Serviço de Neurorradiologia, Hospital Dona Estefânia e São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Publicação sob a forma de poster electrónico no XVI Congresso da SPNR Diagnóstica e Terapêutica, 19 e 20 novembro 2021, Lisboa
- Neuroradiology volume 64, pages1047–1076 (2022); doi.org/10.1007/s00234-022-02903-2
Background: Anaerobic bacteria are uncommon etiologic agents of acute mastoiditis in children. However, recent studies suggest an increase in the incidence of Fusobacterium necrophorum middle ear infections, often associated with exuberant destructive processes of the structures of the outer and middle ear and otic capsule, with possible intracranial complications. Fusobacterium necrophorum The purpose of this presentation is to review the imaging findings of two pediatric patients with exuberant middle ear otitis due to Fusobacterium necrophorum.
Methods: We present two pediatric clinical cases of complicated acute otitis media caused by with special focus on imaging characteristics.
Results: We describe the cases of two children, aged 2-3 years, who presented to the emergency room with otalgia and otorrhea, highlighting the presence of meningeal signs in the observation. The two patients had elevated levels of inflammatory markers and cerebral spinal fluid analysis compatible with meningitis. In the imaging evaluation, exuberant infectious/inflammatory processes of the middle ear were visualized, extending to the external canal and labyrinthine structures, emphasizing optic capsule bone erosion in the first case and of the petrous bone in the second case. Nodular dural masses were identified in both cases in the internal auditory canal, probably reactive. Ear exsudates cultures were positive for bacterial DNA PCR Fusobacterium necrophorum. Both children underwent ENT surgical intervention and prolonged antibiotic therapy with favorable outcome.
Conclusion: Acute otitis media due to Fusobacterium necrophorum is often associated with a complicated course and warrants particular attention by pediatricians. The presence of extensive inflammatory changes in the middle ear and adjacent structures, with destruction/erosion of osseous components and associated intracranial complications, should alert the neuroradiologist to infection by this anaerobic agent. In such cases the empiric antibiotic treatment must include agents to treat Fusobacterium necrophorum.
Keywords: Ear infections; Fusobacterium necrophorum; Imaging