Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA.
Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA.
Am J Emerg Med. 2020 Jun;38(6):1296.e5-1296.e7. doi: 10.1016/j.ajem.2020.01.028. Epub 2020 Jan 17.
Opisthotonos, extreme involuntary neck and back extension, is rarely seen in modern emergency departments. Vaccines have prevented the most common causes of this clinical presentation. Alternatively, otitis media is one of the most common pediatric infections and is characteristically non-invasive and harmless. In exceedingly rare cases, otitis media can develop complications and progress to invasive pneumococcal diseases including mastoiditis and meningitis. Streptococcus pneumoniae accounts for the majority of otitis media infections, however, since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) otitis media and its complications have decreased significantly. The present case reports of a previously healthy and immunized child presenting to a pediatric emergency department (PED) with opisthotonos, and was found to have pneumococcal meningitis, bacteremia and mastoiditis arising from otitis media.
角弓反张，即颈部和背部极度不自主伸展，在现代急诊部门很少见。疫苗已经预防了这种临床表现的最常见原因。另一方面，中耳炎是最常见的儿科感染之一，其特征是非侵袭性和无害的。在极为罕见的情况下，中耳炎可能会发展为并发症，并进展为侵袭性肺炎球菌病，包括乳突炎和脑膜炎。肺炎链球菌引起了大多数中耳炎感染，然而，自从 7 价肺炎球菌结合疫苗（PCV7）和 13 价肺炎球菌结合疫苗（PCV13）问世以来，中耳炎及其并发症的发生率显著下降。本病例报告了一名既往健康且免疫接种的儿童因角弓反张就诊儿科急诊部（PED），并被发现患有由中耳炎引起的化脓性脑膜炎、菌血症和乳突炎。
