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Acute mastoiditis in children: Pseudomonas aeruginosa as a leading pathogen
Yonatan Butbul-Aviel1, Dan Miron, Raphael Halevy
1Pediatric Department 'B', Ha'Emek Medical Center, Afula 18101, Israel.
Insights
Acute mastoiditis in children can often be diagnosed clinically, with most cases resolving with antibiotics alone. Pathogen identification is key, as Streptococcus pneumoniae is common in first-time infections, while Pseudomonas aeruginosa is more frequent in recurrent cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Acute mastoiditis is a severe temporal bone infection and a common sequela of otitis media.
- Early identification and management are crucial for preventing complications in children.
Purpose of the Study:
- To analyze the clinical characteristics, causative pathogens, treatment strategies, and outcomes of acute mastoiditis in pediatric patients.
- To differentiate pathogen prevalence based on prior history of acute otitis media.
Main Methods:
- Systematic review of medical records for children diagnosed with acute mastoiditis between 1990 and 2000.
- Clinical data, microbiological cultures, and imaging findings were analyzed.
Main Results:
- Fifty-seven children were included; 45.6% had mastoiditis complicating their first episode of acute otitis media.
- Common pathogens included Pseudomonas aeruginosa (25%) and Streptococcus pneumoniae (20%).
- Over 91% of children recovered with antibiotic treatment alone; surgery was infrequent.
Conclusions:
- Clinical diagnosis is often sufficient for acute mastoiditis, with CT scans reserved for suspected complications.
- Streptococcus pneumoniae was the primary pathogen in children without prior acute otitis media, whereas Pseudomonas aeruginosa predominated in those with recurrent infections.
- The majority of pediatric acute mastoiditis cases can be managed effectively with medical therapy, minimizing the need for surgical intervention.
Objective:
Acute mastoiditis is a serious bacterial infection of the temporal bone and is the most common complication of otitis media. The goal of this study is to assess the clinical features, pathogens, management, and outcome of acute mastoiditis in children in northern Israel.
Methods:
A systematic review of medical records of all children who were admitted with acute mastoiditis from January 1990 through December 2000.
Results:
Fifty-seven children were included. Median was age: 36 months. In 26 patients (45.6%) mastoiditis complicated the first episode of acute otitis media (AOM). Twenty-five children (44%) received antibiotic treatment prior to admission. Frequent symptoms included mastoid area erythema in 54 children (94.7%), proptosis of the auricle in 52 children (91.2%) and fever in 43 children (75.4%). Middle ear, and subperiostal culture yielded growth of pathogen in 30 children (75%), two cultures yielded more then one pathogen. The most frequent pathogens were: Pseudomonas aeruginosa in 10 children (25%), Streptococcus pneumoniae in eight children (20%), Group A streptococcus in six children (15%). The highest incidence of Streptococcus pneumoniae was found in children who did not suffer from AOM before admission (35 vs. 5%). Fifty-two (91.2%) children were cured with antibiotic treatment alone. Seventeen children underwent computed tomography (CT) of the mastoid. Mastoid bone destruction was demonstrated in six children and subperiostal abscess in eight. Mastoidectomy was performed in five children.
Conclusions:
The diagnosis of acute mastoiditis can be made on clinical basis alone requiring CT only when complications are suspected. Half of the children admitted with acute mastoiditis had no previous history of recurrent AOM. In those children S. pneumoniae was the leading pathogen while P. aeruginosa was more prevalent in children with recurrent AOM. Most of the children recovered with medical therapy alone, without surgical intervention.