Epidural abscess epidemiology and demographics: Difference between revisions
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==Overview== | ==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: [[intracranial space|intracranially]] or in the [[spinal canal]]. In both cases, in order to prevent severe morbidity and fatal outcomes, accurate diagnosis and prompt therapy should be applied as early as possible. According to the location of the infection, the epidemiology of each of the two types of abscess will differ. This is due to the nature of the location of the disease, but also due to other factors described below. | 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]], which accounts for less than 2% of focal [[CNS]] [[infections]]. <ref>{{Cite book | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages = }}</ref>. It may occur in two different places: [[intracranial space|intracranially]] or in the [[spinal canal]]. In both cases, in order to prevent severe morbidity and fatal outcomes, accurate diagnosis and prompt therapy should be applied as early as possible. According to the location of the infection, the epidemiology of each of the two types of abscess will differ. This is due to the nature of the location of the disease, but also due to other factors described below. In both cases, in order to prevent severe morbidity and fatal outcomes, accurate diagnosis and prompt therapy should be applied as early as possible. | ||
==Epidemiology And Demographics== | ==Epidemiology And Demographics== | ||
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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, which accounts for less than 2% of focal CNS infections. [1]. It may occur in two different places: intracranially or in the spinal canal. In both cases, in order to prevent severe morbidity and fatal outcomes, accurate diagnosis and prompt therapy should be applied as early as possible. According to the location of the infection, the epidemiology of each of the two types of abscess will differ. This is due to the nature of the location of the disease, but also due to other factors described below. In both cases, in order to prevent severe morbidity and fatal outcomes, accurate diagnosis and prompt therapy should be applied as early as possible.
Epidemiology And Demographics
Intracranial Epidural Abscess
The most rare type of epidural abscess, it accounts for only 1 in 10 cases of the disease. Despite this fact, it is the 3rd most common focal intracranial infection, following brain abscess and subdural empyema. Before the arrival of antibiotics, the most common cause were sinusitis, otitis and mastoiditis. Today it happens most often following neurosurgical procedures and in IV drug users. The cases not related to iatrogenesis, occur more commonly in adolescent males, since they are more prone to sinusitis and its complications. This incidence is due to the increase of vascularity of the diploic system and development of frontal sinus between the 7th and 20th year of age, which contributes to the spread of the infection, since the sinus mucosa communicates with the marrow spaces of the frontal bone, as well as with the veins of the dura mater. [2] According to a study of Gallagher et al 15 out of 176 patients with sinusitis, developed some kind of intracranial suppuration as a complication. Of these, 23% developed epidural abscess. [3]
Spinal Epidural Abscess
The most common type of epidural abscess, it can occur in patients of all ages, however is more common in those with more than 50 years of age, with studies showing a male predominance of the disease. [4][5] The incidence of this disease has doubled during the past two decades, to 0.2-2 cases per 10,000 hospital admissions. Possible explanations for this rise, despite therapy improvements, include: [6][7]
- Increased sensitivity and accuracy of the diagnostic methods, with the use of contrast enhanced MRI;
- Immunocompromised and aged population;
- Increased number of neurosurgical and other spinal invasive procedures for anaesthesia and pain management;
- Increased IV drug users.
In the case of spinal catheter placement, the infection might occur at several occasions, namely:
- At the time of placement of the catheter;
- Ascending contamination from the skin flora;
- Injections through the catheter with contaminated syringes;
- From bacteria causing hematogenous seeding of the catheter material.
According to a meta-analysis published in 2000, "the mortality rates of spinal epidural abscess have not changed significantly over the last 25 years". [7][8]
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB; et al. (2004). "Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature". South Med J. 97 (3): 279–82, quiz 283. PMID 15043336.
- ↑ Gallagher RM, Gross CW, Phillips CD (1998). "Suppurative intracranial complications of sinusitis". Laryngoscope. 108 (11 Pt 1): 1635–42. PMID 9818818.
- ↑ Pilkington, S. A.; Jackson, S. A.; Gillett, G. R. (2003). "Spinal epidural empyema". British Journal of Neurosurgery. 17 (2): 196–200. doi:10.1080/0268869031000108990. ISSN 0268-8697.
- ↑ 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.
- ↑ Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
- ↑ 7.0 7.1 Strauss I, Carmi-Oren N, Hassner A, Shapiro M, Giladi M, Lidar Z (2013). "Spinal epidural abscess: in search of reasons for an increased incidence". Isr Med Assoc J. 15 (9): 493–6. PMID 24340840.
- ↑ Reihsaus E, Waldbaur H, Seeling W (2000). "Spinal epidural abscess: a meta-analysis of 915 patients". Neurosurg Rev. 23 (4): 175–204, discussion 205. PMID 11153548.