ナイジェリアのIle-Ifeにおける小児の頭蓋内膿瘍：症例シリーズと文献のレビュー

Intracranial abscesses in children at Ile-Ife, Nigeria: a case series and review of literature.

• Oluwatosin E Olorunmoteni
• Chiazor U Onyia
• Jerome B E Elusiyan
• Osagie J Ugowe
• Toluwani E Babalola
• Ibitoye Samuel

抄録

目的:

中枢神経系（CNS）感染症は小児の罹患率と死亡率の重要な原因となっており、一部の小児では脳実質内や頭蓋外の構造物に膿瘍が発生しやすい。我々は、Obafemi Awolowo University Teaching Hospital Complex (OAUTHC)における頭蓋膿瘍を有する小児の臨床プロファイルと転帰について述べることを目的とした。

PURPOSE: Central nervous system (CNS) infections are significant causes of morbidities and mortalities in children with some being prone to the development of abscesses which can either be within the brain parenchyma or located in extracranial structures. We aimed to describe the clinical profile and outcome of children with cranial abscesses at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC).

方法:

OAUTHC Ile-Ifeの小児救急病棟に来院した連続症例を募集した。これらの小児の発症パターン、素因因子、転帰を調査した。

METHODS: Consecutive cases presenting at the Children Emergency Ward of OAUTHC Ile-Ife were recruited. The pattern of presentation, predisposing factors and outcome of these children were studied.

結果:

6ヶ月以内に入院した641名のうち6名が頭蓋膿瘍と診断され、有病率は0.9%であった。発症前の症状の平均期間は12.7±13.4日であった。5例（83.3％）に頭蓋内膿瘍が認められ，2例（33.3％）に多発性の頭蓋内膿瘍が認められた．1例は前頭副鼻腔炎後のPott's puffy tumourであった。外科的管理は2例（33.3％）で、開頭術と退院によるものであった。そのうち2名は死亡し、症例死亡率は33.3％であった。

RESULTS: Among the 641 children admitted within a 6-month period, six were diagnosed with cranial abscess giving a hospital prevalence of 0.9%. The mean duration of symptom prior to presentation was 12.7 ± 13.4 days. Five (83.3%) of the patients had intracranial abscesses which were multiple in two (33.3%) children. One patient had Pott's puffy tumour following frontal sinusitis. Surgical management was done for two (33.3%), and this was by craniotomy and evacuation. Two of the patients died with a case fatality rate of 33.3%.

結論:

稀ではあるが、特に資源の乏しい環境下では、頭蓋膿瘍は依然として小児の生命を脅かすものである。局所感染症の早期診断と早期治療が予後を改善する。

CONCLUSION: Though uncommon, cranial abscesses remain life threatening in children especially in resource-poor settings. Early presentation and early treatment of local infections will improve outcome.