Epidural abscess causes

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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. It may occur in two different places: intracranially or in the spinal canal. According to the region of infection, some causing organisms will be shared by both types of abscess, however, others will be different, 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

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

Common Causes

Although some causing 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 more common causes of each epidural abscess, in order for the physician to start proper therapy as early as possible. ^[1]^[2]^[3]

Intracranial Epidural Abscess

If infection following sinusitis case:

Microaerophilic organisms

Anaerobic streptococci
Other anaerobes - Propionibacterium

If infection following neurosurgery:

Osteomyelitis of the skull

Spinal Epidural Abscess

Staphylococcus aureus
MRSA (increasing incidence)
Mycobacterium tuberculosis (in some developing countries) ^[4]

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Coagulase-negative staphylococci, MRSA, Propionibacterium, Sporothrix, Staphylococcus aureus, Staphylococcus epidermidis
Drug Side Effect	No underlying causes
Ear Nose Throat	Mastoiditis, Otitis, Peptostreptococcus species, Sinusitis
Endocrine	No underlying causes
Environmental	Expanded polytetrafluethylene
Gastroenterologic	Aerobic gram-negative bacilli, Dracunculus, Echinococcus, Escherichia coli
Genetic	No underlying causes
Hematologic	Bloodstream infections
Iatrogenic	Anesthetic procedures, Back surgery, Craniotomy, Epidural analgesia, Epidural catheter, Neurosurgery, Recent neurosurgery, Scalp venous catheter, Spinal surgery
Infectious Disease	Aerobic gram-negative bacilli, Anaerobes, Anaerobic streptococci, Bloodstream infections, Bone infections, Candida, Coagulase-negative staphylococci, Dracunculus, Echinococcus, Escherichia coli, Fungi, Gram-negative bacteria, Gram-negative rods, Gram-positive bacilli, Mastoiditis, Microaerophilic organisms, MRSA, Mycobacterium tuberculosis, Osteomyelitis of the skull, Osteomyelitis, Otitis, Parasites, Peptostreptococcus species, Propionibacterium, Pseudomonas aeruginosa, Pyogenic infectious discitis, Sinusitis, Staphylococcus aureus, Staphylococcus epidermidis, Streptococci
Musculoskeletal/Orthopedic	Bone infections, Osteomyelitis of the skull, Osteomyelitis, Pyogenic infectious discitis
Neurologic	No underlying causes
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	Aspergillus species, Mycobacterium tuberculosis, Pseudomonas aeruginosa
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	Candida
Trauma	Head injury, Sporothrix, Trauma
Urologic	No underlying causes
Miscellaneous	Aerobic gram-negative bacilli, Anaerobes, Anaerobic streptococci, Aspergillus species, Bloodstream infections, Candida, Coagulase-negative staphylococci, Dracunculus, Echinococcus, Escherichia coli, Fungi, Gram-negative bacteria, Gram-negative rods, Gram-positive bacilli, Microaerophilic organisms, MRSA, Mycobacterium tuberculosis, Osteomyelitis of the skull, Osteomyelitis, Parasites, Peptostreptococcus species, Pseudomonas aeruginosa, Pyogenic infectious discitis, Sporothrix, Staphylococcus aureus, Staphylococcus epidermidis, Streptococci

Causes in Alphabetical Order

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.
↑ 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.

[pmid7395641-4] Griffiths DL (1980). "Tuberculosis of the spine: a review". Adv Tuberc Res. 20: 92–110. PMID 7395641.

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