American Journal of Clinical Neurology and Neurosurgery
Articles Information
American Journal of Clinical Neurology and Neurosurgery, Vol.4, No.1, Mar. 2019, Pub. Date: Mar. 19, 2019
Spinal Epidural Abscess in Immunocompetent Child: A Case Report and Review of Literature
Pages: 1-7 Views: 1330 Downloads: 372
Authors
[01] Al-Saadi Tariq, Department of Neurosurgery, Montreal Neurological Institute and Hospital - McGill University, Montreal, Canada; Department of Neurosurgery, Khoula Hospital, Muscat, Oman.
[02] Al Shandoudi Leena, Department of Pediatrics, Sultan Qaboos University, Muscat, Oman.
[03] Al Sharqi Jawahir, Department of Pediatrics, Royal Hospital, Muscat, Oman.
[04] Al Adawi Zakariya, Department of Pediatrics, Armed Force Hospital, Muscat, Oman.
[05] Al Sharqi Ali, Department of Neurosurgery, Sultan Qaboos University, Muscat, Oman.
Abstract
Spinal epidural abscess (SEA) is uncommon and rare condition in immunocompetent population and even more rare in pediatric group. The incidence of spinal epidural abscess appears to be increasing and comprises up to 2 per 10,000 hospital admissions. The presentation is variable and diagnosis can be easily missed on first visit. The diagnosis is established by history, clinical examination finding, increased inflammatory markers and neurological imaging. Surgical decompression and drainage in combination with antibiotic for four to six weeks are the typical treatment for SEA. An alternative treatment with parenteral antibiotic only is an alternative treatment. We reported an 11-year-old girl presented fever, chest and back pain she was found to have unsteady gait and lower extremity weakness. Spinal MRI showed heterogeneous enhancing collection in the posterior epidural space from the level of T2 vertebra to T10 vertebra. She was treated with antibiotic for 6 weeks without complications.
Keywords
Spine, Epidural, Abscess, Immunocompetent, Pediatric
References
[01] Suppiah S, Meng Y, Fehlings M, Massicotte E, Yee A, Shamji M. How Best to Manage the Spinal Epidural Abscess? A Current Systematic Review. World Neurosurgery. 2016; 93: 20-28.
[02] Vergori A, Cerase A, Migliorini L, Pluchino M, Oliveri G, Arrigucci U et al. Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature. IDCases. 2015; 2 (4): 109-115.
[03] Harris T, Seamon J. Spontaneous spinal epidural abscess in a 21-month-old child. The American Journal of Emergency Medicine. 2014; 32 (12): 1558.e1-1558.e2.
[04] Hawkins M, Bolton M. Pediatric Spinal Epidural Abscess: A 9-Year Institutional Review and Review of the Literature. PEDIATRICS. 2013; 132 (6): e1680-e1685.
[05] Rigamonti D, Liem L, Sampath P, et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol. 1999; 52 (2): 189–196, discussion 197.
[06] Wheeler D, Keiser P, Rigamonti D, Keay S. Medical management of spinal epidural abscesses: case report and review. Clin Infect Dis. 1992; 15 (1): 22–27.
[07] Nussbaum ES, Rigamonti D, Standiford H, Numaguchi Y, Wolf AL, Robinson WL. Spinal epidural abscess: a report of 40 cases and review. Surg Neurol. 1992; 38 (3): 225–231.
[08] Aycan, A., Aktas, O., Guzey, F., Tufan, A., Isler, C., Aycan, N., Gulsen, İ. and Arslan, H. (2016). Rapidly Progressive Spontaneous Spinal Epidural Abscess. Case Reports in Infectious Diseases, 2016, pp. 1-4.
[09] G. M. Vilke and E. A. Honingford, “Cervical spine epidural abscess in a patient with no predisposing risk factors,” Annals of Emergency Medicine, vol. 27, no. 6, pp. 777–780, 1996.
[10] H.-J. Tang, H.-J. Lin, Y.-C. Liu, and C.-M. Li, “Spinal epidural abscess-experience with 46 patients and evaluation of prognostic factors,” Journal of Infection, vol. 45, no. 2, pp. 76–81, 2002.
[11] Tunkel AR. Subdural empyema, epidural abscess and suppurative intracranial trombophlebitis. In: Mandell GL, Bennet JE, Dolin R, editors. Principle and practice of infectious diseases. 7th ed., Philadelphia: Elsevier; 2010. p. 1281–3.
[12] Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM 2008; 101: 1–12.
[13] Karikari IO, Powers CJ, Reynolds RM, Mehta AI, Isaacs RE. Management of spontaneous spinal epidural abscess: a single center 10 years experience. Neurosurgery 2009; 65: 919–23.
[14] Darouiche RO. Spinal epidural abscess. N Engl J Med 2006; 355: 2012–20.
[15] J. A. Shulman and H. M. Blumberg, “Paraspinal and spinal infections,” in Infections of the Central Nervous System, H. P. Lambert, Ed., pp. 374–391, BC Decker, Philadelphia, Pa, USA, 1991.
[16] Zimmerer SM, Conen A, Mu¨ller AA, Sailer M, Taub E, Flu¨ckiger U, et al. Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4 year prospective study. Eur Spine J 2011; 20: 2228–34.
[17] Chen WC, Wang JL, Wang JT, Chen YC, Chang SC. Spinal epidural abscess due to Staphylococcus aureus: clinical manifestations and outcomes. J Microbiol Immunol Infect. 2008; 41 (3): 215–221.
[18] Pradilla G, Nagahama Y, Spivak AM, Bydon A, Rigamonti D. Spinal epidural abscess: current diagnosis and management. Curr Infect Dis Rep. 2010; 12 (6): 484–491.
[19] Auletta JJ, John CC. Spinal epidural abscesses in children: a 15-year experience and review of the literature. Clin Infect Dis. 2001; 32 (1): 9–16.
[20] Walter RS, King JC Jr, Manley J, Rigamonti D. Spinal epidural abscess in infancy: successful percutaneous drainage in a nine-month-old and review of the literature. Pediatr Infect Dis J. 1991; 10 (11): 860864.
[21] Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore). 1992; 71 (6): 369–385.
[22] Karikari IO, Powers CJ, Reynolds RM, Mehta AI, Isaacs RE. Management of a spontaneous spinal epidural abscess: a singlecenter 10-year experience. Neurosurgery. 2009; 65 (5): 919–923, discussion 923–924.
[23] Siddiq F, Chowfin A, Tight R, Sahmoun AE, Smego RA Jr. Medical vs surgical management of spinal epidural abscess. Arch Intern Med. 2004; 164 (22): 2409–2412.
[24] Sethna NF, Clendenin D, Athiraman U, Solodiuk J, Rodriguez DP, Zurakowski D. Incidence of epidural catheter-associated infections after continuous epidural analgesia in children. Anesthesiology. 2010; 113 (1): 224–232.
[25] Leys D, Lesoin F, Viaud C, et al. Decreased morbidity from acute bacterial spinal epidural abscesses using computed tomography and nonsurgical treatment in selected patients. Ann Neurol. 1985; 17 (4): 350–355.
[26] Tyagi R. Spinal infections in children: A review. Journal of Orthopaedics. 2016; 13 (4): 254-258.
[27] Torgovnick J, Sethi N, Wyss J. Spinal epidural abscess: clinical presentation, management and outcome (Curry WT, Hoh BL, Hanjani SA, et al. Surg Neurol 2005; 63: 364-71). Surgical Neurology. 2005; 64 (3): 279.
[28] Rigamonti D, Liem L, Sampath P, Knoller N, Numaguchi Y, Schreibman DL, Sloan MA, Wolf A, Zeidman S. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 1998; 52: 189-97.
[29] Beaudooin MG, Klein L. Epidural abscess following multiple spinal anaesthetics. Anaesth Intensive Care 1984; 12 (7): 163-4.
[30] Burstal R, Wegener F, Hayes C, Lantry G. Epidural analgesia: prospective audit of 1062 patients. Anaesth Intensive Care 1998; 26: 165-72.
[31] Du Pen SL, Peterson DG, Williams A, Bogosian AJ. Infection during chronic epidural catheterization: diagnosis and treatment. Anethesiology 1990; 73: 905-9.
[32] Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a metaanalysis of 915 patients. Neurosurg Rev 2000; 232: 175-204.
[33] Corboy JR, Price RW. Myelitis and toxic, inflammatory, and infectious disorders. Curr Opin Neurol Neurosurg 1993; 6: 564-70.
[34] Ingham HR, Sisson PR, Mendelow AD, Kalbag RM. Pyogenic neurosurgical infections. London 7 Edward Arnold; 1991.
[35] Krauss WE, McCormick PC. Infections of the dural spaces. Neurosurg Clin N Am 1992; 3: 421-33.
[36] Martin MJ, Yuan HA. Neurosurgical care of spinal epidural, subdural, and intramedullary abscesses and arachnoiditis. Orthop Clin North Am 1996; 27: 125-36.
[37] Soehle M, Wallenberg T. Spinal epidural abscess: clinical manifestations, prognostic factors, and outcomes. Neurosurgery 2002; 51: 79-87.
[38] Wheeler D, Keiser P, Rigamonti D, Keay S. Medical management of spinal epidural abscesses: case report and review. Clin Infect Dis 1992; 15: 22-7.
[39] Fischer EG, Greene Jr CS, Winston KR. Spinal epidural abscess. Neurosurgery 1981; 9: 257-60.
[40] Schlossberg D, Shulman JA. Spinal epidural abscess. South Med J 1977; 79: 669-73.
[41] Walter RS, King JC, Manley J, Rigamonti D. Spinal epidural abscess in infancy: successful percutaneous drainage in a nine-month-old and review of the literature. Pediatr Infect Dis J 1991; 19: 860-4.
[42] Bouchez B, Arnott G, Delfosse JM. Acute spinal epidural abscess. J Neurol. 1985; 231: 343-4.
[43] Messer HD, Lenchner GS, Bruit JCM, Resas S. Lumbar spinal epidural abscess managed conservatively. J Neurosurg. 1977; 46: 825-9.
[44] Hanigan WC, Asner NG, Elwood PW. Magnetic resonance imaging and the nonoperative treatment of spinal epidural abscess. Surg Neurol. 1990; 34: 408-13.
[45] Leys D, Lesoin F, Viaud C, Pasquier F, Rousseaux M, Jomin M, Petit H. Decreased morbidity from acute bacterial spinal epidural abscesses using computed tomography and nonsurgical treatment in selected patients. Ann Neurol 1985; 17: 350-5.
[46] Mampalam TJ, Rosegay H, Andrews BT, Rosenblum ML, Pitts LH. Nonoperative treatment of spinal epidural infections. J Neurosurg 1989; 71: 208-10.
[47] Vergori A, Cerase A, Migliorini L, Pluchino M, Oliveri G, Arrigucci U, et al. Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature. ID Cases 2015; 2: 109-15.
[48] Bair-Merritt M, Chung C, Collier A. Spinal Epidural Abscess in a Young Child. Pediatrics 2000; 106: e39.
[49] Tang K, Xenos C, Sgouros S. Spontaneous spinal epidural abscess in a neonate. With a review of the literature. Childs Nerv Syst 2001; 17: 629-31.
[50] Flikweert E, Postema R, Briel J, Lequin M, Hazebroek F. Spinal epidural abscess presenting with abdominal pain. Eur J Pediatr Surg 2002; 12: 141-3.
[51] Kiymaz N, Demir Ö. Spontaneous cervical paraspinal and epidural giant abscess in a child. Neurol Med Chir 2005; 45: 540-2.
[52] Mantadakis E, Birbilis T, Michailidis L, Souftas V, Chatzimichael A. Spinal epidural abscess in a young girl without risk factors. Eur J Pediatr 2011; 170: 945-8.
[53] Rook JL, Duffey D, DeRoos S. A case of autonomically mediated pain due to spinal epidural abscess in an adolescent female. Pediatr Emerg Care 2011; 27: 530-2.
[54] Hawkins M, Bolton M. Pediatric spinal epidural abscess: a 9-year institutional review and review of the literature. Pediatrics 2013; 132: e1680-5.
[55] Pathak A, Singh P, Gehlot P, Dhaneria M. Spinal epidural abscess treated with antibiotics alone. BMJ Case Rep 2013; 30: bcr 2013009285.
[56] Sales JG, Tabrizi A, Elmi A, Soleimanpour J, Gavidel E. Adolescence spinal epidural abscess with neurological symptoms: case report, a lesson to be re-learnt. Med J Islam Repub Iran 2013; 27: 38-41.
[57] Harris TJ, Seamon JP. Spontaneous spinal epidural abscess in a 21-month-old child. Am J Emerg Med 2014; 32: e1-2.
[58] Prasad M, De Vere N. Spinal epidural abscess masquerading as an acute abdomen. Pediatr Neurol 2014; 50: 540-1.
[59] Aycan A, Aktas OY, Guzey FK, Tufan A, Isler C, Aycan N, et al. Rapidly progressive spontaneous spinal epidural abscess. Case Rep Infect Dis 2016; 2016: 7958291.
[60] Horner K, Yamada M, Zuccoli G, Rosenberg S, Greene S, Vellody K, Zuckerbraun NS. A 34-Day-Old With Fever, Cerebrospinal Fluid Pleocytosis, and Staphylococcus aureus Bacteremia. Pediatrics 2016; 137: (1).
[61] Paro-Panjan D, Grcar LL, Pecaric-Meglic N, Tekavcic I. Epidural cervical abscess in a neonate. Eur J Pediatr 2006; 165: 730-1.
[62] Shawar R, Patamasucon P, Rowles S. Case 2: Fever and back pain in 13-year-old girl. Pediatr Rev 2017; 38: 46-7.
[63] Rood CJ, Whitefield JS, Hayek, RA. A 10-year-old boy with fever, sudden onset of lower back pain, and gait change. Pediatr Ann 2014; 43: 177-80.
[64] Raus I, Tatar S, Coroiu R. Diagnostic use of magnetic resonance imaging of a cervical epidural abscess and spondylodiscitis in an infant – case report. Clujul Med 2015; 88: 555-9.
[65] Hazelton B, Kesson A, Prelog K, Carmo K, Dexter M. Epidural abscess in a neonate. J Paediatr Child Health 2012; 48: 132-5.
[66] Fotaki A, Anatoliotaki M, Tritou I, Tzagaraki A, Kampitaki M, Vlachaki, G. Review and case report demonstrate that spontaneous spinal epidural abscesses are rare but dangerous in childhood. Acta Paediatrica 2018 doi: 10.1111/apa.14579.
[67] Kim MC, Jung HT. Pediatric lumbar epidural abscess combined with cauda equina syndrome: case report. Asian Spine J. 2011; 5 (2): 133-7.
600 ATLANTIC AVE, BOSTON,
MA 02210, USA
+001-6179630233
AIS is an academia-oriented and non-commercial institute aiming at providing users with a way to quickly and easily get the academic and scientific information.
Copyright © 2014 - American Institute of Science except certain content provided by third parties.