Intracranial Pyogenic Complications of Sinusitis in Children , a 20-year Study

  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.

Changes in Penile Microbiome Following Pediatric Circumcision

 Mishra and colleges from several medical centers in the USA, Italy and India studied the characterization of Changes in Penile Microbiome Following Pediatric Circumcision. While microbiome and host regulation contribute independently to many disease states, it is unclear how circumcision in pediatric population influences subsequent changes in penile microbiome.

They analyzed 11 paired samples, periurethral collection, before and after circumcision, to generate microbiome and mycobiome profiling. Sample preparation of 16S ribosomal RNA and internal transcribed spacer sequencing was adapted from the methods developed by the National Institutes of Health Human Microbiome Project.

Several notable microbiome and mycobiome compositional differences were observed between pre- and postcircumcision patients. Pairwise comparisons across taxa revealed a significant decrease (p < 0.05, false discovery rate corrected) of microbiome organisms (Clostridiales, Bacteroidales, and Campylobacterales) and mycobiome (Saccharomycetales and Pleosporales) following circumcision. A total of 14 pathways were found to differ in abundance between the pre- and postcircumcision groups (p < 0.005, false discovery rate <0.1 and linear discriminant analysis score >3; five enriched and nine depleted). The pathways reduced after circumcision were mostly involved with amino acid and glucose metabolism, while pathways prior to circumcision were enriched in genetic information processing and transcription processes. 

The study found that bacteria and fungi involved in chronic inflammation appear to be more prevalent in uncircumcised boys. The investigators concluded that circumcision may reduce the risk of chronic inflammation of the penis later in life.

The study was published in European Urology Focus on December  2022. https://pubmed.ncbi.nlm.nih.gov/36566099/