Epidural abscess causes: Difference between revisions

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Revision as of 14:58, 15 July 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

An epidural abscess is a rare suppurative infection of the central nervous system, a collection of pus localised in the epidural space, lying outside the dura mater. It may occur in two different places: intracranially or in the spinal canal. According to the region of infection, some responsible organisms will be shared by both types of abscess however, others will differ, mainly because of the risk factors involved in that particular area and the mechanisms of infection. In the case of intracranial epidural abscess, the most common risk factors are sinusitis and neurosurgical procedures, while in the case of spinal epidural abscess, the most common risk factors are infections of the surrounding tissues and spinal procedures.

Causes

Life Threatening Causes

Life-threatening conditions may result in death or permanent disability within 24 hours if left untreated. Epidural abscess is a life-threatening condition and must be treated as such irrespective of the cause.

Common Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	Cholesteatoma, mastoiditis, otitis, sinusitis
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	Bloodstream infections
Iatrogenic	Anesthetic procedures, back surgery, craniotomy, epidural analgesia, epidural catheter, neurosurgery, post-surgical infections, scalp venous catheter, spinal surgery
Infectious Disease	Aerobic gram-negative bacilli, anaerobes, anaerobic streptococci, aspergillus, blastomycosis, bloodstream infection, bone infections, candida, coagulase-negative staphylococci, dracunculus, echinococcus, encephalitis, escherichia coli, fungi, gram-negative bacilli, gram-negative bacteria, gram-positive bacilli, HIV, mastoiditis, meningitis, microaerophilic organisms, MRSA, mycobacterium tuberculosis, osteomyelitis, otitis, parasites, peptostreptococcus, post-surgical infections, propionibacterium, pseudomonas aeruginosa, pyogenic infectious discitis, sinusitis, sporothrix, staphylococcus aureus, staphylococcus epidermidis, streptococci
Musculoskeletal/Orthopedic	Bone infections, osteomyelitis, pyogenic infectious discitis
Neurologic	Encephalitis, head injury, meningitis
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Mycobacterium tuberculosis
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Immunocompromised host, Low CD4+ cell count
Sexual
Trauma	Head injury, road traffic accidents, Trauma
Urologic	No underlying causes
Miscellaneous	Back surgery

Causes in Alphabetical Order

2

Causes of Epidural Abscess Bases on Classification

Although some infectious organisms might be responsible for either type of epidural abscess, others are more common of one of those. Therefore, it is important to specify the most common causes of each epidural abscess, in order for the physician to start proper therapy as early as possible. ^[1]^[2]^[3]^[4]^[5]

Intracranial Epidural Abscess

If infection following sinusitis case:

If infection following neurosurgery:

Osteomyelitis of the skull

Spinal Epidural Abscess

References

↑ Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
↑ Danner, R. L.; Hartman, B. J. (1987). "Update of Spinal Epidural Abscess: 35 Cases and Review of the Literature". Clinical Infectious Diseases. 9 (2): 265–274. doi:10.1093/clinids/9.2.265. ISSN 1058-4838.
↑ Nussbaum ES, Rigamonti D, Standiford H, Numaguchi Y, Wolf AL, Robinson WL (1992). "Spinal epidural abscess: a report of 40 cases and review". Surg Neurol. 38 (3): 225–31. PMID 1359657.
↑ Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM (1992). "Bacterial spinal epidural abscess. Review of 43 cases and literature survey". Medicine (Baltimore). 71 (6): 369–85. PMID 1359381.
↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
↑ Griffiths DL (1980). "Tuberculosis of the spine: a review". Adv Tuberc Res. 20: 92–110. PMID 7395641.

[Darouiche2006-1] Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.

[DannerHartman1987-2] Danner, R. L.; Hartman, B. J. (1987). "Update of Spinal Epidural Abscess: 35 Cases and Review of the Literature". Clinical Infectious Diseases. 9 (2): 265–274. doi:10.1093/clinids/9.2.265. ISSN 1058-4838.

[pmid1359657-3] Nussbaum ES, Rigamonti D, Standiford H, Numaguchi Y, Wolf AL, Robinson WL (1992). "Spinal epidural abscess: a report of 40 cases and review". Surg Neurol. 38 (3): 225–31. PMID 1359657.

[pmid1359381-4] Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM (1992). "Bacterial spinal epidural abscess. Review of 43 cases and literature survey". Medicine (Baltimore). 71 (6): 369–85. PMID 1359381.

[5] Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.

[pmid7395641-6] Griffiths DL (1980). "Tuberculosis of the spine: a review". Adv Tuberc Res. 20: 92–110. PMID 7395641.

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[2]

[3]

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[5]

[6]

@@ Line 27: / Line 27: @@
 |-bgcolor="LightSteelBlue"
 | '''Dermatologic'''
-|bgcolor="Beige"|  [[Coagulase-negative Staphylococcus|Coagulase-negative staphylococci]], [[MRSA]], [[Propionibacterium]], [[Sporotrichosis|Sporothrix]], [[Staphylococcus aureus]], [[Staphylococcus epidermidis]]
+|bgcolor="Beige"|  No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 35: / Line 35: @@
 |-bgcolor="LightSteelBlue"
 | '''Ear Nose Throat'''
-|bgcolor="Beige"| [[Mastoiditis]], [[Otitis]], [[Peptostreptococcus|Peptostreptococcus species]], [[Sinusitis]]
+|bgcolor="Beige"| [[Cholesteatoma]], [[mastoiditis]], [[otitis]], [[sinusitis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 43: / Line 43: @@
 |-bgcolor="LightSteelBlue"
 | '''Environmental'''
-|bgcolor="Beige"| Expanded polytetrafluethylene
+|bgcolor="Beige"| No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
 | '''Gastroenterologic'''
-|bgcolor="Beige"| [[Aerobic]] [[gram-negative]] [[bacilli]], [[Dracunculus]], [[Echinococcus]], [[Escherichia coli]]
+|bgcolor="Beige"| No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 55: / Line 55: @@
 |-bgcolor="LightSteelBlue"
 | '''Hematologic'''
-|bgcolor="Beige"| [[Bloodstream]] [[infections]]
+|bgcolor="Beige"| [[Bloodstream infections]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Iatrogenic'''
-|bgcolor="Beige"| [[Anesthesia|Anesthetic procedures]], [[Vertebral column|Back]] [[surgery]], [[Craniotomy]], [[Epidural analgesia]], [[Epidural catheter]], [[Neurosurgery]], Recent [[neurosurgery]], [[Scalp]] [[venous]] [[catheter]], [[Vertebral column|Spinal]] [[surgery]]
+|bgcolor="Beige"| [[anesthesia|Anesthetic procedures]], [[surgery|back surgery]], [[craniotomy]], [[epidural analgesia]], [[epidural catheter]], [[neurosurgery]], [[post-surgical infections]], [[intravenous therapy|scalp venous catheter]], [[surgery|spinal surgery]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Infectious Disease'''
-|bgcolor="Beige"| [[Aerobic]] [[gram-negative]] [[bacilli]], [[Anaerobes]], [[Anaerobic]] [[streptococci]], [[Bloodstream]] [[infections]], [[Bone]] [[infections]], [[Candida]], [[Coagulase-negative Staphylococcus|Coagulase-negative staphylococci]], [[Dracunculus]], [[Echinococcus]], [[Escherichia coli]], [[Fungi]], [[Gram-negative bacteria]], [[Gram-negative]] [[Rod cell|rods]], [[Gram-positive]] [[bacilli]], [[Mastoiditis]], [[Microaerophile|Microaerophilic organisms]], [[MRSA]], [[Mycobacterium tuberculosis]], [[Osteomyelitis]] of the [[skull]], [[Osteomyelitis]], [[Otitis]], [[Parasites]], [[Peptostreptococcus|Peptostreptococcus species]], [[Propionibacterium]], [[Pseudomonas aeruginosa]], [[Pyogenic]] [[infectious]] [[discitis]], [[Sinusitis]], [[Staphylococcus aureus]], [[Staphylococcus epidermidis]], [[Streptococci]]
+|bgcolor="Beige"| [[gram-negative bacteria|Aerobic gram-negative bacilli]], [[anaerobes]], [[streptococcus|anaerobic streptococci]], [[aspergillus]], [[blastomycosis]], [[bloodstream infection]], [[bone infections]], [[candida]], [[staphylococcus|coagulase-negative staphylococci]], [[dracunculus]], [[echinococcus]], [[encephalitis]], [[escherichia coli]], [[fungi]], [[gram-negative bacilli]], [[gram-negative bacteria]], [[gram-positive bacteria|gram-positive bacilli]], [[HIV]], [[mastoiditis]], [[meningitis]], [[microaerophile|microaerophilic organisms]], [[MRSA]], [[mycobacterium tuberculosis]], [[osteomyelitis]], [[otitis]], [[parasites]], [[peptostreptococcus]], [[post-surgical infections]], [[propionibacterium]], [[pseudomonas aeruginosa]], [[discitis|pyogenic infectious discitis]], [[sinusitis]], [[sporotrichosis|sporothrix]], [[staphylococcus aureus]], [[staphylococcus epidermidis]], [[streptococci]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Musculoskeletal/Orthopedic'''
-|bgcolor="Beige"| [[Bone]] [[infections]], [[Osteomyelitis]] of the [[skull]], [[Osteomyelitis]], [[Pyogenic]] [[infectious]] [[discitis]]
+|bgcolor="Beige"| [[Bone infections]], [[osteomyelitis]], [[discitis|pyogenic infectious discitis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Neurologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Encephalitis]], [[head injury]], [[meningitis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 99: / Line 99: @@
 |-bgcolor="LightSteelBlue"
 | '''Pulmonary'''
-|bgcolor="Beige"| [[Aspergillus|Aspergillus species]], [[Mycobacterium tuberculosis]], [[Pseudomonas aeruginosa]]
+|bgcolor="Beige"| [[Mycobacterium tuberculosis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 107: / Line 107: @@
 |-bgcolor="LightSteelBlue"
 | '''Rheumatology/Immunology/Allergy'''
-|bgcolor="Beige"|No underlying causes
+|bgcolor="Beige"|[[Immunocompromised host]], [[CD4|Low CD4+ cell count]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Sexual'''
-|bgcolor="Beige"| [[Candida]]
+|bgcolor="Beige"|
 |-
 |-bgcolor="LightSteelBlue"
 | '''Trauma'''
-|bgcolor="Beige"| [[Head injury]], [[Sporotrichosis|Sporothrix]], [[Trauma]]
+|bgcolor="Beige"| [[Head injury]], [[motor vehicle accident|road traffic accidents]], [[Trauma]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 123: / Line 123: @@
 |-bgcolor="LightSteelBlue"
 | '''Miscellaneous'''
-|bgcolor="Beige"| [[Aerobic]] [[gram-negative]] [[bacilli]], [[Anaerobes]], [[Anaerobic]] [[streptococci]], [[Aspergillus|Aspergillus species]], [[Bloodstream]] [[infections]], [[Candida]], [[Coagulase-negative Staphylococcus|Coagulase-negative staphylococci]], [[Dracunculus]], [[Echinococcus]], [[Escherichia coli]], [[Fungi]], [[Gram-negative bacteria]], [[Gram-negative]] [[Rod cell|rods]], [[Gram-positive]] [[bacilli]], [[Microaerophile|Microaerophilic organisms]], [[MRSA]], [[Mycobacterium tuberculosis]], [[Osteomyelitis]] of the [[skull]], [[Osteomyelitis]], [[Parasites]], [[Peptostreptococcus|Peptostreptococcus species]], [[Pseudomonas aeruginosa]], [[Pyogenic]] [[infectious]] [[discitis]], [[Sporotrichosis|Sporothrix]], [[Staphylococcus aureus]], [[Staphylococcus epidermidis]], [[Streptococci]]
+|bgcolor="Beige"| [[surgery|Back surgery]]
 |-
 |}