What is the most common pathogen in Pott's puffy tumor?

From the Guidelines

The most common pathogen in Pott's puffy tumor is Streptococcus species, particularly Streptococcus milleri group, followed by Staphylococcus aureus. Pott's puffy tumor is a rare but serious complication of frontal sinusitis characterized by subperiosteal abscess with osteomyelitis of the frontal bone. The infection typically begins in the frontal sinuses and spreads through the bone by direct extension or through the venous system.

Key Points to Consider

• Anaerobic bacteria like Bacteroides and Fusobacterium species are also frequently isolated, often as part of polymicrobial infections 1.
• The presence of these pathogens necessitates broad-spectrum antibiotic therapy that covers both aerobic and anaerobic organisms, typically including a third-generation cephalosporin plus metronidazole, or a beta-lactam/beta-lactamase inhibitor combination.
• Treatment usually requires both surgical drainage and prolonged antibiotic therapy for 4-6 weeks.
• Early identification and treatment are crucial as this condition can lead to intracranial complications including meningitis, epidural abscess, or brain abscess if left untreated, as noted in the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1.

Management Approach

• A contrast-enhanced CT scan (preferably coronal thin cut) of the head, orbits, and sinuses is essential to confirm intracranial or intraorbital suppurative complications; in such cases, intravenous antibiotics should be started immediately 1.
• Consultation with an otolaryngologist, an ophthalmologist, and an infectious disease expert is appropriate for guidance regarding the need for surgical intervention and the selection of antimicrobial agents 1.

From the Research

Pathogens in Pott's Puffy Tumor

• The most common pathogens in Pott's puffy tumor are typically polymicrobial, with an anaerobe-predominant microbiome 2.
• Specific bacteria that have been identified as causative agents include:
  • Streptococci, such as Streptococcus milleri and Streptococcus pneumoniae 3.
  • Staphylococci, including methicillin-resistant Staphylococcus aureus 4.
  • Anaerobic bacteria, such as those found in the Streptococcus constellatus group 5.
  • Pseudomonas aeruginosa 4.

Clinical Presentations and Treatment

• Pott's puffy tumor often presents with symptoms such as headache, frontal swelling, and fever 5, 4.
• Treatment typically involves a combination of broad-spectrum antibiotics and surgical intervention, including endoscopic sinus surgery and/or open transcranial approaches 6, 2, 4.
• The choice of treatment approach depends on factors such as patient age, history of prior endoscopic sinus surgery, and presence of intracranial involvement 2.