Review of CNS Abscess in Children

Background: CNS abscesses are rare and severe conditions. These infections are categorized based on their location: epidural abscess, subdural empyema and brain abscess. Treatment requires a combination approach with antibiotic therapy and frequently surgical drainage.

Objective: To describe the clinical manifestations, predisposing factors, diagnosis, treatment and outcome of pediatric patients with CNS abscesses

Methods: Retrospective single-center study of pediatric patients with CNS abscesses in the 2000-2018 period. Neonatology patients were excluded.

Results: A total of 32 patients were included in the study (brain abscess 31%, subdural empyema 31%, brain + subdural 6%, epidural abscess 25%). Age range was 1,5 months to 16 years (median 6 years). Male/female ratio was 2:1. Predisposing factors were identified in all patients. Most important predisposing factors were mastoiditis and sinusitis (56%), complex congenital cardiopathy (16%) and bacterial meningitis (13%). Etiologic agents were identified in 18 patients (Staphylococcus aureus 28%; Streptococcus pneumoniae 28%; Streptococcus intermedius 22%; gram-negative bacilli 17%). Fever, headache, earache, vomits and seizures (41%) were the signs and symptoms most often described. Half of patients underwent surgery of the CNS abscess (brain abscess 75%, epidural abscess 25%). Two main initial antibiotic schemes were used, cefotaxima-vancomycin-metronidazole (42%) and meropenem-vancomycin (48%). More frequently used oral antibiotics were quinolones, metronidazole and linezolid. Median of duration of antibiotic treatment (intravenous + oral) was 69 days (range 40-120). One patient died and seven had permanent sequels.

Conclusions: Congenital heart diseases and otorhinolaryngological infections were the main underlying disorders. Antibiotic therapy was enough to resolve small epidural abscesses and small subdural empyema. But most patients with brain abscesses and big subdural empyema also required surgical treatment.