Amat F
Service des urgences pédiatriques, hôpital d'enfants Armand-Trousseau, 75012 Paris, France.
Arch Pediatr. 2010 Mar;17(3):258-62. doi: 10.1016/j.arcped.2009.11.012. Epub 2010 Feb 4.
Acute sinusitis in children is a controversial issue in terms of its diagnostic criteria, classification and therapeutic management. A therapeutic delay can lead to complications if the cause is bacterial. Guidelines have been set, but they are not consensual in pediatrics. Complications of acute bacterial sinusitis are uncommon in children, but they can be extremely severe and cause high morbidity and mortality. Because of their rarity, they often are not identified early, exposing the patient to an unfavorable outcome. We report on a case of acute bacterial pan-sinusitis complicated with thrombophlebitis of the cavernous sinuses and meningitis in a 9-year-old child, in spite of early and adapted antibiotic therapy. The bacterial agent was Staphylococcus aureus, which had no resistance or toxin profile. The progression was favorable under intravenous antibiotic therapy and after bilateral sphenoidectomy. This case raises the question of the best therapy for acute bacterial sinusitis in pediatrics and the management of complications.
儿童急性鼻窦炎在诊断标准、分类及治疗管理方面是一个存在争议的问题。如果病因是细菌性的，治疗延迟可能会导致并发症。虽然已经制定了指南，但在儿科领域尚未达成共识。急性细菌性鼻窦炎的并发症在儿童中并不常见，但可能极其严重，会导致高发病率和死亡率。由于其罕见性，往往不能早期识别，从而使患者面临不良后果。我们报告一例9岁儿童急性细菌性全鼻窦炎合并海绵窦血栓性静脉炎和脑膜炎的病例，尽管进行了早期且适当的抗生素治疗。病原体为金黄色葡萄球菌，其无耐药性或毒素特征。在静脉抗生素治疗及双侧蝶窦切除术后病情好转。该病例引发了关于儿科急性细菌性鼻窦炎的最佳治疗方法及并发症管理的问题。
