Bacterial meningitis after sinus surgery in five adult horses.
Authors: Bach Fabienne S, Bodo Gabor, Kuemmerle Jan M, Bienert-Zeit Astrid, Hainisch Edmund K, Simhofer Hubert
Journal: Veterinary surgery : VS
Summary
# Bacterial Meningitis After Equine Sinus Surgery: A Cautionary Case Series Suppurative meningoencephalitis represents a rare yet invariably fatal complication following paranasal sinus surgery in horses, as demonstrated through review of five adult cases presenting between 2005 and 2010. The affected horses had undergone conventional surgical treatment for primary sinusitis (one case) or secondary sinusitis secondary to apical dental infection, sinus cysts, or ethmoturbinate masses (four cases), with postoperative management including repeated sinus lavage and antimicrobial therapy. Despite appropriate antimicrobial coverage, four of five horses exhibited undulating pyrexia in the immediate postoperative period, and all subsequently developed progressive neurologic signs that proved unresponsive to treatment; necropsy findings confirmed suppurative meningoencephalitis in all cases. The potential routes of infection remain incompletely characterised, though the proximity of surgical sites to the meninges and cerebrospinal fluid compartment warrants careful consideration of aseptic technique, wound contamination during repeated lavage procedures, and the adequacy of surgical closure. Equine practitioners should maintain heightened vigilance for early neurologic signs following sinus surgery—particularly in cases with persistent postoperative fever despite antimicrobial therapy—and consider whether alternative surgical approaches, modified aftercare protocols, or enhanced infection control measures might reduce the risk of this catastrophic complication.
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Practical Takeaways
- •Meningitis is a rare but invariably fatal complication after sinus surgery; maintain high suspicion for CNS involvement if pyrexia persists or neurologic signs develop postoperatively
- •Aggressive infection control during and after sinus surgery is critical—consider whether conventional lavage protocols are adequate and whether extended antimicrobial prophylaxis is justified
- •Early recognition of neurologic signs (ataxia, altered mentation, seizures) following sinus surgery may allow palliative care planning, as outcomes in this series were uniformly fatal
Key Findings
- •All 5 horses that developed meningitis after paranasal sinus surgery died despite antimicrobial therapy and treatment
- •Four of five horses presented with undulating pyrexia postoperatively despite ongoing antimicrobial therapy
- •Suppurative meningoencephalitis was confirmed via necropsy in all cases
- •Underlying conditions included secondary sinusitis from dental infection (1), sinus cysts (2), and ethmoturbinate masses (2)