Fusobacterium necrophorumuna etiología poco frecuente, pero en aumento, de la mastoiditis aguda en niños pequeños

Abstract

Introduction: Although acute mastoiditis is mainly caused by Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes, in recent years there has been an increase in the incidence of Fusobacterium necrophorum, especially in infants. Case report 1: A infant who goes to the emergency department due to fever, decay and refusal of food. He is tachycardic with affectation of the general state, slight cutaneous pallor and neck stiffness, being normal the rest of the physical examination. With the suspicion of sepsis/bacteremia, intravenous cefotaxime is started. After 2 hours, left otorrhea appears and after 36 hours mastoidism. Cranial CT shows bilateral acute otomastoiditis with left subperiosteal abscess, requiring left mastoidectomy and drainage of subperiosteal abscess. In the culture of the subperiosteal abscess, F. necrophorum is isolated. Case report 2: Infant taken to the emergency due to the persistence of fever and the appearance of otorrhea at 24 hours of receiving oral amoxicillin-clavulanate for acute acute otitis media. It presents good general condition, the constants are normal and physical examination highlights left otorrhea with mastoidism. Cranial CT confirms bilateral otomastoiditis with possible left subperiosteal abscess. Left mastoidectomy and subperiosteal abscess drainage are performed. In the culture of the subperiosteal abscess, F. necrophorum is isolated. Conclusion: In infants with acute mastoiditis, we must keep in mind the F. necrophorum as a possible etiological agent, associated with worse evolution, greater need for surgical treatment and higher risk of complications than other germs.