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Characterization of Inflammatory Responses During Intranasal Colonization with Streptococcus pneumoniae
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A 20-Year Study of Intracranial Pyogenic Complications of Sinusitis in Children

Mina Smiljkovic1, Jennifer Tat1,2, Susan E Richardson2

  • 1From the Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

The Pediatric Infectious Disease Journal
|October 18, 2023
PubMed

Insights

Intracranial complications of sinusitis in children, such as epidural empyema, lead to significant morbidity. Early diagnosis and broad-spectrum antibiotics are crucial to prevent neurologic sequelae in pediatric sinusitis cases.

Area of Science:

  • Pediatric Infectious Diseases
  • Pediatric Neurology
  • Neurosurgery

Background:

  • Sinusitis in children can lead to severe intracranial pyogenic complications.
  • These complications pose a significant risk of long-term sequelae.

Purpose of the Study:

  • To characterize the clinical, epidemiologic, and microbiologic features of pediatric intracranial sinusitis complications.
  • To identify factors associated with adverse outcomes.

Main Methods:

  • Retrospective chart review of pediatric cases over 20 years.
  • Identification of cases using International Classification of Diseases (ICD)-9 and ICD-10 codes.
  • Analysis of intracranial microbiologic samples.

Main Results:

  • 104 cases of complicated sinusitis were identified.
  • Epidural empyema (48%) and subdural empyema (44%) were most common.
  • Streptococcus anginosus was the predominant pathogen, but polymicrobial infections were frequent (38%).
  • 24% of patients experienced persistent neurologic sequelae or death.
  • Neurologic sequelae were associated with cerebritis and extensive intracranial disease on imaging.

Conclusions:

  • Intracranial sinusitis complications remain a significant cause of childhood morbidity.
  • Polymicrobial infections necessitate broad-spectrum empiric antibiotic therapy.
  • Delayed diagnosis, indicated by extensive intracranial involvement, may contribute to poor outcomes.
Abstract

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