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Review and case report demonstrate that spontaneous spinal epidural abscesses are rare but dangerous in childhood
Author(s) -
Fotaki Anastasia,
Anatoliotaki Maria,
Tritou Ioanna,
Tzagaraki Aggeliki,
Kampitaki Maria,
Vlachaki Georgia
Publication year - 2019
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14579
Subject(s) - medicine , magnetic resonance imaging , staphylococcus aureus , surgery , etiology , epidural abscess , abscess , lumbar , differential diagnosis , antibiotics , vertebral osteomyelitis , osteomyelitis , radiology , pathology , genetics , bacteria , microbiology and biotechnology , biology
Aim A spinal epidural abscess ( SEA ) is a rare paediatric bacterial infection, with possible devastating neurological sequelae. We explored localisation in the cervical segment, which is unusual, but more dangerous, than other SEA s. Methods We describe 22 cases (12 male) of paediatric SEA s without risk factors: 21 from a literature search from 2000 to 2017 and a 30‐month‐old boy with a spontaneous cervical SEA due to Group A Streptococcus . Results The average age was eight years and the symptoms were mainly fever, back pain and motor deficit, with an aetiological diagnosis in 68%. Methicillin‐sensitive Staphylococcus aureus was isolated in six patients, methicillin‐resistant Staphylococcus aureus in two, Staphylococcus aureus with unknown susceptibility patterns in three and Group A Streptococcus in four. All patients underwent gadolinium‐enhanced magnetic resonance imaging and most abscesses were localised in the thoracic and lumbar areas. More than half (59%) underwent surgery to remove pus and granulation tissue and nine were just treated with antimicrobial therapy for an average of 5.3 weeks. Most patients had good outcomes. Conclusion SEA s were underestimated in children due to the rarity and spectrum of differential diagnoses. Timely diagnosis, immediate antibiotics, spinal magnetic resonance imaging and prompt neurosurgical consultations were essential for favourable outcomes.