Pediatric subdural empyema as a complication of meningitis: could CSF protein/CSF glucose ratio be used to screen for su

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ORIGINAL ARTICLE

Pediatric subdural empyema as a complication of meningitis: could CSF protein/CSF glucose ratio be used to screen for subdural empyema? Rumeysa Yalçinkaya 1 & Gönül Tanir 1 & Ayşe Kaman 1 & Fatma Nur Öz 1 & Türkan Aydin Teke 1 & Sevgi Yaşar Durmuş 1 & Ayşe Seçil Ekşioğlu 2 & Ahmet Emre Aycan 3 & Mehmet Ceyhan 3 Received: 5 February 2020 / Revised: 2 July 2020 / Accepted: 25 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Subdural empyema (SDE) is a rare condition which can appear secondary to meningitis in childhood, especially in infants. This study was planned to evaluate and compare clinical and laboratory features, treatment, and outcome of children with SDE to those with acute bacterial meningitis (ABM) without SDE. The electronic medical files of 266 patients diagnosed with ABM between January 2009 and December 2019 were evaluated. Patients’ demographic and clinical features, laboratory results, cranial imaging findings, treatment, and outcomes were recorded. SDE was identified in 10 patients, 3.7% of all diagnosed with meningitis. The etiology of SDE was identified in eight (80%). The most common responsible pathogen was Streptococcus pneumoniae. Cranial imaging was performed between the 2nd and 13th days of admission, and the most common reason of performing cranial imaging was persistence of fever. Two patients were healed with 4–6 weeks of antibiotic treatment without surgery, eight (80%) needed surgical intervention. Conclusion: The clinical signs and symptoms of SDE may be subtle. If the fever persists or focal neurological findings are seen during the treatment of bacterial meningitis, SDE should be suspected. Furthermore, patients with ABM who are determined to have a protein-to-glucose ratio in the cerebrospinal fluid above 4.65 should be carefully monitored for SDE development. What is known: • Subdural empyema may develop subsequently to meningitis, especially in the infant age group in whom very little is known in terms of disease characteristics. • Delay in diagnosis and treatment can cause long-term neurologic sequelae and mortality.

Communicated by Nicole Ritz * Rumeysa Yalçinkaya [email protected]

Ayşe Seçil Ekşioğlu [email protected] Ahmet Emre Aycan [email protected]

Gönül Tanir [email protected]

Mehmet Ceyhan [email protected]

Ayşe Kaman [email protected] 1

Department of Pediatric Infectious Diseases, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey

Türkan Aydin Teke [email protected]

2

Department of Radiology, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey

Sevgi Yaşar Durmuş [email protected]

3

Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey

Fatma Nur Öz [email protected]

Eur J Pediatr What is new: • Persistence or relapse of fever during the treatment of acute meningitis is an important warning sign for SDE even if there are no other symptoms. • C