Review and case report demonstrate that spontaneous spinal epidural abscesses are rare but dangerous in childhood

Autor: Ioanna Tritou, Maria Kampitaki, Aggeliki Tzagaraki, Georgia Vlachaki, Maria Anatoliotaki, Anastasia Fotaki
Rok vydání: 2018
Předmět:
Male
Methicillin-Resistant Staphylococcus aureus
medicine.medical_specialty
Fever
Gadolinium
Hospitals
General
medicine.disease_cause
Risk Assessment
Severity of Illness Index
03 medical and health sciences
Rare Diseases
0302 clinical medicine
Lumbar
Pharmacotherapy
030225 pediatrics
Back pain
Humans
Medicine
030212 general & internal medicine
Infusions
Intravenous
Muscle Weakness
Neck Pain
Greece
medicine.diagnostic_test
business.industry
Granulation tissue
Magnetic resonance imaging
General Medicine
Staphylococcal Infections
Prognosis
Spinal cord
Magnetic Resonance Imaging
Anti-Bacterial Agents
Surgery
Treatment Outcome
medicine.anatomical_structure
Epidural Abscess
Staphylococcus aureus
Child
Preschool
Pediatrics
Perinatology and Child Health
Cervical Vertebrae
Etiology
Drug Therapy
Combination
medicine.symptom
Emergency Service
Hospital
business
Zdroj: Acta Paediatrica. 108:28-36
ISSN: 1651-2227
0803-5253
Popis: Aim A spinal epidural abscess (SEA) is a rare paediatric bacterial infection, with possible devastating neurological sequelae. We explored localisation in the cervical segment, which is unusual, but more dangerous, than other SEAs. Methods We describe 22 cases (12 male) of paediatric SEAs without risk factors: 21 from a literature search from 2000 to 2017 and a 30-month-old boy with a spontaneous cervical SEA due to Group A Streptococcus. Results The average age was eight years and the symptoms were mainly fever, back pain and motor deficit, with an aetiological diagnosis in 68%. Methicillin-sensitive Staphylococcus aureus was isolated in six patients, methicillin-resistant Staphylococcus aureus in two, Staphylococcus aureus with unknown susceptibility patterns in three and Group A Streptococcus in four. All patients underwent gadolinium-enhanced magnetic resonance imaging and most abscesses were localised in the thoracic and lumbar areas. More than half (59%) underwent surgery to remove pus and granulation tissue and nine were just treated with antimicrobial therapy for an average of 5.3 weeks. Most patients had good outcomes. Conclusion SEAs were underestimated in children due to the rarity and spectrum of differential diagnoses. Timely diagnosis, immediate antibiotics, spinal magnetic resonance imaging and prompt neurosurgical consultations were essential for favourable outcomes.
Databáze: OpenAIRE
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