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 pe...
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| creator | Blyth, C.C. Gomes, L. Sorrell, T.C. da Cruz, M. Sud, A. Chen, S.C.-A. |
| description | 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 |
| doi_str_mv | 10.1111/j.1469-0691.2010.03231.x |
| format | Article |
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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.</description><identifier>ISSN: 1198-743X</identifier><identifier>EISSN: 1469-0691</identifier><identifier>DOI: 10.1111/j.1469-0691.2010.03231.x</identifier><identifier>PMID: 20384699</identifier><language>eng</language><publisher>Oxford, UK: Elsevier Ltd</publisher><subject>Adult ; Age ; Aged ; Aged, 80 and over ; Antimicrobial agents ; Bacteria ; Bacteria - classification ; Bacteria - isolation & purification ; Bacterial ; Bacterial arthritis and osteitis ; Bacterial diseases ; Bacterial infections ; Bacterial Infections - diagnosis ; Bacterial Infections - epidemiology ; Bacterial Infections - microbiology ; Bacterial Infections - pathology ; Biological and medical sciences ; Comorbidity ; Cranial nerves ; Data processing ; Deafness ; Diabetes mellitus ; Ear ; Female ; fungi ; Fungi - classification ; Fungi - isolation & purification ; Hospitals ; Human bacterial diseases ; Humans ; Immunosuppression ; Infectious diseases ; Male ; Medical research ; Medical sciences ; Middle Aged ; Mycoses - diagnosis ; Mycoses - epidemiology ; Mycoses - microbiology ; Mycoses - pathology ; Osteomyelitis ; Osteomyelitis - diagnosis ; Osteomyelitis - epidemiology ; Osteomyelitis - microbiology ; Osteomyelitis - pathology ; Otitis externa ; Pain ; Pathogens ; Pseudomonas aeruginosa ; Radiology ; Retrospective Studies ; Risk Factors ; Sampling ; Sinusitis ; skull base ; Skull Base - microbiology ; Skull Base - pathology ; Survival ; Survival Analysis ; Zygomycetes</subject><ispartof>Clinical microbiology and infection, 2011-02, Vol.17 (2), p.306-311</ispartof><rights>2011 European Society of Clinical Infectious Diseases</rights><rights>2010 The Authors. Journal Compilation © 2010 European Society of Clinical Microbiology and Infectious Diseases</rights><rights>2015 INIST-CNRS</rights><rights>2010 The Authors. 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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.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antimicrobial agents</subject><subject>Bacteria</subject><subject>Bacteria - classification</subject><subject>Bacteria - isolation & purification</subject><subject>Bacterial</subject><subject>Bacterial arthritis and osteitis</subject><subject>Bacterial diseases</subject><subject>Bacterial infections</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - epidemiology</subject><subject>Bacterial Infections - microbiology</subject><subject>Bacterial Infections - pathology</subject><subject>Biological and medical sciences</subject><subject>Comorbidity</subject><subject>Cranial nerves</subject><subject>Data processing</subject><subject>Deafness</subject><subject>Diabetes mellitus</subject><subject>Ear</subject><subject>Female</subject><subject>fungi</subject><subject>Fungi - classification</subject><subject>Fungi - isolation & purification</subject><subject>Hospitals</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mycoses - diagnosis</subject><subject>Mycoses - epidemiology</subject><subject>Mycoses - microbiology</subject><subject>Mycoses - pathology</subject><subject>Osteomyelitis</subject><subject>Osteomyelitis - diagnosis</subject><subject>Osteomyelitis - epidemiology</subject><subject>Osteomyelitis - microbiology</subject><subject>Osteomyelitis - pathology</subject><subject>Otitis externa</subject><subject>Pain</subject><subject>Pathogens</subject><subject>Pseudomonas aeruginosa</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sampling</subject><subject>Sinusitis</subject><subject>skull base</subject><subject>Skull Base - microbiology</subject><subject>Skull Base - pathology</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Zygomycetes</subject><issn>1198-743X</issn><issn>1469-0691</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUtP3DAUhS1UxPsvVJFQxSrBjzi5QeoCRqUgTdUFILGzHOem8tSTUDuhzL_H6QxUYgPe-Nr-ju1zDyEJoxmL43SRsbyoUlpULOM07lLBBcuetsje68GnWLMK0jIX97tkP4QFpZQLke-QXU4FRK7aI3Dze3QurXXApA8D9ssVOjvYcJa0Y_dLu-QxZEmtzYDexpXtWjSD7btDst1qF_BoMx-Qu8tvt7OrdP7z-_XsfJ4aWZQsbUxTItdQ06rlhQHRIJagpQbD2woAJeNaUMglFrmssZBcU25kK1ktBJfigJys733w_Z8Rw6CWNhh0TnfYj0FBWXAhQcD7ZHRMGc_zSB6_IRf96LtoQzHJKwmsZBMFa8r4PgSPrXrwdqn9SjGqphjUQk3dVlO31RSD-heDeorSz5sHxnqJzavwpe8R-LIBdDDatV53xob_nCgLkDB5-rrm_lqHqw9_QM3mP6Yq6i_WeowRPVr0KhiLncHG-pijanr7vptnlo-14A</recordid><startdate>201102</startdate><enddate>201102</enddate><creator>Blyth, C.C.</creator><creator>Gomes, L.</creator><creator>Sorrell, T.C.</creator><creator>da Cruz, M.</creator><creator>Sud, A.</creator><creator>Chen, S.C.-A.</creator><general>Elsevier Ltd</general><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><scope>7QP</scope><scope>7T7</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>201102</creationdate><title>Skull-base osteomyelitis: fungal vs. bacterial infection</title><author>Blyth, C.C. ; 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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.</abstract><cop>Oxford, UK</cop><pub>Elsevier Ltd</pub><pmid>20384699</pmid><doi>10.1111/j.1469-0691.2010.03231.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Aged Aged, 80 and over Antimicrobial agents Bacteria Bacteria - classification Bacteria - isolation & purification Bacterial Bacterial arthritis and osteitis Bacterial diseases Bacterial infections Bacterial Infections - diagnosis Bacterial Infections - epidemiology Bacterial Infections - microbiology Bacterial Infections - pathology Biological and medical sciences Comorbidity Cranial nerves Data processing Deafness Diabetes mellitus Ear Female fungi Fungi - classification Fungi - isolation & purification Hospitals Human bacterial diseases Humans Immunosuppression Infectious diseases Male Medical research Medical sciences Middle Aged Mycoses - diagnosis Mycoses - epidemiology Mycoses - microbiology Mycoses - pathology Osteomyelitis Osteomyelitis - diagnosis Osteomyelitis - epidemiology Osteomyelitis - microbiology Osteomyelitis - pathology Otitis externa Pain Pathogens Pseudomonas aeruginosa Radiology Retrospective Studies Risk Factors Sampling Sinusitis skull base Skull Base - microbiology Skull Base - pathology Survival Survival Analysis Zygomycetes |
| title | Skull-base osteomyelitis: fungal vs. bacterial infection |
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