Wu Tien-Ju, Chiu Nan-Chang, Huang Fu-Yuan
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2008 Feb;41(1):62-7.
Subdural empyema (SDE) is a serious neurological condition in children and adults. Although otorhinolaryngeal infections are regarded as the most important predisposing factors in the literature, this has not been our experience. This study reviewed clinical data on pediatric patients with SDE at our institution over the last 20 years.
Charts of children hospitalized in Mackay Memorial Hospital from 1985 to 2005, with a final diagnosis of SDE were reviewed. Gender, predisposing factors, symptoms and signs, bacteriologic data, diagnostic work-up, treatment procedures, and outcome were collected and analyzed.
In total, 31 patients were enrolled. Twenty seven of them (87.1%) were below the age of one year. The male-to-female ratio was 1.21. Only 3 patients (9.7%) had prior otorhinolaryngeal infections; 6 patients (19.4%) had SDE following head trauma or surgery. The leading clinical manifestations were fever (96.8%), seizure (70.1%), and focal neurological signs (58.1%). The most common pathogens included Streptococcus pneumoniae (16.1%), group B Streptococcus (12.9%), Haemophilus influenzae type b (12.9%), Salmonella spp. (12.9%), Escherichia coli (9.7%) and Pseudomonas aeruginosa (9.7%). Cerebrospinal fluid leukocyte counts and protein levels were usually high and the glucose levels were usually low. SDE was first suspected or found via brain sonography in 9 infants. Nine patients (29.0%) received only medical treatment for SDE. Three patients (9.7%) died--all were infected by S. pneumoniae. Twelve patients (38.7%) recovered without neurological sequelae.
In the past 20 years, most of our cases of pediatric SDE occurred in infancy, and only one-tenth of them had prior otorhinolaryngeal infections. Brain sonography could be a helpful tool for early diagnosis of SDE in infancy.
硬膜下积脓（SDE）是儿童和成人中一种严重的神经系统疾病。尽管在文献中鼻咽喉感染被视为最重要的诱发因素，但我们的经验并非如此。本研究回顾了过去20年我院儿科SDE患者的临床资料。
回顾了1985年至2005年在马偕纪念医院住院且最终诊断为SDE的儿童病历。收集并分析了性别、诱发因素、症状和体征、细菌学数据、诊断检查、治疗方法及结果。
共纳入31例患者。其中27例（87.1%）年龄在1岁以下。男女比例为1.21。仅有3例患者（9.7%）既往有鼻咽喉感染；6例患者（19.4%）在头部外伤或手术后发生SDE。主要临床表现为发热（96.8%）、惊厥（70.1%）和局灶性神经体征（58.1%）。最常见的病原体包括肺炎链球菌（16.1%）、B族链球菌（12.9%）、b型流感嗜血杆菌（12.9%）、沙门氏菌属（12.9%）、大肠杆菌（9.7%）和铜绿假单胞菌（九、7%）。脑脊液白细胞计数和蛋白水平通常较高，葡萄糖水平通常较低。9例婴儿通过脑部超声首次怀疑或发现SDE。9例患者（29.0%）仅接受了SDE的药物治疗。3例患者（9.7%）死亡——均感染肺炎链球菌。12例患者（38.7%）康复且无神经后遗症。
在过去20年中，我们儿科SDE的大多数病例发生在婴儿期，其中只有十分之一有既往鼻咽喉感染。脑部超声可能是婴儿期SDE早期诊断的有用工具。
