Skull-base osteomyelitis: fungal vs. bacterial infection

Abstract

Skull-base osteomyelitis (SBO) occurs secondary to invasive bacterial and fungal infection. Distinguishing between fungal and bacterial aetiologies of SBO has significant therapeutic implications. An 18-year (1990-2007) retrospective review of patients with SBO presenting to Westmead Hospital was performed. Epidemiological, clinical, laboratory and radiology data were collated. Twenty-one patients (median age 58 years) with SBO were identified: ten (48%) had bacterial and 11 (52%) had fungal SBO. Diabetes mellitus (57%) and chronic otitis externa (33%) were the most frequent co-morbidities; immunosuppression was present in five cases (24%). Cranial nerve deficits occurred in ten (48%) patients. The commonest pathogens were Pseudomonas aeruginosa (50% bacterial SBO) and a zygomycete (55% fungal SBO). Compared to bacterial SBO, fungal SBO was more frequently associated with underlying chronic sinusitis, sinonasal pain, facial/periorbital swelling and nasal stuffiness or discharge and the absence of purulent ear discharge (all p <0.05). Bacterial SBO was more frequently associated with deafness, ear pain or ear discharge (all p <0.05). Median time to presentation was longer in patients with bacterial SBO (26.3 weeks vs. 8.1 weeks, p 0.08). Overall 6-month survival was 88% (14/18 patients). All four deaths occurred in patients with fungal SBO. Immunosuppression was a risk factor for death (p <0.05). Early diagnostic sampling is recommended in patients at increased risk of fungal SBO to enable optimal antimicrobial and surgical management.

Extrasinonasal infiltrative process associated with a sinonasal fungus ball: does it mean invasive fungal sinusitis?

“…Focal bone lysis, sequestrum formation, T1 hypointensity and T2 hyperintensity of bone marrow, and adjacent soft tissue infiltration are the most common imaging findings (17). Although skull base osteomyelitis can result from direct invasion by IFS itself, its possibility as the cause of the extrasinonasal infiltrative process in our series seems to be low because it carries much worse prognosis than bacterial skull base osteomyelitis (16).…”

“…In our study, diabetes was observed in five of seven patients (71%) with presumed skull Extrasinonasal infiltrative process associated with a sinonasal fungus ball • 351 (28,29). Skull base osteomyelitis usually occurs secondary to infection of the ear or paranasal sinus, especially sphenoid sinus (16,17). Focal bone lysis, sequestrum formation, T1 hypointensity and T2 hyperintensity of bone marrow, and adjacent soft tissue infiltration are the most common imaging findings (17).…”

“…Probable sinogenic cellulitis was diagnosed if a biopsy revealed nonspecific inflammation and the antibiotics treatment was effective (15). Probable skull base osteomyelitis was diagnosed if the patient had radiologic features indicative of bone erosion and responded to antimicrobial therapy (16,17).…”

Are CT and MRI Scanning Reliable in Diagnosing Otogenic Skull Base Osteomyelitis in Non-Immunocompromised Elderly Patients? A Case Series and Review of the Literature

“…3,5 Cranial nerve palsies can occur and have been reported in close to half the patients in some series. 3,5,11 Cranial nerve VII is the most commonly affected but cranial nerves IX, X, XI and XII can also be involved. 12 This is thought to occur due to the infection traversing the fissures of Santorini and the tympanomastoid suture to the Haversian system of the compact bone, and finally to the skull base.…”

Investigation of the Inhibition of Carbon Steel Corrosion in Hydrochloric Acid Solutions by Domperidone Drug

“…So, there has been increasing search for green inhibitors. Recently, there are several studies carried out on the use of drugs as inhibitors [5][6][7][8][9][10][11]. The drugs are biocompatibility in nature, environmentally acceptable, readily available and a renewable source.…”