infectious-diseases-2016_posters-accepted-abstracts

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Volume 4, Issue 4(Suppl) J Infect Dis Ther 2016
ISSN: 2332-0877, JIDT an open access journal
Page 91
Notes:
Infectious Diseases 2016
August 24-26, 2016
conferenceseries.com
August 24-26, 2016 Philadelphia, USA
&
Infectious DiseasesJoint Event on 2nd World Congress on
Pediatric Care & Pediatric Infectious Diseases
International Conference on
Meningitis, intracranial abscess and suppurative thrombophlebitis of the lateral and/or cavernous
sinuses are dreadful complications of chronic infectious/inflammatory conditions of the middle
ear: A rare case of meningitis caused by recurrent cholesteatoma
Veeraraghavan Meyyur Aravamudan
National University Hospital, Singapore
A46 year old Malay male with past surgical history of mastoidectomy in 2007 for cholesteatoma was admitted with sudden onset of
headache, altered level of consciousness and lethargy for 1 day. Associated symptoms includedmultiple episodes of non-projectile
vomiting and photophobia. He denied blurring of vision, otalgia and otorrhea. Physical examination revealed a lethargic looking
male patient with a GCS of 3. His temperature was 38.5oC. Neck rigidity was present on movement in all directions. Cranial nerve
and fundoscopic examination was unremarkable. He had skew deviation of eyes to right. Rest of the neurological examination did
not reveal any motor deficits. He was started on empirical intravenous ceftriaxone, vancomycin, acyclovir and ampicillin for clinically
suspected meningitis while awaiting lumbar puncture results. Computerized tomography (CT) of brain was normal. Cerebrospinal
fluid (CSF) obtained from lumbar puncture showed cell count of 900 units per mm3 with 80% lymphocytes and 20% neutrophils,
protein of 0.92 gram per liter and glucose was 1.7 mmol per liter. Gram stain did not reveal any organism and cultures were negative.
Polymerase chain reaction (PCR) for neurotropic viruses i.e., HSV, measles, mumps and enterovirus were negative. Cerebrospinal
fluid acid fast bacillus (AFB) smear was negative. Computerized tomography (CT) temporal bone with contrast showed right middle
ear and mastoid cholesteatoma with surrounding infected granulation tissue which extended into the inner ear and intracranially.
He was subsequently referred to ENT and underwent right modified radical mastoidectomy. He made a good clinical recovery.
Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or
mastoid process. Because of their erosive and expansile properties they can destroy the ossicles and can potentially spread into the
base of the skull into the brain causing meningitis. Even though the incidence of cholesteatoma causing meningitis is rare, these are
still potential life threatening complications. Cholesteatoma is still considered a surgical disease requiring either the complete removal
of its squamous lined matrix or its exteriorization for continued aural toilet and ventilation. In the pre-antibiotic era, the mortality
rate from intracranial complications following the otologic diseases was approximately 75%. In the post-antibiotic era, mortality was
around 34%. Meningitis is the most common intracranial complication. There are three dissemination passages for the occurrence of
otogenic meningitis which are hematogenous, congenital dehiscence (such as Hyrtl’s fissures) or preformed (osseous erosion). Every
patient with suspicion of complication needs to be followed up by several medical specialties and must be submitted to full physical
exam and computerized tomography with contrast. The treatment must be aggressive with early initiation of intravenous antibiotic
and early drainage of the infectious focus in order to reduce the morbidity and mortality rate. Early recognition and computerized
tomography of temporal bone were important in diagnosis of meningitis secondary to cholesteatoma and prompt referral to ENT
surgeon for early surgery should be considered to avoid long-term complications.
Biography
Veeraraghavan Meyyur Aravamudan is senior resident in advanced internal medicine at National University Hospital, Singapore
Veeraraghavan Meyyur Aravamudan, J Infect Dis Ther 2016, 4:4(Suppl)