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.
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