Abstract
Background: Meningitis is the most common intracranial complication of sinusitis. Objective: Determine the frequency of sinusitis using CT scans in children with documented meningitis. Methods and materials: A prospective, cross sectional study was done in pediatric infectious ward of Rasul Hospital in Tehran, Iran during 2010-2011. In this study 65 cases with meningitis were evaluated for presence of sinusitis (according to symptoms, criteria and paranasal CT scan). Results: CSF obtained in 112 cases. Cases with meningitis aged 1 month-16 years old with a mean of 4.2 years. Definite bacterial meningitis was the final diagnosis in 40/112 patients (35.7%; missing=5). Second step: Paranasal sinus CT scan had been performed in 65 cases with final diagnosis of meningitis. Cases were between 1 month to 16 years old (mean age of 4.2 y). 51% of the patients were male and 49% were female. Bacterial meningitis was diagnosed in 55.3% (36/65) and aseptic meningitis in 44.7% (29/65). Sinuses were reported to be undeveloped in 7.6% (n=5) of younger than 4 months old cases. Sinusitis was diagnosed in 30.7% (20/65) of all cases with meningitis; 3.4% (1/29) in those with aseptic meningitis and 52% (19/36) in those with bacterial meningitis which shows significant difference between the 2 groups (P<0.05). The involved sinuses included: pan sinusitis with 15% (3/20) case. Maxillary sinusitis the most common type observed (16/20); on the next places comes; sphenoid sinusiti (7/20); ethmoeid sinusitis (4/20) and finally isolated frontal sinusitis was seen in 0% of cases. Chronic type of sinusitis was reported in 50% (n=10) of all cases. Conclusion: The prevalence of sinusitis in documented cases of meningitis (septic & aseptic meningitis) was 31%, and was more common (25%) in bacterial meningitis. Meningeal manifestations (e.g. meningeal signs and symptoms; or CSF changes) might be due to bacterial sinusitis. Most cases of meningitis in children are accompanied with sinusitis. Differentiation between the two sources and definition of the initial site of infection is always problematic. Appropriate bacterial sinusitis treatment is needed to prevent meningitis. We recommend sinus tract to be evaluated in every meningitis patient (septic or aseptic). Furthermore, adequate treatment in chronic sinusitis would help prevent readmission.
Highlights
Eommunity acquired sinusitis is one of the most common causes to seek medical attention especially from paediatricians [1,2]
Second step: Paranasal sinus CT scan had been performed in 65 cases with final diagnosis of meningitis
Most cases of meningitis in children are accompanied with sinusitis
Summary
Eommunity acquired sinusitis is one of the most common causes to seek medical attention especially from paediatricians [1,2]. Given that meningitis is the most common intracranial complication of sinusitis and bacterial meningitis is one of the most potentially serious infections in infants and older children which can be accompanied with a high rate of acute complications and long-term morbidity, an accurate and rapid diagnosis of acute bacterial meningitis is essential for early treatment and good outcome. Signs and symptoms are often non specific and it is not always possible to make a differential diagnosis between bacterial and aseptic meningitis [4,5,6,7,8]. According to a study performed by Younis et al most cases of meningitis in children are accompanied with sinusitis [9]. Meningitis is the most common intracranial complication of sinusitis
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