Diagnosis, treatment and prognosis of otomastoiditis induced by Fusobacterium necrophorum: A retrospective multicentre cohort study. (August 2022)

• Record Type: Journal Article
• Authors: Thevis, Madelon; Leow, Theresa Y.S.; Bekkers, Stijn; Otten, Josje; Waterval, Jerome J.; Derks, Jolanda; Buil, Jochem B.; Kunst, Henricus P.M.; Jansen, Thijs T.G.
• Is Part Of: Anaerobe. Volume 76(2022)
• Publication Date: 2022-08
• Subjects: Fusobacterium necrophorum -- Metronidazole -- β-lactam -- Otomastoiditis -- Osteomyelitis -- Meningitis -- Sinus thrombosis -- Anaerobes -- Neurological sequelae; Anaerobic infections -- Periodicals; Anaerobic bacteria -- Periodicals; Bacterial diseases -- Periodicals; Computer network resources; Anaerobic protozoa -- Periodicals; 579.3
• DOI: 10.1016/j.anaerobe.2022.102587
• Languages: English
• ISSNs: 1075-9964

Abstract

Abstract: Objectives: Otomastoiditis caused by the anaerobic Fusobacterium necrophorum (F. necrophorum) often induces severe complications, such as meningitis and sinus thrombosis. Early diagnosis is difficult, partly because little is known about specific early signs. Comprehensive research about clinically chosen antimicrobial therapy has not been done yet and prognostic information about otomastoiditis caused by F. necrophorum is scarce. More knowledge about this subject is required. Methods: In this retrospective cohort study, we included all cases of otomastoiditis caused by F. necrophorum treated in two university medical centres in the Netherlands during the past 10 years. Data was gathered from patient records and analysed using independent sample T-tests and Chi 2 -tests. Results: This study reveals that otomastoiditis caused by F. necrophorum potentially induces neurological sequelae. Thereby, 80% of all included patients (n = 16) needed readmission within six months due to recurrence or complications of otomastoiditis caused by F. necrophorum . Mean (range) of age, CRP and temperature were 4.5 years (0.9–29.3), 243 mg/L (113–423) and 40 °C (37–41). All patients were hospitalized and treated with antibiotics, mostly metronidazole (n = 13/16) and a β -lactam (n = 15/16). Additional treatment contained low molecular weight heparin (83%, n = 10/12), dexamethasone (78%, n = 7/9) and/or surgery (80%, n = 12/16, whereof 9/12 mastoidectomy). Conclusions: Patients and/or their parents need to be informed about this potential unfortunate prognosis when otomastoiditis caused by F. necrophorum is diagnosed. To improve early diagnosis, otomastoiditis caused by F. necrophorum should be suspected and therefore immediately cultured when a) young children present with otomastoiditis, with b) high CRP values, and/or c) vomiting and decreased consciousness. Highlights: ∙Otomastoiditis caused by F. necrophorum can induce neurological sequelae. ∙ Readmission is often needed due to recurrence/complications of the disease. ∙Patients(' parents) need to be informed about its potential unfortunate prognosis. ∙Patients are often of young age and show severe clinical presentation. ∙Antibiotics are leading in treatment, potential combined with mastoidectomy.