Fusobacterium necrophorum, a major provider of sinus thrombosis in acute mastoiditis: A retrospective multicentre paediatric study.

Autor: Coudert A; Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France., Fanchette J; Service d'ORL Pédiatrique, Hôpital Necker, Centre Hospitalier et Universitaire, Paris, France., Regnier G; Service d'ORL Pédiatrique, Hôpital Gui de Chauliac, Centre Hospitalier et Universitaire, Montpellier, France., Delmas J; Service d'ORL Pédiatrique, Hôpital de la Timone, Centre Hospitalier et Universitaire, Marseille, France., Truy E; Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France., Nicollas R; Service d'ORL Pédiatrique, Hôpital de la Timone, Centre Hospitalier et Universitaire, Marseille, France., Akkari M; Service d'ORL Pédiatrique, Hôpital Gui de Chauliac, Centre Hospitalier et Universitaire, Montpellier, France., Couloignier V; Service d'ORL Pédiatrique, Hôpital Necker, Centre Hospitalier et Universitaire, Paris, France., Ayari-Khalfallah S; Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France.
Jazyk: angličtina
Zdroj: Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery [Clin Otolaryngol] 2020 Mar; Vol. 45 (2), pp. 182-189. Date of Electronic Publication: 2019 Dec 10.
DOI: 10.1111/coa.13478
Abstrakt: Objective: To evaluate in children the clinical severity and evolution of otogenic lateral sinus thrombosis (OLST) due to Fusobacterium necrophorum compared with other bacterial otogenic thrombosis and propose a specific management flowchart for Fusobacterium OLST.
Design: A retrospective multicentre cohort study.
Settings: Four French ENT paediatric departments.
Participants: A total of 260 under 18 years old admitted for acute mastoiditis were included. Initial imaging was reviewed to focus on complicated mastoiditis and 52 OLST were identified. Children were then divided into two groups according to bacteriological results: 28 in the "OLST Fusobacterium group" and 24 in the "OLST other bacteria group".
Results: There was a significant association between F necrophorum and OLST (P < .001). When compared to the OLST other bacteria group, children in the OLST Fusobacterium group were significantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation: higher CRP (113 mg/L vs 175.7 mg/L, P = .02) and larger subperiosteal abscess (14 mm vs 21 mm, P < .01). Medical management was also more intensive in the OLST Fusobacterium group than in the OLST other bacteria group: increased number of conservative surgeries (66.7% vs 92.9%, P = .03) and longer hospital stay (13.7 days vs 19.8 days, P = .02). At the end of follow-up, the clinical course was good in both groups without any neurological sequelae.
Conclusions: Thrombotic complications are very frequent in case of Fusobacterium mastoiditis and clinicians should be aware of the initial severity of the clinical presentation. Under appropriate management, the clinical course of Fusobacterium OLST is as good as that of other bacterial otogenic thrombosis.
(© 2019 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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