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Subdural empyema in infant meningitis: diagnosis, therapy, and prognosis
Abstract:
Collections of subdural fluid during the course of infant Hemophilus influenzae meningitis have been demonstrated in the past by routine subdural taps and, more recently, by computed tomography. While the fluid is usually a benign effusion, the clinical picture and CT pattern may suggest a subdural abscess (empyema) necessitating further subdural punctures. This is a review of nine infants with subdural empyema. As reported in the literature, a remarkably good prognosis is apparent following treatment with subdural taps and systemic antibiotics. Six of seven H. influenzae cases were ampicillin-resistant in this series.
Insights
Subdural empyema in infants, often linked to Hemophilus influenzae meningitis, shows a good prognosis with subdural taps and antibiotics. However, many H. influenzae strains are ampicillin-resistant, impacting treatment choices.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Radiology
Background:
- Subdural fluid collections are common in infant meningitis, diagnosed via subdural taps or CT scans.
- While often benign effusions, they can indicate subdural abscess (empyema), requiring intervention.
- Computed tomography (CT) aids in differentiating effusions from empyema.
Purpose of the Study:
- To review cases of infant subdural empyema.
- To assess the prognosis and treatment outcomes for subdural empyema in infants.
- To highlight challenges in treating H. influenzae-related empyema.
Main Methods:
- Retrospective review of nine infants diagnosed with subdural empyema.
- Analysis of clinical presentation, CT findings, and treatment strategies.
- Evaluation of patient outcomes following intervention.
Main Results:
- Subdural empyema in infants generally has a favorable prognosis with appropriate treatment.
- Treatment typically involves subdural taps and systemic antibiotics.
- A significant proportion (six of seven) of H. influenzae cases in this series exhibited ampicillin resistance.
Conclusions:
- Early diagnosis and intervention are crucial for favorable outcomes in infant subdural empyema.
- Systemic antibiotics and subdural drainage are effective treatment modalities.
- The high rate of ampicillin resistance in H. influenzae necessitates consideration of alternative antibiotic regimens.