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Subdural empyema as a complication of odontogenic maxillary sinusitis. Empiema subdural secundario a sinusitis maxilar de origen odontógeno. N. Palomo. DOI: / Subdural empyema as a complication of odontogenic maxillary sinusitis. Empiema subdural secundario a sinusitis maxilar . Se presenta un caso de recidiva de infección postquirúrgica en forma de empiema subdural por Proprionibacterium acnes tras un primer empiema drenado en.

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Subdural empyema caused by Peptostreptococcus sp.: ESD can be caused by a primary infection located in the paranasal sinuses. This report presents pharyngitis in a young girl which later developed into a subdural empyema caused by the bacteria Peptostreptococcus sp. The report emphasizes the correct clinical valuation of pharyngitis subdursl a risk factor for developing subdural empyema in children.

A Subdural Empyema ESD is defined as a collection of purulent fluid in the space situated between the internal level of the dura mater and the external membrane of the arachnoid mater.

It is a rare clinical condition, accompanied by a higher morbidity and mortality if not diagnosed and treated early 1. Currently, the vaccine aubdural drastically reduced the number of cases 12.

The ESD risk process allows the infection to disseminate in the cerebral hemispheres leading to the subsequent development of an encephalic abscess 1. A year retrospective study with cerebral abscesses was performed.

Patients were in general male, younger than 2 years of age or over 80 years of age suffering from other underlying conditions, specifically in the frontal and parietal areas of the brain 3. Subdudal certain cases, there was a synergy of various infections, occurring empieema episodes that resemble sinusitis and pharyngitis 6 – 9. Peptostreptococcus magnus is often the causative empirma of subudral tract infections such as sinusitis and otitis media middle earinfections of the abdomen, of female genitourinary tract, mouth gums and teethand central nervous system.

The latter location becomes infected because of the bacterial migration from primary foci of infection. As previously described in many cases, it can lead to a fatal infection at this stage 310 The medical protocol for treating an infection caused by Peptostreptococcus sp. The present study aimed at calling attention to acute pharyngitis as a risk factor for subdural empyema caused by Peptostreptococcus sp.

A year-old female patient with no previous referred diseases complained of a one-week persistent cephalalgia that was diagnosed at a hospital in Cerro de Pasco, Peru. At the time the patient had fever and acute pharyngitis. She received metamizole and paracetamol.

Five days later high fever and a major headache persisted, and were aggravated by nausea, vomiting, four days of paresthesia and weakness in the inferior left limb. A computed axial encephalic tomography indicated a subdural hematoma in the right frontoparietal section, and the patient was immediately transferred to the emergency room at the National Guillermo Almenara Irigoyen Hospital.

A neurological evaluation, as well as an electrocardiogram were performed. In the preoperative assessment of the patient, no cause of immunosuppression was diagnosed. Additionally, in the evaluation, we did not identify any calvarial defects or calvarial erosions by CT. The conclusion was a subdural empyema caused by dural damage due to the hematological spread of infection.

In the laboratory exams CSF cerebrospinal fluid: The subdural empyema diagnosis was based on a right frontoparietal decompressive craniectomy, and a stressed subdural empyema evaluation, continuous irrigation. The bone plate was deposited in the abdominal wall. The patient was then transferred to the Pediatric Intensive Care Unit where she received postoperative care and progressed favorably; the drainage was removed and evidence of recuperation reached a 15 point in the Glasgow scale without motor or sensory impairment.

The patient was transferred to neurosurgery and received antibiotic therapy consisting of Meropenem, Vancomycin, and Metronidazole and was discharged after subdurla days in the hospital. The reason for using subdurla triplet antibiotic was based on the characteristics of the broad spectrum of antibiotics against the bacteria and the unknown etiological empiiema at the time of treatment.


Additionally, continued outpatient antibiotherapy was maintained for two weeks post-discharge. Monitoring of encephalic healing with TAC was performed on the right frontoparietal encephalomalacia four months later.

Seven months after hospital discharge the patient received cranioplasty with miniplates to restore the skullcap. Although the use of contrast is ideal, the computed axial tomography TAC without contrast is a great instrument for diagnosing initial subdural empyema as observed in this study 1. On the sheet stained with Dmpiema containing the purulent fluid that was empie,a after craniectomy, one could observe typical Gram-positive cocci of Peptostreptococcus sp.

In contrast, the culture is more sensitive and reported better results in the identification of the etiological agent compared to the sheet reading. In our study, we observed that culture for anaerobic bacteria could identify pure colonies of Peptostreptococcus sp.

However, in some cases, the isolation of the agent is difficult due to increased susceptibility to contamination in anaerobic conditions, as well empima possible contamination due to transport and extraction It is important to note that Peptostreptococcus sp.

In the latter case, Peptostreptococcus sp. The great vascularization of the pharynx and the development of the localized infection at this stage of life could be explained as a risk of ESD caused by Peptostreptococcus sp.

It is clinically important to mention that, in rare occasions, subdural lesions are associated with empieja by which the intervention of the subdural level should be prompt and correct with surgical management and antibiotics 1 The most frequently occurring clinical symptoms of ESD in children and adolescents are fever, headache, irritability, nausea, vomiting and altered states of conscience.

Subdurxl symptomatology can last one to two weeks after the confirmation of diagnosis, therefore, the empidma of ESD in a patient with fever and respiratory infection and later neurological symptoms is of medical importance 1. These descriptive characteristics contrast with the progression of the illness in the reported case, which was diagnosed with pharyngitis as the only determining factor of infection and evolved with nausea, vomiting and paresthesia of the inferior left limb as aggregate important factors.

The infection route of ESD is determined by its etiology; for example, in the infections of paranasal sinuses, the frequently isolated agents are aerobic Strepcoccus and anaerobic Streptococcus intermedius. In addition, it is relevant to mention that it is very rare to isolate Streptococcus pneumonia e despite the bacteria being a frequent agent of sinusitis in children, even if studies report it as a subcural agent of meningitis 116 In postoperative and posttraumatic infections, the most frequently isolated agents are Staphylococcus aureus and coagulase negative Staphylococcus 1.

It is important to emphasize that ESD caused by a pharyngitis is rare. A prior study showed ESD related to pharyngitis in a 7-year-old child with a 7-day fever, even though the etiologic agent was Streptococcus subdurla In empifma with our study, one can isolate Peptostreptococcus sp. Treatment of ESD is medical and surgical; medically, it consists of using broad-spectrum antibiotics, like third-generation cephalosporins, carbapenems and metronidazole 18 – 20more efficient to treat aerobic agents than aerobic ones, during three to four weeks post-surgical drainage.

This regimen contrasts with the treatment that is established for the patient prescribed with sybdural, metronidazole and vancomycin, although the latter emmpiema recommended to treat ESD before surgeries or after trauma due to the presumption of microbial contamination 16.

Current disease guidelines mention that, in infants and young children, ESD could be the aftermath for lifetime complications, if not properly managed, so the imaging in the primary diagnosis as Computed Tomography CT or Cranial ultrasonography are recommended The surgical treatment was craniectomy to allow the complete evacuation of empyema, as recommended in a previous study Antibiotics management depends on the route of infection.


Vancomycin, ceftriaxone plus metronidazole should suhdural supplied when the etiological agent is unknown and drug resistance is probable Subdurl the time of antibiotics use, we did not know the etiological agent; therefore, we subduarl three antibiotics to subdutal a range of bacteria that could have caused the infection in the patient; vancomycin Gram-positive coccimeropenem Gram-negative bacilli and metronidazole anaerobic cocci.

The recommended surgery is a decompressive craniectomy with the advantage of reaching the area of infection to remove the necrotic tissue and drain the purulent fluid, unlike a trepanation 1.

In the present case, the intervention was carried out by the decompression of the right frontoparietal region and, as recommended by previous studies, and the drainage of purulent fluid from the subdural empyema 1.

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It is recommended that a neurosurgeon and an otolaryngologist perform a continued postoperative evaluation to ensure the favorable progression of the patient or if the patient requires new surgical interventions, for instance to drain persisting or recurring fluids 1. In our study, only one surgical intervention was carried out to correctly drain the purulent fluid. Study limitations were that pharyngitis was classified only by the patient’s signs and symptoms and no sample was taken initially to identify the causative agent Moreover, in respect to the subdural empyema, classical microbiology was used only to identify the genus Peptostreptococcus sp.

It can be concluded that pharyngitis can be a risk factor for development of subdural empyema in children; therefore, it is important to correctly validate pharyngitis at an early stage and implement the follow-up and the clinical treatment without dismissing the case. Trend of bacterial meningitis in children over a 14 year period through in Japan – an analysis based on studies in 27 institutions. Microbiological spectrum of brain abscess at a tertiary care hospital in South India: A report of four cases all leading to blindness.

Contemporary management of deep neck space infections. Otolaryngol Head Neck Surg. Anaerobic meningitis due to Peptostreptococcus species: Recovery of anaerobic bacteria from clinical specimens in 12 years at two military hospitals.

Meningitis and epidural abscess related to pansinusitis. Meningitis and shunt infection caused by anaerobic bacteria in children. Riggio MP, Lennon A. Specific PCR detection of Peptostreptococcus magnus.

Subdural empyema – Wikipedia

Brain abscess complicating dental caries in children. Finegoldia magna formerly Peptostreptococcus magnus: Am J Med Sci. Cavernous sinus thrombophlebitis caused by sphenoid sinusitis – report sibdural autopsy case. A case of peptostreptococcal meningitis associated with subarachnoid hemorrhage and subdural hematoma. The clinical picture, treatment and prognosis of meningitis due to anaerobic and nonfermentative bacteria. Metronidazole therapy of anaerobic bacteremia, meningitis, and brain abscess.

Subdural empyema caused by Peptostreptococcus sp.: a complication of acute pharyngitis

Subdural empyema in children. Glob J Health Sci. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Case Report Subdural empyema caused by Peptostreptococcus sp.: Subdural empyema; Peptostreptococcus sp; Collection infection; Pharyngitis. May 18, ; Accepted: How to cite this article.