Fusobacterium necrophorum, a major provider of sinus thrombosis in acute mastoiditis: A retrospective multicentre paediatric study

• Published in: Clinical otolaryngology Vol. 45; no. 2; pp. 182 - 189
• Main Authors: Coudert, Aurélie, Fanchette, Julia, Regnier, Gaëlle, Delmas, Justine, Truy, Eric, Nicollas, Richard, Akkari, Mohamed, Couloignier, Vincent, Ayari‐Khalfallah, Sonia
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.03.2020
• Subjects: Bacteria; Children; Complications; Flow charts; Fusobacterium; Fusobacterium necrophorum; Management; Mastoiditis; Neurological complications; otitis media; otitis media with effusion; otology; skull base surgery; Surgery; Thromboembolism; Thrombosis; Fusobacterium necrophorum; otology; otitis media; skull base surgery; otitis media with effusion; mastoiditis
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/coa.13478

Objective To evaluate in children the clinical severity and evolution of otogenic lateral sinus thrombosis (OLST) due to Fusobacterium necrophorum compared with other bacterial otogenic thrombosis and propose a specific management flowchart for Fusobacterium OLST. Design A retrospective multicentre cohort study. Settings Four French ENT paediatric departments. Participants A total of 260 under 18 years old admitted for acute mastoiditis were included. Initial imaging was reviewed to focus on complicated mastoiditis and 52 OLST were identified. Children were then divided into two groups according to bacteriological results: 28 in the “OLST Fusobacterium group” and 24 in the “OLST other bacteria group”. Results There was a significant association between F necrophorum and OLST (P < .001). When compared to the OLST other bacteria group, children in the OLST Fusobacterium group were significantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation: higher CRP (113 mg/L vs 175.7 mg/L, P = .02) and larger subperiosteal abscess (14 mm vs 21 mm, P < .01). Medical management was also more intensive in the OLST Fusobacterium group than in the OLST other bacteria group: increased number of conservative surgeries (66.7% vs 92.9%, P = .03) and longer hospital stay (13.7 days vs 19.8 days, P = .02). At the end of follow‐up, the clinical course was good in both groups without any neurological sequelae. Conclusions Thrombotic complications are very frequent in case of Fusobacterium mastoiditis and clinicians should be aware of the initial severity of the clinical presentation. Under appropriate management, the clinical course of Fusobacterium OLST is as good as that of other bacterial otogenic thrombosis.