Department of Otolaryngology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
School of Public Health, Yale University, New Haven, Connecticut, U.S.A.
Otol Neurotol. 2019 Aug;40(7):e704-e712. doi: 10.1097/MAO.0000000000002290.
To undertake a large-scale review of otogenic intracranial sepsis in an area of highly prevalent HIV and tuberculosis (TB) to re-examine and inform early diagnosis and treatment efforts.
Seventy-seven consecutive cases of otogenic intracranial sepsis in KwaZulu-Natal, South Africa were reviewed for demographics, presentation, imaging, HIV status, culture results, and outcomes.
The most common intracranial complications were intracranial abscess (46.8%), hydrocephalus (31.2%), subdural empyema (28.6%), and epidural empyema (26.0%). Ear discharge (87.0%), postauricular abscess (29.9%), and hearing loss (29.9%) were notable presenting symptoms. Overall mortality was 15.6%. Of the 45.5% of patients with HIV testing, 54.2% were HIV+, Mortality among HIV+ patients was 15.8% but only 6.3% in HIV- patients (p = 0.61, OR = 2.8). Eight patients (10.4%) had culture or histological evidence of TB infection.
Otogenic intracranial complications continue to present late and are associated with significant mortality and morbidity, despite advances in diagnostic and treatment modalities. This study represents one of the largest case-series in the literature, and the first to specifically evaluate the effects of HIV and TB infection.Patient presentation and severity of illness varied; however, a majority of patients presented with ear discharge and no focal neurological signs. An effect size for higher mortality among HIV+ patients compared with HIV- patients was noted but was not significant. Tuberculosis infection was prevalent compared with previous studies.This study reinforces the need for enhanced screening and early treatment of ear disease to minimize associated mortality and morbidity, particularly in immunocompromised patients.
在艾滋病病毒（HIV）和结核病（TB）高发地区开展大规模的耳源性颅内脓毒症回顾性研究，重新审视和指导早期诊断和治疗工作。
对南非夸祖鲁-纳塔尔省的 77 例耳源性颅内脓毒症连续病例进行回顾性分析，研究内容包括人口统计学、临床表现、影像学检查、HIV 状态、培养结果和结局。
最常见的颅内并发症包括颅内脓肿（46.8%）、脑积水（31.2%）、硬膜下积脓（28.6%）和硬膜外积脓（26.0%）。耳漏（87.0%）、耳后脓肿（29.9%）和听力损失（29.9%）是显著的临床表现。总死亡率为 15.6%。在接受 HIV 检测的 45.5%患者中，54.2% HIV 阳性，HIV 阳性患者的死亡率为 15.8%，而 HIV 阴性患者的死亡率为 6.3%（p=0.61，OR=2.8）。8 例（10.4%）患者的培养或组织学检查有结核感染证据。
尽管诊断和治疗方法有所进步，但耳源性颅内并发症仍会出现迟发，并导致严重的死亡率和发病率。本研究是文献中最大的病例系列之一，也是首个专门评估 HIV 和 TB 感染影响的研究。患者的临床表现和疾病严重程度存在差异；然而，大多数患者以耳漏和无局灶性神经体征为主要表现。与 HIV 阴性患者相比，HIV 阳性患者的死亡率更高，但差异无统计学意义。与以往的研究相比，结核感染更为普遍。本研究强调了需要加强对耳部疾病的筛查和早期治疗，以最大限度地降低相关死亡率和发病率，尤其是在免疫功能低下的患者中。
