Otogenic Infections Research Articles

Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era

BackgroundCOVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017–2019), COVID (2020–2021), and post-COVID period (2022–June 2023) looking for possible epidemiological and/or clinical changes.Material and methodsAn English language questionnaire was sent to ESPN members about year of the event, patient’s age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up.ResultsTwo hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%.ConclusionsThese results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.

Imaging spectrum and complications of otogenic infections: insights into delayed diagnosis.

Skull base osteomyelitis (SBO) is a late manifestation of complicated otogenic infections that presents a diagnostic challenge. Delayed or missed diagnoses lead to high morbidity and mortality and can be attributed to non-specific symptoms, subtle early radiologic findings, radiologic mimicry of nasopharyngeal carcinoma (NPC), and under-recognition from clinician and radiologists. This pictorial review aims to emphasize on early imaging recognition and distinction between SBO and NPC.

Pediatric intracranial empyema complicating otogenic and sinogenic infection

ObjectiveTo describe and compare clinical and microbiological features, surgical and medical management, and outcomes of children with otogenic and sinogenic intracranial empyema (IE) in an institution with an established multidisciplinary protocol. To use the study findings to inform and update the institutional algorithm. MethodsRetrospective analysis was carried out on the electronic healthcare records of all children with oto-sinogenic IE admitted in a 5-year period. ResultsA total of 76 patients were identified and treated according to an institutional protocol. Two distinct groups were identified: intracranial empyema related to otogenic infection (OI-IE, n = 36) or sinogenic infection (SI-IE, n = 40). SI-IE was seen in older children and had a significantly higher morbidity. Sub-dural IE was seen in a minority (n = 16) and only in SI-IE and required urgent collaborative ENT-neurosurgery. Extra-dural IE occurred more frequently and was seen in both SI-IE and OI-IE. No death and overall low morbidity were observed. Particularities found in SI-IE and OI-IE groups (as thrombosis, microbiology, antibiotic treatment, duration and outcome) permitted the delineation of these groups in our updated algorithm. ConclusionThe presence of a collaborative multidisciplinary protocol permits the step-wise co-ordination of care for these complex patients in our institution. All patients received prompt imaging, urgent surgical intervention, and antibiotic treatment. Microbiological identification was possible for each patient and antibiotic rationalization was permitted through use of Polymerase chain reaction (PCR) testing in cases of sterile cultures. Of note, intracranial empyema related to sinogenic infection is shown to have significantly more severe clinical presentation, a higher morbidity, and a longer duration of antibiotic therapy than that related to otogenic infection. Study findings allowed for the update and clarification of the institutional protocol, which now clearly demarcates the clinical presentation, biological evidence, radiology, surgical and medical treatments in children with oto-sinogenic IE.

Cerebral Abscess In A Child With Unknown Origin Of Infection

Introduction: The incidence of brain abscesses is higher in developing countries. The classic triad of fever, headache, and focal neurological signs was seen in 9–28% of the pediatric cases. Brain abscesses occur infrequently with potentially life-threatening conditions. Case Report: The patient was a child 1 year 8 months old with a main complaint of weakness in the left arm and leg progressively for one month. She had a local seizure on her left arm and leg one month before admission with a duration of 30 minutes. She was irritable for the last two weeks. The strength of the upper and lower extremities was 3 respectively. The physiology reflex was hyper-reflex on the upper and lower extremities. A Head non-contrast CT scan showed a hypodense lesion on the right parietal with a perifocal edema lesion. A head contrast CT scan showed a hypodense lesion on the right parietal with ring enhancement measuring approximately 6,2 cm x 4,5 cm. Craniotomy evacuation abscess with near total capsulectomy was done on initial and capsule resection was done. Discussion: Brain abscess is a focal pyogenic infection of the brain parenchyma, and the frontotemporal lobe is the most common site of brain abscess, followed by frontal-parietal, parietal, occipital lobes, and cerebellar. The most common risk factors that predispose a child to the formation of a brain abscess include congenital heart disease, sinus and otogenic infections, and poor dental hygiene. The triad of brain abscess, including headache, fever, and neurological symptoms is only present in (15%) of the cases reported. Medical treatment is recommended in patients without increased intracranial pressure, with symptoms of less than 1 week long and abscess of less than 2 cm seen in tomography. The suggested time of treatment is between 6 and 8 weeks with intravenously administered antibiotics. A full recovery rate from the infection of about 60–70% is reported in the case of early diagnosis and proper therapy Conclusion: Cerebral abscess in pediatrics with unknown origin of infection may happen in 12%. Early diagnosis and treatment of pediatric cerebral abscesses can reduce morbidity and mortality rates. A broadspectrum antibiotic is an optimal treatment in the postoperative evacuation of cerebral abscess cases with unknown origin infection.

Malignant Otitis Externa: Unveiling the Hidden Danger of ICA Pseudoaneurysm.

Pseudoaneurysm of the internal carotid artery following otogenic infection is rare but leads to catastrophic outcomes. In our case series, we present two patients with ICA pseudoaneurysm complicated by malignant otitis externa, and we emphasise the importance of timely diagnosis and management to prevent fatal outcomes. A pseudoaneurysm should be ruled out in a patient with malignant otitis externa presenting with recurrent epistaxis or ear bleed.

Pertinence of Streptococcus anginosus group in intracerebral abscesses in the era of extended antibiotic resistance

Aims• To study the incidence of Streptococcus anginosus group (SAG) in pyogenic or community acquired intra cerebral abscess.• To understand the risk factors for the same.• To analyze the specific radiological features and clinical outcome after surgery and antibiotic therapy. MethodsThis is a retrospective observational study of case series over a period of one year. Patients diagnosed with intracerebral abscess were included in the study. Pus collected from were received in the laboratory and processed according to the standard protocols. Data regarding the clinical findings and demographics were collected from medical records. FindingsA total of 202 samples were studied. 103 were found to be pyogenic. SAG were isolated from 21 samples (20.38%) and all the isolates were sensitive to Penicillin. Age of the patients ranged from 18months to 68years. Male preponderance was noted with male to female ratio of 4:1. Otogenic infections were the most common predisposing factors and focus of infection could not be ascertained in 5 patients. All patients were treated with surgical intervention and antibiotics (Vancomycin, Amikacin and Metronidazole) for 6 weeks and recovery was remarkable. One patient succumbed to the illness. ConclusionSAG can be an aggressive pathogen with propensity for abscess formation. Chronic Suppurative Otitis Media (CSOM) is still a major cause of intracerebral abscess in developing country like India which is a benign and curable disease and should not be neglected. Injudicious use of antibiotics and negligence regarding the dose and duration of therapy from both patients and health care providers is the major cause for common infections to become more difficult to treat and succumbing to complications.

Bacterial meningitis secondary to otogenic infection in 10 French bulldogs: A retrospective case series.

There is limited published information to guide the clinical management of bacterial meningitis/encephalitis in dogs. This was a retrospective case series comprising 10 French bulldogs from two referral centres. The cases were diagnosed with bacterial meningitis/encephalitis suspected secondary to otogenic infection based on detection of abnormal fluid/soft tissue opacity within the middle/inner ear, associated meningeal/intracranial involvement through MRI, the findings of cerebro-spinal fluid (CSF) analysis suggestive of sepsis and/or clinical improvement following antibiosis. Ten dogs were included (three female and seven male), with a median age of 60 months. Dogs presented with acute onset (median 2 days), progressive history of vestibular signs and/or intra-oral or cervical pain. Five dogs had gross signs of concurrent otitis externa. Common MRI findings included material within the tympanic bulla with adjacent meningeal enhancement. Analysis of CSF documented pleocytosis in all eight dogs, intracellular bacteria seen in three with positive bacteriological culture in two dogs. One dog was euthanised following diagnosis. Nine remaining dogs received antimicrobial therapy and six underwent surgical management. Three dogs treated surgically were neurologically normal within 2 weeks and the remaining three improved. Two dogs treated medically improved and one had complete resolution reported within a 4-week follow-up period. Study limitations include its retrospective nature and small sample size with minimal longer term follow-up. Bacterial meningitis/encephalitis in French bulldogs can require both medical and surgical treatment to achieve a favourable outcome.

Cerebral sinovenous thrombosis associated with head/neck infection in children: Clues for improved management.

To compare paediatric patients with cerebral sinovenous thrombosis (CSVT) with and without head/neck infection to improve management of the condition. We conducted a bicentric retrospective study of consecutive children (neonates excluded) with radiologically confirmed CSVT, comparing children with a concurrent head/neck infection and children with other causes. A total of 84 consecutive patients (46 males and 38 females) with a median age of 4 years 6 months (range 3 months-17 years 5 months) were included. Associated head/neck infection was identified in 65.4% of cases and represented the main identified CSVT aetiology. Children in the head/neck infection group displayed a milder clinical presentation and less extensive CSVT. Median time to complete recanalization was significantly shorter in this group (89 days [interquartile range 35-101] vs 112.5 days [interquartile range 83-177], p= 0.005). These findings were even more pronounced in the subgroup of patients with otogenic infection and no neurological sign. As CSVT in the setting of an otogenic infection and no neurological sign seems to represent a milder condition with a shorter course, these results suggest adapting current recommendations: consider earlier control imaging in paediatric otogenic CSVT, and shorter anticoagulant treatment if recanalization is obtained. Children with cerebral sinovenous thrombosis related to head/neck infections have a milder clinical presentation. They also have a shorter recanalization time, especially if there is otogenic infection without neurological symptoms.

Risk factors and clinical Outcome of Tetanus in Pediatric ICU of a developing country.

Objective: To evaluate the Risk factors and clinical Outcome of Tetanus in Pediatric ICU of a developing country. Study Design: Prospective Cross-sectional study. Setting: PICU of National Institute of Child Health Karachi. Period: September 2019 to March 2020. Material & Methods: All cases of tetanus aged one month to 15 years were included with non-probability, convenient technique. Only children whose parents/guardians did not consent to the study participation, were excluded. Results: We enrolled 53 patients in study. Mean age was 8.2 years. Gender distribution was 33:20 male to female. History of trauma was present in 27% cases. Maximum ICU stay was 16 days (mean). Metallic material was used in 9/27 (33%) and wooden material was used in 4/27 (15%) patients, while in 14(51%) other materials were used. Otogenic infection was present in 9/53 (17%), post injury infection occurs in 1/53 (2%) while others are unknown. Conclusion: Tetanus is preventable disease with high morbidity, and mortality. It can be addressed at mass level with campaigns and prohibited with compliant EPI scheduled vaccination.

Concurrent management of suppurative intracranial complications of sinusitis and acute otitis media in children

ObjectiveIntracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention. MethodsA retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted. Results65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%. ConclusionIntracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.

An Eight Year Clinico-Microbiological Retrospective Study on Brain Abscesses in India.

Background:Intracranial abscesses have been a diagnostic and therapeutic challenge since time immemorial for both the microbiologists and the neurosurgeons. There is paucity of detailed studies documenting the infecting organism causing brain abscesses in South India.Aims:The study aimed at identifying and assessing the prevalence of aerobic, anaerobic bacteria and fungi associated with brain abscesses at a tertiary care hospital in South India.Methods and Material:Eight years data was collected from the records of culture reports from 2007 to 2010 and 2013 to 2018. The corresponding clinical case records were retrieved for the assessment of risk factors. Risk factors of brain abscess development were assessed based on clinical cases records.Results:Data from 140 brain abscess cases obtained over a period of 8 years were analyzed. Out of the 140 samples, 66 (47.14%) were culture positive in which 33 (50%) had single aerobic/facultative anaerobic bacteria, 20 (30.3%) had mixture of more than one aerobic/facultative anaerobic bacteria, 12 (18.18%) had single obligate anaerobic bacteria and 1(1.5%) sample had Mycobacterium tuberculosis isolated. Among the total 92 isolates, Pseudomonas aeruginosa (21/92, 23%) and Staphylococcus aureus (20/92, 22%) predominated. Bacteroides fragilis group was the most common obligate anaerobe isolated. There were no fungal isolates. As there were various isolates isolated, hence there is heterogeneity of isolates detected Neuroanatomically, parietal lobe (45/140, 32%) was the most common location. Otogenic infection was the major risk factor for parietal and temporal lobe abscess (P value < .05).Conclusions:It has become essential for the microbiologists to be aware of unusual isolates from brain abscess and its complex nature. Obscurity and difficulty in their microbiological diagnosis calls for more such detailed studies.

Intracranial infected collections and epidemiology in the top end, Northern Territory, Australia. A 10-year case series.

The incidence of intracranial infected collections (IIC) ranges between 0.4 and 1.2/100 000 persons per year. There is anecdotal evidence that residents in Top End of the Northern Territory are at a greater risk of infections with protracted clinical presentations. To our knowledge, there is no study to date to explore IIC in the Top End. Retrospective observational analysis of IIC in the Top End, Northern Territory, Australia from 2009 to 2019. International classification of disease code G06 was used to identify cases diagnosed at Royal Darwin, Gove District and Katherine Hospital with no restriction of age or gender. A total of 51 cases were identified. This equated to an incidence of 2.9 (95% CI 2.2-3.8) in 100 000 PPY. When separated into Indigenous and non-Indigenous populations, the respective incidences were 8.65 (95% CI 6.2-12.1) and 1.1 (95% CI 0.7-1.9) in 100 000 PPY. The Indigenous population was at a significantly higher risk of IIC compared with non-Indigenous Australians with a relative risk of 7.3 (P< 0.0001 95% CI 4.0-13.3). The most common aetiology was otogenic infections with all cases being identified in the Indigenous population. Comparison of other clinical parameters between the two populations were not statistically significant. Within the limitations of a retrospective study, the incidence of IICs is higher in the Top End than reported elsewhere in the literature. This is particularly true for the Indigenous population.

Encephalitis and Brain Abscess.

This article reviews infections of the brain parenchyma and includes an overview of the epidemiology, pathogenesis, diagnostic approach, and management of infectious encephalitis and brain abscess. The epidemiology of infectious encephalitis and brain abscess has changed in recent years. Vaccination has reduced the incidence of certain viruses associated with encephalitis, while a decrease in fulminant otogenic infections has led to fewer brain abscesses associated with otitis media. However, changes in climate and human population density and distribution have enabled the emergence of newer pathogens and expanded the geographic range of others, and greater adoption of intensive immunosuppressive regimens for autoimmune conditions has increased the risk of opportunistic infections of the brain. The widespread use of early neuroimaging, along with improved diagnostic methodologies for pathogen detection, newer antimicrobial therapies with better brain penetration, and less invasive neurosurgical techniques, has resulted in better outcomes for patients with infectious encephalitis and brain abscess. Novel technologies including metagenomic next-generation sequencing are increasingly being applied to these conditions in an effort to improve diagnosis. Nevertheless, both infectious encephalitis and brain abscess continue to be associated with substantial mortality. Infectious encephalitis and brain abscess can present as neurologic emergencies and require rapid assessment, thorough and appropriate diagnostic testing, and early initiation of empiric therapies directed against infectious agents. Close clinical follow-up, proper interpretation of diagnostic results, and appropriate tailoring of therapeutic agents are essential to optimizing outcomes. Diagnosis and management of parenchymal brain infections are complex and often best achieved with a multidisciplinary care team involving neurologists, neurosurgeons, neuroradiologists, infectious disease physicians, and pathologists.

OTOGENIC BRAIN ABSCESS MANAGEMENT STRATEGY : AN INSTITUTIONAL EXPERIENCE.

Abstract: Otogenic brain abscess is a potentially lifethreatening complication of otitis media, which requires a high index of suspension for prompt diagnosis and management. This study is a retrospective analysis of 20 cases of otogenic brain abscess that has been managed at our institute from 2000 to 2018. Although the prevalence has decreased signicantly due to the use of antibiotics, the problem still persists. Headache, fever and vomiting are the most common presenting symptoms. The use of advanced imaging techniques has contributed a lot in making the diagnosis faster. In contrast to previous studies where the temporal lobe is the most common site, both cerebellar and temporal lobe involvement has been seen to occur equally among our study population. . Pseudomonas was found to be the most common organism as compared to Proteus mirabilis in most of the recent studies. Immediate therapy with intravenous antibiotics was found responsible for 32% of the sterile cultures. Twelve(60%) of our patients underwent interval mastoidectomy, of which seven patients underwent mastoidectomy at two weeks, and ve patients were intervened at six weeks and rest eight were managed in the same sitting. No change was observed in these groups in terms of outcome after six weeks of follow-up. Although rare brain abscess continues to be a serious complication of otitis media which needs immediate attention with a multidisciplinary approach. Keywords: Brain abscess; Otogenic infection; Otitis media; Magnetic resonance imaging; Computed tomography

A Case Report : Massive Subdural Empyema Following Ventriculo-Peritoneal Shunt Placement in Child Patient

Background: Subdural empyema is a critical neurosurgical condition that arise from neurosurgical procedures, trauma, meningitis, sinusitis, or otogenic infection. Reported mortality rates vary from 4.4% to 24%. Ventriculoperitoneal (VP) shunt placement is one of the most common procedures and reported rates for shunt infections are relatively high. However, their association with subdural empyema is rare. Case Report: One years old boy who presented with fever, lethargy, and inability to walk was admitted to the hospital. He was undergone Vp-shunt 1 month ago because of hydrocephalus. At the time of admission, the child was alert, had a moderate right hemiparesis, and a macrocephalic appearance. An emergency CT scan showed well-circumscribed subdural empyema. Discussion: A craniotomy was performed, then thick fibrous capsule underlying the dura mater was encountered, finally the pus was totally removed. Postoperatively, he was fully alert with a marked motoric improvement. Diplococus gram positive was found. The patient was given appropriate antibiotic treatment for 3 weeks periode. Conclusion: Subdural empyema is an unusual complication of a VP-shunt. Although rare in children, it is still a neurosurgical problem. The combination of medication and surgery treatment in Subdural empyema resulted in a good response.

Intracranial Abscesses: An Institutional Study

Background: Brain abscess is defined as a focal intracranial infection that is initiated as an area of cerebritis and evolves into a collection of pus surrounded by a vascularized capsule. These are complications of head trauma, neurosurgical operations, meningitis, and otogenic, mastoid, and paranasal air sinus infections. Management involves both medical and surgical treatment. Surgical management includes either aspiration or excision of lesions larger than 2.5 cm in diameter, depending on brain location. However, literature on surgical treatment is replete with several procedures which, on their own, may not determine outcome. Aim: Aim is to study the epidemiology, management and outcome of various treatment modalities of brain abscess in our institute. Material and Methods: We conducted a retrospective study of demographic data as well as indications, treatment modalities, and outcomes of various surgical procedures for evacuation of intracranial abscesses in patients admitted to our Neuro-intensive care unit at R.N.T. Medical College, Udaipur, Rajasthan, India from January 2013 to June 2019. Results: We carried out 53 procedures in 43 (30 male and 13 female) patients with various intracranial abscesses. Most abscesses [16, i.e. 37%] occurred in the second decade and second most common in the first decade [15, i.e. 34%]. In infants 4 (9%) cases of intracranial abscesses were present. None of the infants had features of congenital heart disease. The predisposing factors were mostly otolaryngologic (15) or posttraumatic (8). Most commonly abscesses were located in frontal 13 (30%) followed by cerebellar 9 (21%). Burr hole evacuation was done in 74% of cases. 3 patients (7% of cases) died. Prognosis appears to worsen with ventriculitis, multiple abscesses especially in infants, and immunosuppression. Conclusion: In conclusion, brain abscess still continues to be a formidable challenge, with prognosis that dramatically improved over the last decades due to advances in brain imaging, neurosurgical techniques and better use of old and more recent antibacterial agents. Mortality is improved compared with historical series; however, long-term morbidity is significant particularly in the infant population. Further researches must be conducted to clarify specific aspects, such as anticonvulsant prophylaxis/therapy, and also for the improvement of microbiological diagnosis.

Surgical management of raised intracranial pressure secondary to otogenic infection and venous sinus thrombosis

PurposeThis study reviews paediatric patients with raised intracranial pressure as a result of venous sinus thrombosis secondary to otogenic mastoiditis, requiring admission to the paediatric neuroscience centre at the University Hospital Wales, Cardiff. The consensus regarding the management of otogenic hydrocephalus in the published literature is inconsistent, with a trend towards conservative over surgical management. We reviewed our management of this condition over a 9-year period especially with regard to ventriculo-peritoneal (VP) shunting.MethodsAnalysis of a prospectively collected database of paediatric surgical patients was analysed and patients diagnosed with otogenic hydrocephalus from November 2010 to August 2018 were identified. Our data was compared with the published literature on this condition.ResultsEleven children, 7 males and 4 females, were diagnosed with otogenic hydrocephalus over the 9-year period. Five (45.5%) required VP shunt insertion to manage their intracranial pressure and protect their vision. The remaining six patients (54.5%) were managed medically.ConclusionsWhen children with mastoiditis and venous sinus thrombosis progress to having symptoms or signs of raised intracranial pressure, they should ideally be managed within a neuroscience centre. Of those children, almost half will need permanent cerebrospinal fluid diversion to protect their sight.

Clinical characteristics and complications of skull base osteomyelitis: A 12-year study in a teaching hospital in South India.

Context:Skull base osteomyelitis (SBO) is an uncommon disease with substantial morbidity and mortality.Aims:The aim of this study is to characterize clinical features, outcomes, and complications of SBO. We also looked at differences in clinical profile in otogenic and non-otogenic SBO.Materials and Methods:This is a single-center retrospective observational study. Patients aged more than 15 years of age with clinical and radiological diagnosis of SBO admitted in general medicine department in a teaching hospital in South India from March 2006 to February 2018 were recruited.Results:A total of 41 patients with SBO were identified and included. Mean age was 56.9 ± 10.7 years. In all, 90% of patients (37/41) had diabetes mellitus and 29% (12/41) had recent head/neck surgery. Only 19% (8/41) needed ICU care, and mortality was 21% (9/41). Most common symptom was headache seen in 73% (30/41) of patients. Majority, 61% (25/41), had otogenic infections. Otogenic infections were associated with longer duration of diabetes mellitus (mean = 11.5 vs. 5 years, P = 0.01), higher creatinine levels (mean = 1.66 vs. 0.9 mg/dL, P = 0.014, odds ratio [OR] = 3.8), and higher incidence of cranial nerve palsy (92% vs. 56%; OR = 8.9) compared to non-otogenic SBO. Cranial nerve palsy (78%), meningitis (63%), and cerebral venous thrombosis (43%) were frequent complications of SBO in this study. The causative organisms for SBO in our cohort was bacterial in 60% (15/25) and fungal in 40% (10/25) of the patients. Surgical debridement for source control was done in 54% of patients (22/41) and was associated with survival at discharge (P = 0.001).Conclusions:Bacterial infections are the most common cause of SBO. Otogenic SBO is associated with longer duration of diabetes mellitus and higher incidence of cranial nerve palsy. Therapeutic surgical debridement plays an important role in treatment of SBO and is associated with improved survival.

Brain and Spinal Epidural Abscess

Brain abscesses and spinal epidural abscesses are serious, potentially life-threatening infections of the central nervous system. This article outlines the clinical presentation, evaluation, and management of brain abscesses and spinal epidural abscesses, with a specific focus on bacterial infections. The overall incidence of brain abscesses has declined, in part because of fewer brain abscesses associated with otogenic infections. However, emerging patient populations at high risk for brain abscess include those with a history of penetrating head trauma, neurosurgery, or immunodeficiency. Improved mortality rates for brain abscess are attributable to modern diagnostic imaging, stereotactic-guided aspiration, and newer antimicrobials that readily penetrate into the central nervous system and abscesses. Brain MRI is more sensitive than CT for brain abscess, particularly in the early stages, but CT remains more widely available and can adequately identify potential abscesses and confirm response to treatment. With the advent of minimally invasive neurosurgical techniques, surgical excision is often employed only for posterior fossa, multiloculated, or superficial well-circumscribed abscesses. In select clinical scenarios, conservative medical management may be a safe alternative to a combined surgical and medical approach. Unlike brain abscess, the incidence of spinal epidural abscess is on the rise and has been attributed to higher prevalence of predisposing factors, including spinal procedures and instrumentation. Successful diagnosis and management of brain abscess and spinal epidural abscess requires a collaborative approach among neurologists, neurosurgeons, radiologists, and infectious disease physicians. The foundation of management of brain abscess includes surgical intervention for diagnostic purposes if a pathogen has not been identified or for decompression of larger abscesses or those with mass effect and significant surrounding edema; appropriate dosing and adequate duration of an antimicrobial regimen tailored to the presumptive source of infection and available culture data, and eradication of the primary source of infection. For spinal epidural abscesses, neurologic status at the time of presentation is directly related to outcomes, underscoring the importance of prompt recognition and intervention.

Cerebellar Abscess Caused by Extension of an Otogenic Infection Through the Labyrinth and Internal Auditory Canal.

Cerebellar Abscess Caused by Extension of an Otogenic Infection Through the Labyrinth and Internal Auditory Canal.