ABSTRACT
PURPOSE: To evaluate the microbiology of pediatric orbital cellulitis in blood cultures and abscess drainage cultures following the introduction of the Haemophilus influenzae serotype b (Hib) vaccine. METHODS: The medical records of all pediatrics patients (aged <18 years) at a tertiary pediatric hospital during the period January 2000 to July 2011 with a computed tomography orbital imaging querying "orbital cellulitis," "periorbital cellulitis," "preseptal cellulitis," or "post-septal cellulitis" were retrospectively reviewed. The records, microbiology, and radiology of these patients were reviewed to assess the rates and complications of H. influenzae orbital cellulitis, including bacteremia and meningitis. RESULTS: A total of 149 patients were diagnosed with preseptal or orbital cellulitis, of whom 101 (mean age, 7.2 ± 4.0) had true orbital cellulitis. No patients grew H. influenzae from blood cultures. Of the 101 patients, 30 (29.7%) required surgical drainage and had abscess drainage fluid sent for microbiology. Of these, 18 (64.3%) had a positive culture: 4 (13.3%) grew H. influenzae from their abscess drainage fluid samples; 1 grew H. influenzae alone; and 3 had mixed growth that included H. influenzae. The patients positive for H. influenzae were significantly older and had significantly larger abscesses. CONCLUSIONS: Although there were no cases of H. influenzae bacteremia or meningitis in our cases of orbital cellulitis, abscess drainage fluid microbiology indicated that H. influenzae remains a cause of orbital cellulitis. H. influenzae abscess volume was significantly larger than other bacterial abscesses and was associated with abscesses of mixed bacterial growth in older children.
Subject(s)
Abscess/microbiology , Bacteremia/microbiology , Eye Infections, Bacterial/microbiology , Haemophilus Infections/microbiology , Haemophilus Vaccines/administration & dosage , Haemophilus influenzae/isolation & purification , Orbital Cellulitis/microbiology , Abscess/diagnosis , Abscess/surgery , Bacteremia/diagnosis , Bacteremia/surgery , Bacteria/isolation & purification , Bacterial Capsules , Child , Child, Preschool , Drainage , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/surgery , Female , Haemophilus Infections/diagnosis , Haemophilus Infections/surgery , Humans , Male , Meningitis, Haemophilus/diagnosis , Meningitis, Haemophilus/microbiology , Meningitis, Haemophilus/surgery , Orbital Cellulitis/diagnosis , Orbital Cellulitis/surgery , Retrospective Studies , Tomography, X-Ray Computed , VaccinationABSTRACT
OBJECT: The management of subdural empyema (SDE) has been debated in the literature for decades. Craniotomy and bur hole drainage have been shown to achieve a favorable outcome. However, there is a lack of comparative data for these modes of management of SDE subsequent to meningitis in infants. METHODS: The authors conducted a retrospective review of 33 infants identified with SDE due to meningitis at the Department of Neurosurgery, Chang Gung Memorial Hospital between 2000 and 2006. Preoperative clinical presentation, duration of symptoms, radiological investigations, CSF data, and postoperative outcome were analyzed and compared between these 2 surgical groups. RESULTS: At diagnosis, there were no differences between the groups in age, weight, degree of consciousness, CSF analysis, or duration of fever. The outcome data showed no difference in the number of days until afebrile, number of days of postsurgical antibiotic treatment, neurological outcome, recurrence rate, or complication rate. There was only 1 death in the series. CONCLUSIONS: Subdural empyema due to meningitis in infants is unique with respect to the pathophysiology, presentation, and treatment of SDE. Early detection and removal of SDE provide a favorable outcome in both surgical intervention groups. Bur hole drainage is less invasive, and it is possible to expect a clinical outcome as good as with craniotomy in postmeningitic SDE.
Subject(s)
Craniotomy , Empyema, Subdural/diagnosis , Empyema, Subdural/surgery , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/surgery , Trephining , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Meningitis, Escherichia coli/diagnosis , Meningitis, Escherichia coli/surgery , Meningitis, Haemophilus/diagnosis , Meningitis, Haemophilus/surgery , Meningitis, Pneumococcal/diagnosis , Meningitis, Pneumococcal/surgery , Neurologic Examination , Retrospective Studies , Streptococcal Infections/diagnosis , Streptococcal Infections/surgery , Streptococcus agalactiae , Tomography, X-Ray ComputedABSTRACT
Two infants, an 11-month-old boy and a 7-month-old girl, presented with subarachnoidal abscess associated with severe bacterial meningitis refractory to intensive managements with antibiotics. Computed tomography (CT) revealed bifrontal extracerebral low-density areas and remarkably enhanced surfaces of the bilateral frontal lobes postcontrast. Surgical exploration disclosed thick pus accumulation in the subarachnoid space which required curettage. The boy developed appropriately for his age, but the girl showed severe psychomotor retardation because of additional complications such as subdural fluid collection and hydrocephalus associated with the subarachnoidal abscess. Appropriate early neurosurgical management of subarachnoidal abscess is essential for satisfactory psychomotor development. Postcontrast CT should be performed to detect the subarachnoidal abscess as early as possible, and extensive craniotomy to remove the subarachnoidal pus accumulation performed to preserve psychomotor development.
