, and predictors of outcome of spontaneous subdural empyema (SDE).METHODSThe authors conducted a retrospective study in a tertiary hospital. Children up to 18 years of age, with a diagnosis of SDE with infective etiology, were included in the present cohort. Patients with posttraumatic, postsurgery, and tubercular origin of SDE were excluded from the study. The Glasgow Outcome Scale was used for outcome assessment at the end of 3 months. For analysis purposes, the demographic data, clinical features, radiological data, microbiology, type of surgery, and complication data were categorized, and univariate and multivariable logistic regression analyses were performed to identify the factors associated with outcome.RESULTSNinety-eight children were included in the study and the mean age was 10.9 years. Otogenic origin (34.7%) was the most common source of infection, followed by meningitis (14.3%). The mean duration of symptoms was 12 days. Seventy-six children presented with Glasgow Coma Scale (GCS) score > 8 and the supratentorial location was the most common location. Almost 75% of the children underwent craniotomy or craniectomy and the rest had burr-hole evacuation. Beta-hemolytic Streptococcus (10%) was the most common organism isolated. Cerebral venous thrombosis (CVT; 10.2%) was the most frequent complication in this cohort. The other complications were infarction (6.1%), new-onset seizure (4.1%), and bone flap osteomyelitis (4.1%). Thirteen cases had a recurrence of pus collection, which was more common in the craniotomy group than in the burr-hole group. Age (p = 0.02), GCS score ≤ 8 (OR 8.15, p = 0.001), CVT (OR 15.17, p = 0.001), and presence of infarction (OR 7, p = 0.05) were strongly associated with unfavorable outcome. In multivariable logistic regression analysis, only GCS score ≤ 8 (p = 0.01), CVT (p = 0.02), and presence of infarction (p = 0.04) had a significant impact on unfavorable outcome.CONCLUSIONSPrompt diagnosis and immediate intervention is the goal of management of SDE, especially in children as a delay in diagnosis can result in unconsciousness and secondary complications such as CVT and infarction, which adversely affect outcome.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Predictors Of Outcomementioning

confidence: 99%

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Predictors of outcome of subdural empyema in children

Konar¹,

Gohil²,

Shukla³

et al. 2019

Neurosurgical Focus

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“…However, subtle findings of ear tugging and persistent fever prompted further investigation leading to MRI imaging and further source control. This serves as a reminder for providers to maintain a high index of suspicion for complications in cases of bacterial meningitis, such as SDE, as symptoms may be subtle [10].…”

Section: Discussionmentioning

confidence: 99%

Haemophilus influenzae Type f Meningitis Complicated by Bilateral Subdural Empyema, Central Venous Thrombosis, and Bilateral Sensorineural Hearing Loss in an Immunocompetent 12-month-old

Panning

Mehta

2019

Cureus

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Haemophilus influenzae is a gram-negative coccobacillus that colonizes the nasopharyngeal surface and upper respiratory tract of healthy individuals and includes six encapsulated serotypes as well as non-encapsulated, non-typeable strains. Since the widespread use of the Haemophilus influenzae type b (Hib) conjugate vaccine implemented in 1990, the majority of invasive illness now seen in the United States is secondary to capsular serotypes other than type b and non-typeable strains with the largest burden of disease affecting the extremes of age-infants and the elderly. We report a case of acute Haemophilus influenzae type f meningitis in a 12-month-old female who was previously healthy and had been fully immunized. She demonstrated clinical improvement on ceftriaxone, but persistent fever and ear-tugging resulted in obtaining an MRI that displayed bilateral subdural empyemas requiring burr-hole craniotomy, central venous thrombosis requiring anticoagulation, and bilateral sensorineural hearing loss requiring cochlear implants. Immunological studies confirmed immunocompetency and appropriate response to her previous Hib vaccination, suggesting a significant impact of bacterial virulence. These complications, with the exception of sensorineural hearing loss, have not been reported in the literature for Haemophilus influenzae type f and should be considered in the care of these patients despite clinical appearance given the severity of complications and potential for acute decompensation. Despite the success of vaccination in reducing invasive disease, cases of H. influenzae meningitis continue to occur via less common encapsulated serotypes with unknown complications, making the management and treatment of these infections more difficult for practitioners.

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“…[ 3 ] In the pediatric population, SE often develops as a complication of bacterial meningitis, sinusitis, and otitis media infections, with meningitis being more common among infants compared to older children. [ 9 ] The most common bacterial agents responsible for SEs are anaerobic and microaerobic streptococci, with Staphylococcus aureus as the next most common. [ 4 ] Therefore, it is especially notable when an uncommon agent is identified in these subdural collections.…”

Section: Introductionmentioning

confidence: 99%

Subdural empyema caused by Morganella morganii

Bond¹,

Stadler²

2020

Surgical Neurology International

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Background: Morganella morganii is a species of Gram-negative enteric rod found in normal human gut flora. Pathologically, this most often presents as urinary tract infections, wound infections, and bacteremia. It is highly uncommon for M. morganii to be implicated in a central nervous system infection, with only 12 reported cases of parenchymal abscesses or meningitis. Case Description: A previously healthy 13-month-old female presented with fever of unknown origin and had a witnessed seizure during evaluation. A large left subdural fluid collection was identified, and the patient underwent emergent burr hole drainage and subdural drain placement. Cultures demonstrated M. morganii empyema, and she subsequently completed a course of directed antibiotics. Six months following surgery, she has no further clinical or radiographic evidence of infection, seizures, or neurological sequelae. Conclusion: We describe the first reported case of isolated subdural empyema caused by M. morganii. The child was successfully treated with the evacuation of the empyema and direct antibiotics with no lasting neurological injury.

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Subdural empyema in children

Cited by 29 publications

References 41 publications

Predictors of outcome of subdural empyema in children

Predictors of outcome of subdural empyema in children

Haemophilus influenzae Type f Meningitis Complicated by Bilateral Subdural Empyema, Central Venous Thrombosis, and Bilateral Sensorineural Hearing Loss in an Immunocompetent 12-month-old

Subdural empyema caused by Morganella morganii

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