Intracranial sinusitis complications may cause serious injury in children

Intracranial pyogenic complications of sinusitis remain a serious concern among children, potentially leading to severe morbidity, results of a 20-year study have shown.

Additionally, polymicrobial infections commonly occur, which supports the need for broad-spectrum empiric antibiotic therapy and cautious adjustment of such regimen based on sterile site cultures.

A total of 1,591 charts were reviewed, yielding 104 cases of complicated sinusitis in children (median age 12 years, 69 percent male). The most common complication was epidural empyema (n=50, 48 percent), followed by subdural empyema (n=46, 44 percent) and Pott’s puffy tumour (n=27, 26 percent). Of the children, 54 (52 percent) underwent neurosurgery and 48 (46 percent) had otolaryngologic survey.

Polymicrobial growth was observed in 24 children (38 percent), with Streptococcus anginosus being the predominant pathogen isolated from sterile site specimens (n=40, 63 percent). Intravenous antibiotic therapy was given for a median duration of 51 days.

Notably, 25 children (24 percent) had persistent neurologic sequalae, including one death. Such consequence correlated with the presence of cerebritis (p=0.02) and extensive disease on neuroimaging (p=0.04).

“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,” the authors said.

This study was a single-centre retrospective chart review. The authors identified cases based on International Classification of Diseases diagnostic codes (ICD)-9 and ICD-10 depending on the year and by reviewing all intracranial microbiologic samples.