Intracranial suppuration.
OBJECTIVE
To evaluate prevalence, age, position, predisposing factors, bacteriology, clinical features and outcomes of children with subdural empyema (SDE) and brain abscess (BA).


METHODS
Retrospective hospital-based study in a tertiary children's hospital.


METHODS
Clinical data were reviewed on all children classified as having SDE or BA for 10.75 years from 1 January 1992 to 31 August 2003 at the Royal Alexandra Hospital for Children, Sydney, Australia.


RESULTS
Forty-six children with intracranial suppuration were identified: 26 had BA, 16 had SDE and four children had both SDE and BA. Significant differences between SDE and BA were that: sinusitis was a predisposing factor for SDE (P = 0.01), Streptococcus milleri was the main organism isolated in SDE (P = 0.02), periorbital oedema (P = 0.005) and photophobia (P = 0.02) were clinical features specifically associated with SDE, and 75% of multiple abscesses were in females (P = 0.005). The age distribution of SDE was biphasic, with peaks at <2 years and >7 years. Cases of BA peaked at age 9-11 years. Forty-eight per cent of all children were between 9 and 13 years old; 20% were <1 year old. All the children with SDE and BA were aged 1 year or less. Three of the 46 children died, all with BA. Eighteen (39.1%) returned to normal and 25 (54.3%) had neurological complications. Neurological complications were more common in the BA group.


CONCLUSIONS
The mortality rate of intracranial suppuration is low, but morbidity remains high. A high degree of suspicion is needed to diagnose and treat intracranial infections early.
Leotta
Nicole
N
Department of Allergy, Immunology and Infectious Diseases, Children's Hospital at Westmead, New South Wales, Australia.
Chaseling
Ray
R
Duncan
Glen
G
Isaacs
David
D
D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D013354:Empyema, Subdural / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology; D006261:Headache / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012852:Sinusitis / Q000150:complications; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D034364:Streptococcus milleri Group / Q000187:drug effects / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013492:Suppuration / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D016896:Treatment Outcome; D014839:Vomiting / Q000175:diagnosis / Q000209:etiology
D000900:Anti-Bacterial Agents