Subdural empyema causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Subdural empyema, also referred to as subdural abscess, pachymeningitis interna and circumscript meningitis, is a life-threatening infection.[1] It consists of a localised collection of purulent material, usually unilateral, between the dura mater and the arachnoid mater and accounts for about 15-22% of the reported focal intracranial infections The empyema may develop intracranially (about 95%) or in the spinal canal (about 5%), and in both cases, it constitutes a medical and neurosurgical emergency.[2] Depending on the site of origin of the infection, as well as location of the empyema in the subdural space, there will be different causative agents. The rate of success of growth of bacterial cultures, from the surgically removed pus is 54-81%. Common agents of subdural empyema include: anaerobes, aerobic streptococci, staphylococci, Haemophilus influenzae, Streptococcus pneumoniae and other gram-negative bacilli. [1] In children, subdural empyema most often happens as a complication of meningitis while in adults it usually occurs as a complication of sinusitis, otitis media, mastoiditis, trauma or as a complication of neurological procedures.[1][3]
Causes
Life Threatening Causes
Considering the location of the infection the rapid progress it might have, as well as the structures affected, subdural empyema is considered a life-threatening entity in itself. Therefore, any of the causative agents and situations that may lead to the development of a subdural empyema should be considered life-theratening causes.
Common Causes
Adults
The most common cause of subdural empyema in adults is the complication of an infection of the air sinuses: frontal, ethmoid, sphenoid and maxillary. The causative organisms of the empyema will be similar to those causing the infection of the sinuses, as well as other possible causes, such as epidural abscess and brain abscess. Generally multiple organisms are present in the empyema, where anaerobes are almost always an important agent. [2][4]
| Common causative agents |
| ▸ Anaerobes |
| ▸ Aerobic Streptococci |
| ▸ Staphylococci |
| ▸ Haemophilus influenzae |
| ▸ Streptococcus pneumoniae |
| ▸ Other gram-negative bacilli |
Children
The most common cause of subdural empyema in children is the complication of meningitis. The agents isolated from the pus are usually similar to the ones causing meningitis. [2][5]
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | a-hemolytic streptococci, anaerobic streptococci, nonhemolytic streptococci, staphylococcus aureus, Bacteroides species, Enterobacteriaceae, Pseudomonas aeruginosa |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | staphylococcus aureus, staphylococcus epidermidis |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | staphylococcus aureus, staphylococcus epidermidis, Haemophilus influenzae, Escherichia coli, streptococcus pneumoniae, Neisseria meningitidis |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | Enterobacteriaceae, Group B streptococci, Listeria monocytogenes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | Streptococcus pneumoniae, Klebsiella pneumoniae |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | staphylococcus aureus, staphylococcus epidermidis, Enterobacteriaceae |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical order
References
- ↑ 1.0 1.1 1.2 Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.
- ↑ 2.0 2.1 2.2 Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
- ↑ Quraishi H, Zevallos JP (2006). "Subdural empyema as a complication of sinusitis in the pediatric population". Int. J. Pediatr. Otorhinolaryngol. 70 (9): 1581–6. doi:10.1016/j.ijporl.2006.04.007. PMID 16777239. Unknown parameter
|month=ignored (help) - ↑ Yoshikawa TT, Chow AW, Guze LB (1975). "Role of anaerobic bacteria in subdural empyema. Report of four cases and review of 327 cases from the English literature". Am J Med. 58 (1): 99–104. PMID 234678.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.