Skull-base osteomyelitis: fungal vs. bacterial infection.
Skull-base osteomyelitis (SBO) occurs secondary to invasive bacterial and fungal infection. Distinguishing between fungal and bacterial aetiologies of SBO has significant therapeutic implications. An 18-year (1990-2007) retrospective review of patients with SBO presenting to Westmead Hospital was performed. Epidemiological, clinical, laboratory and radiology data were collated. Twenty-one patients (median age 58 years) with SBO were identified: ten (48%) had bacterial and 11 (52%) had fungal SBO. Diabetes mellitus (57%) and chronic otitis externa (33%) were the most frequent co-morbidities; immunosuppression was present in five cases (24%). Cranial nerve deficits occurred in ten (48%) patients. The commonest pathogens were Pseudomonas aeruginosa (50% bacterial SBO) and a zygomycete (55% fungal SBO). Compared to bacterial SBO, fungal SBO was more frequently associated with underlying chronic sinusitis, sinonasal pain, facial/periorbital swelling and nasal stuffiness or discharge and the absence of purulent ear discharge (all p <0.05). Bacterial SBO was more frequently associated with deafness, ear pain or ear discharge (all p <0.05). Median time to presentation was longer in patients with bacterial SBO (26.3 weeks vs. 8.1 weeks, p 0.08). Overall 6-month survival was 88% (14/18 patients). All four deaths occurred in patients with fungal SBO. Immunosuppression was a risk factor for death (p <0.05). Early diagnostic sampling is recommended in patients at increased risk of fungal SBO to enable optimal antimicrobial and surgical management.
Blyth
C C
CC
Centre for Infectious Diseases and Microbiology, ICPMR, Westmead Hospital, Westmead, NSW, Australia.
Gomes
L
L
Sorrell
T C
TC
da Cruz
M
M
Sud
A
A
Chen
S C-A
SC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D015897:Comorbidity; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D010019:Osteomyelitis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000382:microbiology* / Q000473:pathology; D016019:Survival Analysis