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Acute Mastoiditis and the Importance of Pathogen identification: Two Case Reports

par De Crombrugghe De Looringhe, Gabrielle
Référence European Society for Peadiatric Infectious Diseases (36: 28/05/2018 to 02/06/2018: Malmö, Sweden), ACUTE MASTOIDITIS AND THE IMPORTANCE OF PATHOGEN IDENTIFICATION: TWO CASE REPORTS, Vol. ESP18-1079, page (1560)
Publication Publié, 2018-05-28

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Résumé :

BackgroundAcute mastoiditis (AM) is a complication of acute otitis media. Clinical spectrum of AM ranges fromabsence of symptoms with spontaneous resolution to progressive disease with life-threateningcomplications.Case Presentation SummaryTwo cases of bilateral mastoiditis in 8 months-old children were diagnosed at two weeks interval in asecondary Hospital in Brussels. Both patients were treated by intravenous 3rd generationcephalosporin.In our first case, no ear pus sample was taken in order to isolate infecting pathogen andantibiotherapy was started immediately. However, the patient presented an adequate treatmentresponse, becoming afebrile and presenting a decrease of the retroauricular swelling within the first 24hours following antibiotherapy.On the second patient, we performed a tympanocentesis before starting antibiotherapy. This patientdidn’t show adequate treatment response within 48 hours post antibiotic administration and continuedwith high fever, toxic aspect and the apparition of a macular rash with redness, tenderness and heat ofthe upper and lower limbs.The ear puss culture returned positive for Group A Streptococcus. We considered the macular rashand swelling as suggestive for a Streptococcal-toxic-shock-syndrome with diffuse capillary leak andadded Clindamycin to the treatment. The response to the bitherapy was favorable with rapid apyrexiaas well as decrease of the rash and biological inflammation.Learning Points/DiscussionThis case report highlights the importance of isolating the pathogen in AM in order to guideappropriate antibiotherapy. Given the variety of organisms causing AM and the potential for antibioticresistance, the importance of isolating the germ cannot be overemphasized.