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Cavernous sinus thrombophlebitis in Zimbabwe
E M Scrimgeour1, O Neves, M A Sammud
1Department of Medicine, University of Zimbabwe, Avondale, Harare.
Insights
Cavernous sinus thrombophlebitis (CST) is a serious condition. Prompt diagnosis and high-dose antistaphylococcal antibiotics are crucial for better outcomes in patients with CST.
Area of Science:
- Neurology
- Infectious Diseases
- Ophthalmology
Background:
- Cavernous sinus thrombophlebitis (CST) is a rare but life-threatening condition.
- It often presents with severe symptoms and can lead to significant morbidity and mortality.
Purpose of the Study:
- To describe the clinical features, treatment, and outcomes of CST in black African patients.
- To identify factors contributing to the high mortality rate observed in this cohort.
Main Methods:
- Retrospective case series of 19 patients diagnosed with CST based on clinical criteria.
- Analysis of patient demographics, clinical presentation, treatment regimens, and outcomes.
Main Results:
- The mean age was 22.5 years, with a wide range.
- Only 15.5% of patients recovered completely, with prompt diagnosis and high-dose cloxacillin.
- Significant sequelae (blindness, ophthalmoplegia) occurred in 4 patients, and 31.6% died.
Conclusions:
- Late presentation, delayed diagnosis, and delayed effective antibiotic treatment contributed to high mortality.
- Immediate administration of high-dose antistaphylococcal antibiotics is recommended upon suspicion of CST.
Abstract:
Cavernous sinus thrombophlebitis (CST) was diagnosed in 19 black African patients who presented to two large, general hospitals in Harare, Zimbabwe, over an eight-year period. Diagnosis was based on clinical criteria. The mean age of patients was 22.5 years (range 8 months-70 years). Only three patients (15.5 pc), all of whom were promptly diagnosed and commenced on a regimen including intravenous, high-dose cloxacillin, recovered completely. In ten cases (52.6 pc), initial treatment was penicillin and chloramphenicol. Four of the 19 patients who had serious sequelae including residual blindness, complete ophthalmoplegia or unilateral proptosis, and six patients (31.6 pc) died. The higher than usual mortality rate in this series can be attributed to various factors including late presentation, delay in diagnosis and delay before initiation of effective antibiotic treatment. Whenever CST is suspected, antibiotic treatment should be administered without delay pending further evaluation, and the initial regimen should include high-dose antistaphylococcal antibiotics.