Paranasal Sinus CT Scan Changes in Children with Meningitis: A Cross Section Study, Tehran, IRAN

Background: Meningitis is the most common intracranial complication of sinusitis. Objective: Determine the frequency of sinusitis using CT scans in children with documented meningitis. Methods and materials: A prospective, cross sectional study was done in pediatric infectious ward of Rasul Hospital in Tehran, Iran during 2010-2011. In this study 65 cases with meningitis were evaluated for presence of sinusitis (according to symptoms, criteria and paranasal CT scan). Results: CSF obtained in 112 cases. Cases with meningitis aged 1 month-16 years old with a mean of 4.2 years. Definite bacterial meningitis was the final diagnosis in 40/112 patients (35.7%; missing=5). Second step: Paranasal sinus CT scan had been performed in 65 cases with final diagnosis of meningitis. Cases were between 1 month to 16 years old (mean age of 4.2 y). 51% of the patients were male and 49% were female. Bacterial meningitis was diagnosed in 55.3% (36/65) and aseptic meningitis in 44.7% (29/65). Sinuses were reported to be undeveloped in 7.6% (n=5) of younger than 4 months old cases. Sinusitis was diagnosed in 30.7% (20/65) of all cases with meningitis; 3.4% (1/29) in those with aseptic meningitis and 52% (19/36) in those with bacterial meningitis which shows significant difference between the 2 groups (P<0.05). The involved sinuses included: pan sinusitis with 15% (3/20) case. Maxillary sinusitis the most common type observed (16/20); on the next places comes; sphenoid sinusiti (7/20); ethmoeid sinusitis (4/20) and finally isolated frontal sinusitis was seen in 0% of cases. Chronic type of sinusitis was reported in 50% (n=10) of all cases. Conclusion: The prevalence of sinusitis in documented cases of meningitis (septic & aseptic meningitis) was 31%, and was more common (25%) in bacterial meningitis. Meningeal manifestations (e.g. meningeal signs and symptoms; or CSF changes) might be due to bacterial sinusitis. Most cases of meningitis in children are accompanied with sinusitis. Differentiation between the two sources and definition of the initial site of infection is always problematic. Appropriate bacterial sinusitis treatment is needed to prevent meningitis. We recommend sinus tract to be evaluated in every meningitis patient (septic or aseptic). Furthermore, adequate treatment in chronic sinusitis would help prevent readmission. *Corresponding author: Dr. Samileh Noorbakhsh, MD Professor, Research Center of Pediatric Infectious Diseases, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran, Tel: +98-21-66525328; Fax: +98-21-66516049; E-mail: [email protected]/[email protected] Received February 20, 2013; Accepted June 29, 2013; Published July 10, 2013 Citation: Noorbakhsh S, Zarabi V, Farhadi M, Ghavidel S, Shokrollahi MR, et al. (2013) Paranasal Sinus CT Scan Changes in Children with Meningitis: A Cross Section Study, Tehran, IRAN. Pediat Therapeut 3: 158. doi:10.4172/21610665.1000158 Copyright: © 2013 Noorbakhsh S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Eommunity acquired sinusitis is one of the most common causes to seek medical attention especially from paediatricians [1,2]. The diagnosis is usually made with the help of specific radiographies or computed tomography scans. The microbiology of sinusitis is depended on patient`s age [3]. Given that meningitis is the most common intracranial complication of sinusitis and bacterial meningitis is one of the most potentially serious infections in infants and older children which can be accompanied with a high rate of acute complications and long-term morbidity, an accurate and rapid diagnosis of acute bacterial meningitis is essential for early treatment and good outcome. Signs and symptoms are often non specific and it is not always possible to make a differential diagnosis between bacterial and aseptic meningitis [4-8]. According to a study performed by Younis et al. most cases of meningitis in children are accompanied with sinusitis [9]. Differentiation between the two sources and definition of the initial site of infection is always problematic. Thorough and precise examination in children with sinusitis and appropriate treatment is needed to decrease the risk of bacteremia and subsequent invasive infections (e.g. meningitis, subdural empyema and brain abscess) [10,11]. Introduction of high-resolution CT scans and magnetic resonance imaging and availability of wide-spectrum antibiotics have improved sinusitis management significantly [11,12]. Bacterial meningitis and antimicrobial resistance is common in Iranian children [13-15]. Community acquired rhino sinusitis is one of the most common causes of hospital visits especially to paediatricians in our hospital [1619]. Immunologic evaluation of children with sinusitis is necessary, especially in chronic or resistant cases [16]. Not only community acquired but also nosocomial sinusitis was reported in our center [19]. Citation: Noorbakhsh S, Zarabi V, Farhadi M, Ghavidel S, Shokrollahi MR, et al. (2013) Paranasal Sinus CT Scan Changes in Children with Meningitis: A Cross Section Study, Tehran, IRAN. Pediat Therapeut 3: 158. doi:10.4172/2161-0665.1000158