Intracranial pyogenic complications of sinusitis in children can lead to serious sequelae. Smiljkovic and colleagues from the Hospital for Sick Children, Toronto, Canada; characterized the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period.
One hundred and four cases of complicated sinusitis were
included after review. The most frequent complications were epidural empyema (n
= 50, 48%), subdural empyema (n = 46, 44%) and Pott's puffy tumor (n = 27,
26%). 52% (n = 54) underwent neurosurgery and 46% (n = 48) underwent
otolaryngological surgery. The predominant pathogen isolated from sterile site
specimens was Streptococcus anginosus (n = 40, 63%), but polymicrobial growth
was common (n = 24; 38%). The median duration of intravenous antibiotic therapy
was 51 days (IQR 42-80). Persistent neurological sequelae (or death, n = 1)
were found in 24% (n = 25) and were associated with the presence of cerebritis
and extensive disease on neuroimaging (P = 0.02 and P = 0.04, respectively).
The authors concluded that Intracranial complications of sinusitis
continue to cause significant morbidity in children. Polymicrobial aerobic anaerobic infections
are common, which reinforces the need for broad-spectrum empiric antibiotic
therapy and cautious adjustment of the antibiotic regimen based primarily on
sterile site cultures. The association of neurologic sequelae with the presence
of cerebritis and extensive intracranial involvement on neuroimaging suggest
that delayed diagnosis may be a contributor to adverse outcome.
