[Intracranial suppurations of otorhinolaryngological origin in children in Senegal]

Abstract

Background: Intracranial suppurations (ICSs) are poorly assessed in sub-Saharan Africa, especially in children.

Patients and methods: A retrospective study from 1st January 1996 to 31st December 2004 in children admitted to the pediatric department of the Hôpital Principal de Dakar, Senegal, for a sinogenic or otitic ICS. All cases were diagnosed by CT scan.

Results: Sixteen children (12 boys and 4 girls), mean age of 11.2 years (range, 7-15 years), were admitted with the primary diagnosis of ICS. The mean time from the beginning of fever or neurological disorders to admission was 12 days (range, 1-60 days) and 6 days (range, 1-22 days), respectively. At admission, fever was noted in 14 patients and neurological signs in all patients. Otolaryngologic infections were sinusitis (n=14) or otitis (n=2). ICSs were subdural empyema (n=8), single (n=6) or multiple (n=1) cerebral abscesses, or association of subdural empyema and cerebral abscess (n=1). Bacteriological cultures were seldom positive because of frequent previous antibiotic therapies and showed Staphylococcus aureus (n=2), nongroupable Streptococcus (n=1), or Pseudomonas aeruginosa and Proteus mirabilis (n=1). Antibiotics were given initially intravenously for 30 days, then orally for 30 days. Additionally, some patients received corticosteroids (n=4) or phenobarbitone (n=9). Aspiration drainage of the ICS was undertaken in 13 patients. All the children were cured, 4 of whom had neurological sequelae at follow-up.

Discussion: This pediatric series provides important data on the characteristics of ICS in sub-Saharan Africa. Therapeutic measures adapted to this context are proposed.

Conclusion: Access to CT scan was fundamental in guiding medical and surgical management and ensuring a mostly favorable outcome despite long delays in treatment initiation.