1
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Attouchi I, Dammak N, Zouaghi H, Ben Khelifa M. Intracranial Infections Arising From an Odontogenic Infection: A Report of 2 Cases. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241261883. [PMID: 38895741 PMCID: PMC11184996 DOI: 10.1177/11795476241261883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
Introduction Intracranial empyema is a rare but serious and life-threatening infection. It is an accumulation of purulent material in the subdural or extradural space leading to development of subdural empyema or intracranial epidural abscess, respectively. The incidence of morbidity and mortality is high because the diagnosis is often unsuspected. Infections of dental origin could be responsible for such condition. Case reports A 22-year-old female and 30-year-old male patients, both with no significant medical history, presented with subdural empyema and intracranial epidural abscess, respectively, both complicating pan-sinusitis of dental origin. Successful outcomes were achieved with surgical drainage of the lesions, antibiotic therapy, and extraction of affected teeth. Female patient underwent further management for neurological sequelae, while male patient was discharged without neurological complications. Discussion Intracranial suppuration of odontogenic origin is an uncommon but extremely serious complication. The most common dental origins are caries with periapical involvement and periodontitis. Wisdom tooth extraction is the most common preceding dental procedure for this infection. A multidisciplinary approach is essential for the identification and treatment of suspected oral sources. Antibiotic therapy with surgical approach is the gold standard treatment. Conclusion This sequel to odontogenic infection is quite rare, but it can be prevented by a good oral hygiene and removal of abscessed teeth.
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Affiliation(s)
- Ikram Attouchi
- Department of Oral Medicine and Oral Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Nouha Dammak
- Department of Oral Medicine and Oral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Hela Zouaghi
- Department of Oral Medicine and Oral Surgery, Taher Sfar Hospital, Mahdia, Tunisia
| | - Mohamed Ben Khelifa
- Department of Oral Medicine and Oral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
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2
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Ma Z, Liu H, Liu M, Wang Y, Li C, Xu Y. Metagenomic next-generation sequencing identified a brain abscess caused by mixed oral anaerobe infection: A case report. INFECTIOUS MEDICINE 2024; 3:100109. [PMID: 38846345 PMCID: PMC11153914 DOI: 10.1016/j.imj.2024.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/15/2024] [Accepted: 04/03/2024] [Indexed: 06/09/2024]
Abstract
Fusobacterium vincentii brain abscesses are relatively rare. Here, we report our treatment of an anaerobic brain abscess caused by a mixed infection of Parvimonas micra, Streptococcus constellatus, Fusobacterium vincentii, and Bacteroides heparinolyticus diagnosed by metagenomic next-generation sequencing (mNGS). This is the first reported case of Fusobacterium vincentii in a brain abscess. This case highlights the possibility that oral anaerobic microbes can cause a brain abscess and demonstrates that mNGS has the potential to be deployed to provide rapid infection diagnosis and rationalize antimicrobial therapy for brain abscesses.
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Affiliation(s)
- Zepeng Ma
- Department of Microbiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250000, China
| | - Hui Liu
- Jinan Center for Disease Control and Prevention, Jinan 250000, China
| | - Ming Liu
- Jinan Center for Disease Control and Prevention, Jinan 250000, China
| | - Yuhao Wang
- Department of Microbiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250000, China
| | - Chao Li
- Department of Microbiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250000, China
| | - Yifei Xu
- Department of Microbiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250000, China
- Suzhou Research Institute of Shandong University, Suzhou 215000, China
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3
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Yang F, Malavia M, Chali A, Keeler J. Labial Necrotizing Fasciitis Caused by Pelvic Eggerthia catenaformis Infection. Cureus 2024; 16:e53625. [PMID: 38449955 PMCID: PMC10916910 DOI: 10.7759/cureus.53625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
A patient with comorbid diabetes mellitus, obesity, and hypertension acutely presented to the ED due to labial cellulitis with rapidly progressing symptoms of systemic inflammation. Clinical examination revealed fever and groin pain that was tender to palpation. Initial contrast-enhanced CT scans showed labial cellulitis extending to the inguinal canal, with later CT imaging findings of subcutaneous air indicative of necrotizing fasciitis (NF). Antimicrobial therapy was initiated empirically and later tailored to culture antibiogram. The patient underwent acute surgical abscess drainage and tissue debridement but was transferred to the surgical intensive care unit (SICU) due to postoperative blood loss and hypotension. Two additional surgical procedures were needed before sufficient drainage was achieved, and Eggerthia catenaformis (E. catenaformis) was isolated from all samples. Due to the extent of the infection, the patient was admitted for a total of 16 days, with five days spent in the SICU. They recovered completely due to adequate surgery and antimicrobial therapy for a total of 24 days. Here, we present the third reported case of NF due to E. catenaformiswhile emphasizing timely treatment with empiric antibiotics and surgical intervention.
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Affiliation(s)
- Felix Yang
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mira Malavia
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Ashna Chali
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Jared Keeler
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
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4
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Wei J, Zhong F, Sun L, Huang CY. Brain abscess of odontogenic origin: A case report and literature review. Medicine (Baltimore) 2023; 102:e36248. [PMID: 38050225 PMCID: PMC10695514 DOI: 10.1097/md.0000000000036248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The objective of this study is to investigate and understand the characteristics of odontogenic brain abscess. METHODS A case of brain abscess suspected to be caused by odontogenic infection was documented, and a comprehensive analysis and summary of odontogenic brain abscess cases reported in various countries over the past 20 years was conducted. RESULTS Based on the analysis and synthesis of both the present and previous reports, we have examined and consolidated the distinctive features of odontogenic brain abscess, the potential transmission pathway of pathogenic bacteria, diagnostic assertions, verification techniques, and crucial considerations during treatment. CONCLUSION This investigation contributes to an enhanced comprehension and improved clinical identification of odontogenic brain abscess.
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Affiliation(s)
- Jingyi Wei
- Center of Orthodontics, Department of Dentistry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feiyang Zhong
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lei Sun
- Center of Orthodontics, Department of Dentistry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Cheng-Yi Huang
- Center of Orthodontics, Department of Dentistry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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5
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Abed K, Paciorek M, Bursa D. Potential infection foci in the oral cavity and their impact on the formation of central nervous system abscesses: A literature review. Medicine (Baltimore) 2023; 102:e35898. [PMID: 37986318 PMCID: PMC10659677 DOI: 10.1097/md.0000000000035898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 11/22/2023] Open
Abstract
Despite advancements in preventive, diagnostic, and therapeutic activities in medicine, inflammatory processes of the central nervous system remain a significant problem, posing a serious threat to life and health. Purulent central nervous system infections are unique, including abscesses of the brain and spine, which are severe infections occurring in 0.4% to 0.9% of 1000 patients worldwide. Central nervous system abscesses have varying etiology. For example, organized, encapsulated abscesses of the brain are a unique group of inflammatory processes in the central nervous system caused by inflammation around the teeth in 3% to 10% of cases. Sometimes, the condition of patients with brain abscesses is severe and life-threatening. Therefore, detecting and eliminating all causes early, including those potentially resulting from odontogenic infections, is important; accurate and early diagnosis enables appropriate treatment. This paper presents a review of the information available in the literature on brain abscesses and their relationship with odontogenic foci of infection in the oral cavity.
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Affiliation(s)
- Kamil Abed
- Department of Cranio-Maxillofacial and Oral Surgery and Implantology, Infant Jesus Clinical Hospital-University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
| | - Marcin Paciorek
- Department of Adult Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Dominik Bursa
- Department of Adult Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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6
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Huang G, Zhou X, Zhang Z, Lai W, Zhong Q, Wu D, Ye X. Acute Porphyromonas gingivalis Subdural Abscess with Brain Abscess in the Left Temporal Lobe: A Case Report and Review of Literature. Infect Drug Resist 2023; 16:6487-6491. [PMID: 37795204 PMCID: PMC10546930 DOI: 10.2147/idr.s422691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
Background Brain abscesses are a rare but serious complication of focal intracerebral infection. Case Description We present a patient of acute subdural abscess with brain abscess in the left temporal lobe. After craniotomy, combined with the Third Next Generation Sequencing and Gene Diagnosis (TNGS & GD) of abscess, we prescribed sensitive antibiotics; the patient recovers well and the abscess did not recur. Conclusion For patients with acute subdural abscess, combined craniotomy and the TNGS & GD of abscess could achieve good results.
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Affiliation(s)
- Guanlin Huang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China
| | - Xiaoping Zhou
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China
| | - Zhenyu Zhang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China
| | - Wentao Lai
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China
| | - Qi Zhong
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China
| | - Daxing Wu
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China
| | - Xinyun Ye
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China
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7
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Chen KC, Sun JM, Hsieh CT. Brain abscess caused by Parvimonas micra: A rare case report and literature review. Anaerobe 2023; 80:102711. [PMID: 36736989 DOI: 10.1016/j.anaerobe.2023.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
Brain abscesses mostly develop due to direct infection caused by a nearby infectious lesion or hematogenous spread and are rarely caused by an odontogenic infection. We report a 47-year-old woman who presented with high fever, disturbed consciousness, headache, and neck pain. Imaging studies revealed a ring-shaped enhanced mass in the left frontal lobe causing a mass effect and midline shift. Magnetic resonance spectroscopy revealed a peak alanine concentration of 1.5 ppm. Supraorbital keyhole surgery with abscess removal was performed, and a bacterial culture confirmed a diagnosis of Parvimonas micra infection. After undergoing 6-week antibiotic treatment, the patient's symptoms resolved completely. No recurrence of abscess was observed during the follow-up period. Although brain abscess caused by P. micra has rarely been reported, an odontogenic origin should be investigated, especially when a patient has a history of periodontal infection or tooth extraction.
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Affiliation(s)
- Kuan-Chi Chen
- Department of Surgery, Cathay General Hospital, Taipei City, 106, Taiwan.
| | - Jui-Ming Sun
- Section of Neurosurgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan; Department of Biotechnology, Asia University, Taichung City, 41354, Taiwan.
| | - Cheng-Ta Hsieh
- Division of Neurosurgery, Department of Surgery, Sijhih Cathay General Hospital, New Taipei City, 22174, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, 300044, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, 24205, Taiwan.
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8
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Wager SG, Bourdeau NK, Collins JD. Streptococcus constellatus Brain Abscess in a Middle-Aged Man With an Undiagnosed Patent Foramen Ovale. Cureus 2023; 15:e34626. [PMID: 36891022 PMCID: PMC9987340 DOI: 10.7759/cureus.34626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
Brain abscess is a rare diagnosis. Common sources of infection include direct spread from otic sources, sinuses, or oral cavities, and hematogenous spread from distant sources, including the heart and lungs. Brain abscess with cultures growing oral flora species, in rare cases, may develop from bacteria in the oral cavity entering the bloodstream and then traveling to the brain via a patent foramen ovale. This report highlights a case of brain abscess caused by Streptococcus constellatus in a middle-aged man with an undiagnosed patent foramen ovale.
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Affiliation(s)
- Susan G Wager
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Nina K Bourdeau
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
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9
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Zhang Y, Zhu Y, Wan H. Case report:Multiple abscesses caused by Porphyromonas gingivalis diagnosed by metagenomic next-generation sequencing. Front Med (Lausanne) 2023; 9:1089863. [PMID: 36777162 PMCID: PMC9910333 DOI: 10.3389/fmed.2022.1089863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/29/2022] [Indexed: 01/27/2023] Open
Abstract
Background Extraoral infection by Porphyromonas gingivalis (P. gingivalis) is extremely rare and challenging to diagnose because the fastidious pathogen is difficult to culture by traditional methods. We report the first case of a patient with multiple abscesses in muscles and the brain with dura empyema due to P. gingivalis, which was diagnosed by metagenomic next-generation sequencing (mNGS). Case presentation A 65-year-old male patient was admitted to our hospital for multiple lumps in his body. Brain magnetic resonance imaging (MRI) and lower-limb computed tomography (CT) revealed multiple abscesses in the brain and muscles. A diagnosis of P. gingivalis infection was made based on mNGS tests of blood, cerebrospinal fluid (CSF), and pus samples, as the traditional bacterial culture of these samples showed negative results. Target antibiotic therapy with meropenem and metronidazole was administered, and CT-guided percutaneous catheter drainage of abscesses in both thighs was performed. The size of muscle abscesses reduced significantly and neurological function improved. The patient was followed up for 4 months. No abscesses re-appeared, and the remaining abscesses in his backside and both legs were completely absorbed. He can speak fluently and walk around freely without any neurological deficits. Conclusion Metagenomic next-generation sequencing is helpful for early diagnosis and subsequent treatment of P. gingivalis-associated multiple abscesses.
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Affiliation(s)
- Yichen Zhang
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Guangzhou, China
| | - Youfeng Zhu
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Guangzhou, China,Youfeng Zhu,
| | - Huijuan Wan
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,*Correspondence: Huijuan Wan,
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10
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Lannon M, Trivedi A, Martyniuk A, Farrokhyar F, Sharma S. Surgical aspiration versus excision for intraparenchymal abscess: a systematic review and Meta-analysis. Br J Neurosurg 2022; 36:743-749. [PMID: 36062586 DOI: 10.1080/02688697.2022.2118231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Brain abscesses are associated with considerable morbidity and mortality, requiring timely intervention to achieve favourable outcomes. With the advent of high-resolution computed tomography (CT) imaging, mortality following both aspiration and excision of brain abscesses has improved markedly. As a result, there has been a marked shift in neurosurgical practice with aspiration eclipsing excision as the favoured first-line modality for most abscesses. However, this trend lacks sufficient supporting evidence, and this systematic review and meta-analysis seeks to compare aspiration and excision in the treatment of brain abscess. Twenty-seven studies were included in the systematic review, and seven comparative papers in meta-analysis. Aspiration was the chosen technique for 67.5% of patients. Baseline characteristics from the studies included only in the systematic review demonstrated that abscesses treated by aspiration were typically larger and in a deeper location than those excised. In the meta-analysis, we initially found no significant difference in mortality, re-operation rate, or functional outcome between the two treatment modalities. However, sensitivity analysis revealed that excision results in lower re-operation rate. On average, the included studies were of poor quality with average Methodological Index for Non-Randomized Studies (MINORS) scores of 10.3/16 and 14.43/24 for non-comparative and comparative papers respectively. Our study demonstrates that excision may offer improved re-operation rate as compared to aspiration for those abscesses where there is no prior clinical indication for either modality. However, no differences were found with respect to mortality or functional outcome. Evidence from the literature was deemed low quality, emphasizing the need for further investigation in this field, specifically in the form of large, well-controlled, comparative trials.
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Affiliation(s)
- Melissa Lannon
- Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Arunchala Trivedi
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | | | - Forough Farrokhyar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Sunjay Sharma
- Division of Neurosurgery, McMaster University, Hamilton, Canada
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11
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Turnbull N, Cherdsakul P, Chanaboon S, Hughes D, Tudpor K. Tooth Loss, Cognitive Impairment and Fall Risk: A Cross-Sectional Study of Older Adults in Rural Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16015. [PMID: 36498085 PMCID: PMC9735973 DOI: 10.3390/ijerph192316015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Tooth loss is associated with both cognitive impairment and fall risk. However, the relationships between these variables are complex and bidirectional. Observed associations have been reported in separate studies but data on rural-dwelling older adults remain sparse. This cross-sectional study investigated socioeconomic and dental factors affecting cognitive functions, and the association between tooth loss, cognitive functioning, and fall risk. Two hundred and thirty-one rural-dwelling older adults (60−74 years old) were recruited from a single Dental Service Unit. Cognitive function and fall risk were assessed with the Mini-Mental State Examination and the Morse Fall Scale, respectively. Oral examinations were performed by a dentist using the Community Periodontal Index of Treatment Needs form. 38.1%, had >16 tooth loss. Socioeconomic data and health status were obtained from a questionnaire and interviews. Age, Activities of Daily Living (ADL) score, and the number of teeth lost was significantly associated with impaired cognitive function. Chi-square analysis showed that cognitive function was also associated with fall risk. Past research suggests that much cognitive impairment and fall risk is induced by tooth loss. Service planners need to be aware of the complex bidirectional relationships between these variables and give higher priority to dental services that can improve the general health status and social functioning of older rural adults.
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Affiliation(s)
- Niruwan Turnbull
- Faculty of Public Health, Mahasarakham University, Maha Sarakham 44150, Thailand
- Public Health and Environmental Policy in Southeast Asia Research Unit (PHEP-SEA), Mahasarakham University, Maha Sarakham 44150, Thailand
| | | | - Sutin Chanaboon
- Sirindhorn College of Public Health Khon Kaen, Khon Kaen 40000, Thailand
| | - David Hughes
- Faculty of Medicine, Health & Life Science, Swansea University, Swansea SA2 8PP, UK
| | - Kukiat Tudpor
- Faculty of Public Health, Mahasarakham University, Maha Sarakham 44150, Thailand
- Public Health and Environmental Policy in Southeast Asia Research Unit (PHEP-SEA), Mahasarakham University, Maha Sarakham 44150, Thailand
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Abdulrazeq H, Walek K, Sampath S, Shaaya E, Beqiri D, Woo A, Sampath P. Development of posttraumatic frontal brain abscess in association with an orbital roof fracture and odontogenic abscess: A case report. Surg Neurol Int 2022; 13:539. [DOI: 10.25259/sni_813_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background:
Brain abscess is a potentially fatal condition. Orbital fractures caused by penetrating injury may be associated with intracranial infection. Such complication associated with blunt trauma, orbital roof fractures, and odontogenic abscesses is exceedingly rare.
Case Description:
We report the case of a 40-year-old transgender female with a frontal abscess presenting several weeks following a motor vehicle crash from which she suffered multiple facial fractures and an odontogenic abscess. On computed tomography scan, the patient had multiple right-sided facial fractures, including a medial orbital wall fracture and a right sphenoid fracture extending into the superior orbital roof. There was hemorrhage notable in the right frontal lobe. Communication with the ethmoid sinuses likely provided a conduit for bacterial spread through the orbit and into the intracranial and subdural spaces.
Conclusion:
Skull base fractures that communicate with a sinus, whether it be frontal, ethmoid, or sphenoid may increase the risk of brain abscess, especially in patients who develop an odontogenic abscess. Surgical repair of the defect is essential, and treating patients prophylactically with antibiotics may be beneficial.
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Affiliation(s)
- Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, The Alpert Warren Medical School of Brown University Providence, United States
| | - Konrad Walek
- Department of Neurosurgery, Rhode Island Hospital, The Alpert Warren Medical School of Brown University Providence, United States
| | - Shailen Sampath
- Department of Neurosurgery, Rhode Island Hospital, The Alpert Warren Medical School of Brown University Providence, United States
| | - Elias Shaaya
- Department of Neurosurgery, Rhode Island Hospital, The Alpert Warren Medical School of Brown University Providence, United States
| | - Dardan Beqiri
- Department of Plastic Surgery, Rhode Island Hospital, The Alpert Warren Medical School of Brown University Providence, United States
| | - Albert Woo
- Department of Plastic Surgery, Rhode Island Hospital, The Alpert Warren Medical School of Brown University Providence, United States
| | - Prakash Sampath
- Department of Neurosurgery, Rhode Island Hospital, The Alpert Warren Medical School of Brown University Providence, United States
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13
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Burgos-Larraín LF, Vázquez-Portela Á, Cobo-Vázquez CM, Sáez-Alcaide LM, Sánchez-Labrador L, Meniz-García C. Brain complications from odontogenic infections: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e794-e800. [PMID: 35908649 DOI: 10.1016/j.jormas.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Odontogenic infections can spread through different routes to more remote anatomical areas, such as the brain. Brain abscesses have an incidence of 0.3-1.3 / 100,000 population and only 2-5% are of dental origin. The main objective is to research brain complications derived from odontogenic infections. Secondary objectives were to identify the most common symptoms in brain abscess, to describe the microbiology involved in these infectious processes, report which parts of the brain complex are most commonly affected and report the sequelae of this patients. METHODS A systematic review following the PRISMA Guide and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports was carried out in PubMed, Scopus and Web of Science. The search terms were: Brain infection, brain abscess, oral health oral origin, odont* infect*. RESULTS The database search identified a total of 1000 articles. A total of 18 publications were identified after applying inclusion and exclusion criteria. A total of 38 patients were analyzed. Mean age was 49.64±18.80 years. CONCLUSION The most common symptoms of patients with brain abscess are neurological affectations first and then fever and headache second, without necessarily presenting as a symptomatological triad. Microbiological diagnosis is key to determining the origin of the infection. Anaerobic pathogens such as Streptococcus (F. Milleri), Fusobacterium Nucleatum and Porfiromonas Gingivalis families are common bacterial agents. The frontal lobe is the most frequently affected, followed by the parietal and temporal lobe. The most frequent brain complications are neurological disorders. However, most patients with brain abscesses recover without sequelae.
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Affiliation(s)
- Luis Felipe Burgos-Larraín
- Department of Clinical Specialities, Faculty of Dentistry, Complutense University of Madrid, Spain; Concepción University, Chil
| | - Álvaro Vázquez-Portela
- Department of Clinical Specialities, Faculty of Dentistry, Complutense University of Madrid, Spain; San Pablo-CEU University, Madrid, Spain
| | - Carlos M Cobo-Vázquez
- Department of Clinical Specialities, Faculty of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal, 3, Madrid 28040, Spain; Department of Dentistry and Stomatology, Gregorio Marañón University General Hospital, Madrid, Spain.
| | - Luis Miguel Sáez-Alcaide
- Department of Dentistry and Stomatology, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Luis Sánchez-Labrador
- Department of Dentistry and Stomatology, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Cristina Meniz-García
- Department of Clinical Specialities, Faculty of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal, 3, Madrid 28040, Spain
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14
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Chen M, Lai Z, Cheng M, Liang T, Lin Z. Rare brain and pulmonary abscesses caused by oral pathogens started with acute gastroenteritis diagnosed by metagenome next-generation sequencing: A case report and literature review. Front Cell Infect Microbiol 2022; 12:949840. [PMID: 36250052 PMCID: PMC9561126 DOI: 10.3389/fcimb.2022.949840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Odontogenic brain and pulmonary abscesses are extremely rare infectious diseases. It is mainly caused by the upward or downward transmission of local infection or blood-borne spread. In recent years, with the wide application of some novel testing methods in clinical practice, the diagnosis of unexplained infections such as odontogenic abscesses in different organs has gradually become clear. We report a case of a 21-year-old male who was healthy and had not received any oral treatment before onset. He started with acute gastroenteritis-related symptoms, then developed meningitis-related symptoms seven days later with septic shock. No obvious abscess lesions were found on head computed tomography (CT) at admission, and the etiology was not clear by routine examination, which was very easy to misdiagnose as a serious infection caused by intestinal pathogens. But odontogenic pathogens were found both in his blood and cerebrospinal fluid through metagenomic next-generation sequencing (mNGS) analysis. Subsequently, rechecked imaging examination displayed multiple brain and pulmonary abscesses. Finally, it was diagnosed as an odontogenic brain and pulmonary abscess. After an extremely lengthy anti-infection course (13 weeks of intravenous antibiotics plus 2 weeks of oral antibiotics) and surgery, the patient was improved and discharged from the hospital. From this case, we could see that the development of new diagnostic technologies such as mNGS plays an important role in the early and confirmed diagnosis of diseases previously difficult to diagnose such as odontogenic polymicrobial infections and ultimately helps to improve the prognosis of these patients.
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Affiliation(s)
- Minhua Chen
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Zhiyi Lai
- Intensive Care Unit, Ningbo Fourth Hospital (The Affiliated Xiangshan Hospital of Wenzhou Medical University), Ningbo, China
| | - Mingjun Cheng
- Intensive Care Unit, Chun’an First People’s Hospital (Chun’an Branch of Zhejiang Provincial People’s Hospital and Chun’an Hospital Affiliated to Hangzhou Medical College), Hangzhou, China
| | - Tianyu Liang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Zongbin Lin, ; Tianyu Liang,
| | - Zongbin Lin
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Zongbin Lin, ; Tianyu Liang,
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Amorim RP, Henriques VM, Junior FT, Reis VG, Bulhões SO. Hydrocephalus and Intracranial Hypertension by an Odontogenic Brain Abscess. Cureus 2022; 14:e26945. [PMID: 35989854 PMCID: PMC9380847 DOI: 10.7759/cureus.26945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/08/2022] Open
Abstract
Brain abscesses are rare and severe infections with high mortality, corresponding to neurosurgical emergencies. 12% of all abscesses are caused by odontogenic etiologies, either an infectious process or a dental procedure. This paper describes a case of a patient who underwent tooth extraction, presenting days later with hydrocephalus and intracranial hypertension due to a brain abscess, whose isolated pathogen is the same identified in the oral cavity.
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Achuthanandan S, Dhaliwal A, Lu T, Sharma K. Brain Abscess Due to Lactobacillus Fermentum in an Uncontrolled Diabetic. Cureus 2022; 14:e26360. [PMID: 35775062 PMCID: PMC9239287 DOI: 10.7759/cureus.26360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
Brain abscesses are collections of infectious fluid within the brain parenchyma, with mortality ranging from 15% to 31%. They can result from direct inoculation or via hematogenous spread. Streptococcus and staphylococcus species and Gram-negative bacilli are common bacteria responsible for brain abscesses. In immunocompromised patients, such as those with organ transplants or HIV, brain abscesses can be caused by fungi, mycobacteria, or parasites. Lactobacillus is a very rare cause of brain abscess and has only been observed in a few case reports. We report a case of a woman with uncontrolled diabetes who presented with altered mental status and was found to have a brain abscess secondary to Lactobacillus fermentum.
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Salle L, Usseglio J, Salle H. A not so insignificant appointment at the dentist. ENDOCRINOL DIAB NUTR 2022; 69:379-381. [PMID: 35697469 DOI: 10.1016/j.endien.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/27/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Laurence Salle
- Department of Endocrinology, Diabetology and Nutrition, University Hospital of Limoges, 2, Avenue Martin Luther King, 87042 Limoges, France.
| | - Julie Usseglio
- Department of Maxillo-Facial Surgery, University Hospital of Limoges, 2, Avenue Martin Luther King, 87042 Limoges, France
| | - Henri Salle
- Department of Neurosurgery, University Hospital of Limoges, 2, Avenue Martin Luther King, 87042 Limoges, France
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Andersen C, Bergholt B, Ridderberg W, Nørskov-Lauritsen N. Culture on Selective Media and Amplicon-Based Sequencing of 16S rRNA from Spontaneous Brain Abscess-the View from the Diagnostic Laboratory. Microbiol Spectr 2022; 10:e0240721. [PMID: 35404098 PMCID: PMC9045185 DOI: 10.1128/spectrum.02407-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 11/20/2022] Open
Abstract
Forty-one stored samples from cases of spontaneous brain abscess were investigated to gain insight into the natural history, causative agents, and relevant laboratory diagnostics of a rare infection. Samples from a larger collection were selected based on retrospective analysis of patient records. All samples were subjected to amplicon sequencing of 16S rRNA gene fragments. Supplementary culture on selected media was performed as suggested by bioinformatics analysis. For three cases, no microorganism was disclosed, while Toxoplasma gondii, Aspergillus fumigatus, and various bacteria were the cause of 1, 2, and 35 cases, respectively. Bacterial infections were monomicrobial in 20 cases and polymicrobial in 15; the microorganisms of the latter cases were restricted to residents of cavum oris. Amplicon sequencing did not further enhance the importance of the Streptococcus anginosus group, which was involved in 17 cases, and the single primer set used may be suboptimal for amplification of Actinomyces and Nocardia. But, amplicon-based sequencing unquestionably expanded the number of polybacterial infections, with focus on the Fusobacterium nucleatum group, Parvimonas, and Porphyromonas. Culture on selective media confirmed the presence of F. nucleatum group bacteria, which attained a prominence in spontaneous brain abscess similar to the S. anginosus group. Metagenomics is a powerful tool to disclose the spectrum of agents in polymicrobial infections, but a reliable cutoff value for substantial detection is complex. Commercial media for isolation of F. nucleatum group bacteria from mixed infections are available, and these pathogens should be carefully characterized. Isolation of Parvimonas and Porphyromonas in polymicrobial infections has not been resolved. IMPORTANCE Polymicrobial brain abscess is a challenge to the clinical microbiology laboratory due to the aggregative nature of the dental and oral microbiota. Because polymicrobial infections may escape detection by conventional culture methods, directed therapy toward a single detected bacterium is problematic. Amplicon-based sequencing provides important clues to these infections, but only cultured microorganisms can be fully characterized, subjected to antimicrobial susceptibility testing, and formally named. By use of specific selective culture plates, we successfully isolated bacteria of the Fusobacterium nucleatum group, and these bacteria rose to the same prominence as the widely recognized pathogen, the Streptococcus anginosus group. Named and unnamed members of the Fusobacterium nucleatum group must be further investigated to gain insight into a rare but grave disease.
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Affiliation(s)
- Camilla Andersen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Bergholt
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Winnie Ridderberg
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
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Blunsum A, Treharne C, Tikka T, Iyer A, Tsarfati EM. Sinogenic polymicrobial anaerobic orbital cellulitis: the importance of source control and broad empirical antibiotics. BMJ Case Rep 2022; 15:e248473. [PMID: 35351758 PMCID: PMC8966534 DOI: 10.1136/bcr-2021-248473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/03/2022] Open
Abstract
A man in his twenties with a history of recurrent sinusitis was urgently referred to the emergency department (ED) by an out-of-hours general practitioner following a 2-day history of increasing right eye pain, redness and swelling after a week of coryzal symptoms. He denied visual impairment and any history of recent dental pain or procedures. Initial assessment in ED noted fever, tachycardia and hypotension. Video consultation with ophthalmologist in the ED identified proptosis, periorbital erythema and chemosis with full eye movement solely affecting the right eye. Visual acuity of 6/6 was confirmed in both eyes. After review by the ear, nose and throat (ENT) team, a diagnosis of sinogenic right orbital cellulitis was made, empirical antibiotics started and care transferred to the ENT team for immediate surgical intervention. 48 hours postoperatively, the patient acutely deteriorated, developing ophthalmoplegia and visual acuity of 6/95 in the right eye. Repeat imaging demonstrated a deteriorating picture and urgent surgery was organised at a neighbouring hospital's specialist ENT unit combined with a change to his antibiotics. On day 4, 1 day following transfer, an anaerobic bacterium, Eggerthia catenaformis, was isolated from blood cultures collected on admission. The patient improved clinically following the second surgery and targeted antimicrobial therapy, eventually being discharged 10 days after initial presentation. In addition to E. catenaformis, the Anaerobic Reference Unit (Cardiff) identified two further anaerobic bacteria, Parvimonas micra and Dialister pneumosintes This paper presents the first documented case of polymicrobial anaerobic orbital cellulitis secondary to acute bacterial sinusitis. Moreover, this case underpins the importance of broad empirical antibiotics coupled with surgical source control to effectively manage a rare but sight-threatening and life-threatening disease.
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Affiliation(s)
- Andrew Blunsum
- Infectious Diseases & General Internal Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Clare Treharne
- Department of Ear, Nose and Throat, NHS Lanarkshire, Airdrie, UK
| | - Theofano Tikka
- Department of Otolaryngology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Arunachalam Iyer
- Department of Ear, Nose and Throat, NHS Lanarkshire, Airdrie, UK
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Wisutep P, Kamolvit W, Chongtrakool P, Jitmuang A. Brain abscess mimicking acute stroke syndrome caused by dual Filifactor alocis and Porphyromonas gingivalis infections: A case report. Anaerobe 2022; 75:102535. [DOI: 10.1016/j.anaerobe.2022.102535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
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21
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Karst FW, Brandsma DS, Ilyas N, Kabban M, Fan K. Dento-facial infections in children - A potential red flag for child neglect? Surgeon 2022; 20:373-377. [DOI: 10.1016/j.surge.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
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22
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Sreckovic S, Kadija M, Ladjevic N, Starcevic B, Stijak L, Milovanovic D. The first case of septic arthritis of the knee caused by Eggerthia catenaformis. Anaerobe 2021; 73:102503. [PMID: 34954061 DOI: 10.1016/j.anaerobe.2021.102503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022]
Abstract
Eggerthia catenaformis has been reported as a human pathogen. We present the first case of the primary knee infection caused by Eggerthia catenaformis in a 23-year-old male patient with a knee infection, after primary anterior cruciate ligament reconstruction. Eggerthia catenaformis was confirmed by MALDI-TOF mass spectrometry from synovial fluid. The dental focus was excluded. The isolated bacterial strain showed sensitivity to all of the tested antimicrobials. However, for successful management of knee infection, besides culture-directed antibiotics therapy, arthroscopic debridement and lavage were necessary.
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Affiliation(s)
- Svetlana Sreckovic
- Centre of Anesthesia and Resuscitation, University Clinical Center of Serbia, Belgrade, Serbia; Clinic for Orthopedics Surgery and Traumatology, University Clinical Center of Serbia, Belgrade, Serbia; Medical School, University of Belgrade, Belgrade, Serbia.
| | - Marko Kadija
- Clinic for Orthopedics Surgery and Traumatology, University Clinical Center of Serbia, Belgrade, Serbia; Medical School, University of Belgrade, Belgrade, Serbia
| | - Nebojsa Ladjevic
- Centre of Anesthesia and Resuscitation, University Clinical Center of Serbia, Belgrade, Serbia; Medical School, University of Belgrade, Belgrade, Serbia
| | - Branislav Starcevic
- Clinic for Orthopedics Surgery and Traumatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lazar Stijak
- Medical School, University of Belgrade, Belgrade, Serbia
| | - Darko Milovanovic
- Clinic for Orthopedics Surgery and Traumatology, University Clinical Center of Serbia, Belgrade, Serbia; Medical School, University of Belgrade, Belgrade, Serbia
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Gambin DJ, Vitali FC, De Carli JP, Mazzon RR, Gomes BPFA, Duque TM, Trentin MS. Prevalence of red and orange microbial complexes in endodontic-periodontal lesions: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:6533-6546. [PMID: 34495401 DOI: 10.1007/s00784-021-04164-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/24/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This systematic review assesses the prevalence of microbial complexes in endodontic-periodontal lesion. MATERIALS AND METHODS Nine databases were searched through August 2020. Experts were consulted to indicate additional studies. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies that evaluated the prevalence of microbial orange and red complexes among patients with endodontic-periodontal lesion were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. RESULTS From 572 articles found on all databases, 11 clinical studies were finally included. The following microorganisms were investigated: P. gingivalis, T. forsythia, T. denticola, F. nucleatum, F. periodonticum, P. micra, P. intermedia, P. nigrescens, S. constellatus, C. gracilis, C. rectus, C. showae and E. nodatum. Considering the orange complex, P. micra, E. nodatum and S. constellatus were prevalent in both root canal and periodontal pockets. P. gingivalis and T. forsythia belonging to the red complex were prevalent only in periodontal pockets. The red complex microorganisms were not found very frequently in root canal. CONCLUSIONS There is a similarity between the microbiome of root canal and periodontal pockets, with prevalence of the three microorganisms of the orange complex. Two microorganisms from the red complex were prevalent only in periodontal pockets. CLINICAL RELEVANCE The prevalence of specific microorganisms in endodontic-periodontal lesion is important to understand the microbiological profile of the patients involved and to correlate it with possible clinical and repair conditions of this pathology.
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Affiliation(s)
- Diego José Gambin
- Post-Graduate Program in Dentistry, Faculty of Dentistry, University of Passo Fundo, Av. Brasil Leste, São José, Passo Fundo, RS, 28599052-900, Brazil
| | - Filipe Colombo Vitali
- Department of Dentistry, Post-Graduate Program in Dentistry, Federal University of Santa Catarina (UFSC), Av. Delfino Conti, s/n-Trindade, Florianópolis, SC, 88040-900, Brazil
| | - João Paulo De Carli
- Department of Oral Medicine and Prosthodontics, University of Passo Fundo, Av. Brasil Leste, São José, Passo Fundo, RS, 28599052-900, Brazil
| | - Ricardo Ruiz Mazzon
- Department of Microbiology, Immunology and Parasitology, Federal University of Santa Catarina (UFSC), Av. Delfino Conti, s/n-Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas-UNICAMP, Av. LimeiraPiracicaba, AreiãoSP, 90113414-903, Brazil
| | - Thais Mageste Duque
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Av. Delfino Conti, s/n-Trindade, Florianópolis, SC, 88040-900, Brazil.
| | - Micheline Sandini Trentin
- Department of Periodontics, Faculty of Dentistry, University of Passo Fundo, Av. Brasil Leste, São José, Passo Fundo, RS, 28599052-900, Brazil
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Odontogenic Brain Abscess With Campylobacter gracilis and Fusobacterium nucleatum Complicated by Rupture Into the Ventricle. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Ravikumar R, John DV. Brain Abscess in the Current Decade (2010–2019) in India—A Review. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1725230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractBrain abscess outcomes have improved in recent years due to advancements in cranial imaging, microbiological techniques, minimally invasive neurosurgical procedures, and effective antibiotic treatments. However, the incidence of brain abscess remains unchanged in developing countries. We searched PubMed and Google Scholar for references using the key words “brain abscess” and “India” and reviewed both retrospective and prospective studies published in peer-reviewed journals in the current decade to understand the present status. The review shows that the patients’ ages, the predominance of male patients, the symptoms and locations of brain abscesses, and the types of bacteria associated with them have remained unchanged over the past decade. The most common predisposing condition in recent years has been chronic suppurative otitis media with a mortality rate of 7 to 10%. Middle ear infection is often neglected and not treated aggressively in Asian countries. It requires multidisciplinary treatment strategies to address the primary source of infection and better health awareness to prevent the development of brain abscess.
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Affiliation(s)
- R. Ravikumar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Daisy Vanitha John
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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26
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Chaovarin C, Polpong P, Sungkhachat O. Fusobacterium nucleatum and brain abscess: Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Salle L, Usseglio J, Salle H. A not so insignificant appointment at the dentist. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00117-8. [PMID: 34045155 DOI: 10.1016/j.endinu.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Laurence Salle
- Department of Endocrinology, Diabetology and Nutrition, University Hospital of Limoges, 2, Avenue Martin Luther King, 87042 Limoges, France.
| | - Julie Usseglio
- Department of Maxillo-Facial Surgery, University Hospital of Limoges, 2, Avenue Martin Luther King, 87042 Limoges, France
| | - Henri Salle
- Department of Neurosurgery, University Hospital of Limoges, 2, Avenue Martin Luther King, 87042 Limoges, France
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28
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Feng Z, Liu X, Lian M, Zhang L. Diagnostic, monitoring, and prognostic value of combined detection of lactate dehydrogenase, β2-transferrin, and interleukin-10 for acute intracranial infections. Am J Transl Res 2021; 13:2581-2589. [PMID: 34017417 PMCID: PMC8129277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the value of the combined detection of lactate dehydrogenase (LDH), β2-transferrin (β-2Tf), and interleukin-10 (IL-10) for identification of acute intracranial infections such as meningitis. METHODS A total of 103 patients were placed in the suppurative meningitis group (SMG), 124 patients in the viral meningitis group (VMG). Another 86 patients without any infectious diseases of the central nervous system constituted the control group (CG). The levels of LDH and β-2Tf in the cerebrospinal fluid were determined by enzymatic methods; IL-10 expression was measured by ELISA. The correlation between infection and the LDH, β-2Tf, and IL-10 levels was analyzed by linear correlation analysis, and ROC curve analysis was applied to determine the diagnostic value of combined detection of LDH, β-2Tf, and IL-10 levels for intracranial infections. RESULTS LDH, β-2Tf, and IL-10 levels negatively correlated with the treatment time in both the SMG (r = -0.52, -0.97, and -0.24, respectively, P < 0.01) and VMG (r = -0.70, -0.91, and -0.25, respectively, P < 0.01). Sensitivity and specificity of combined detection of LDH, β-2Tf, and IL-10 for the diagnosis of SM was 80.47% and 75.33%, respectively, while those for VM were 84.24% and 79.24%, respectively. CONCLUSION Combined detection is an excellent indicator for the diagnosis and treatment of intracranial infections.
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Affiliation(s)
- Zhong Feng
- Department of Neurology, The First People's Hospital of Wenling Wenling 317500, Zhejiang, China
| | - Xuan Liu
- Department of Neurology, The First People's Hospital of Wenling Wenling 317500, Zhejiang, China
| | - Mengjia Lian
- Department of Neurology, The First People's Hospital of Wenling Wenling 317500, Zhejiang, China
| | - Li Zhang
- Department of Neurology, The First People's Hospital of Wenling Wenling 317500, Zhejiang, China
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Sakkas A, Nolte I, Heil S, Mayer B, Kargus S, Mischkowski RA, Thiele OC. Eggerthia catenaformis infection originating from a dental abscess causes severe intestinal complications and osteomyelitis of the jaw. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2021; 10:Doc02. [PMID: 33928005 PMCID: PMC8051610 DOI: 10.3205/iprs000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Odontogenic foci may result to generalized infections spreading the bacteria through contiguous anatomic cavities or hematogenous spread. The most reported secondary infections caused by oral pathogens are intracranial abscesses. Although, few reports in the literature describe the bacterial spread to extracranial locations. Case description: We describe the case of a 52-year-old male Caucasian patient who was admitted to our hospital suffering from severe sepsis caused by a submandibular abscess. Eggerthia catenaformis was detected in blood and abscess material (confirmed by MALDI-TOF mass spectrometry). The patient subsequently developed a perihepatic abscess and colon perforation, and was stabilized after several surgical interventions. He remained hospitalized for 66 days receiving intravenous antibiotics. Five months later, jaw osteonecrosis with Actinomyces contamination was detected in the left mandible, which also had to be treated surgically. Three years after the last surgery, no signs of recurrence have been detected. Discussion: Oral and maxillofacial surgeons should understand the characteristics of systemic infections, in which the potentially causal intraoral odontogenic foci often lack acute symptoms. If other origins of infection are not detected, elimination of the potentially causal odontogenic foci should be performed. However, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated through more studies.
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Affiliation(s)
- Andreas Sakkas
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Isabel Nolte
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Sebastian Heil
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Boris Mayer
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Steffen Kargus
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Robert A Mischkowski
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Oliver C Thiele
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany
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Multiple Brain Abscesses of Odontogenic Origin. May Oral Microbiota Affect Their Development? A Review of the Current Literature. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the last few years, the role of oral microbiota in the setting of oral diseases such as caries, periodontal disease, oral cancer and systemic infections, including rheumatoid arthritis, cardiovascular disease and brain abscess (BA), has attracted the attention of physicians and researchers. Approximately 5–7% of all BAs have an odontogenic origin, representing an important pathological systemic condition with a high morbidity and mortality. A systematic search of two databases (Pubmed and Ovid EMBASE) was performed for studies published up to 5 January 2021, reporting multiple BAs attributed to an odontogenic origin. According to PRISMA guidelines, we included a total of 16 papers reporting multiple BAs due to odontogenic infections. The aim of this review is to investigate the treatment modality and the clinical outcome of patients with multiple BAs due to odontogenic infections, as well as to identify the most common pathogens involved in this pathological status and their role, in the oral microbiota, in the onset of oral infections. A multidisciplinary approach is essential in the management of multiple BAs. Further studies are required to understand better the role of microbiota in the development of multiple BAs.
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31
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Krarup JF, Nielsen HL, Danstrup CS. Severe deep neck space infection caused by Eggerthia catenaformis. BMJ Case Rep 2021; 14:14/4/e241384. [PMID: 33811097 PMCID: PMC8023740 DOI: 10.1136/bcr-2020-241384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A 64-year-old woman was acutely referred to the Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital due to rapidly progressing neck swelling, fever and dysphagia. Clinical examination revealed submental swelling, trismus and laryngeal inflammation. A contrast-enhanced CT scan showed infection in the deep neck spaces with multiple abscesses. The patient underwent acute surgery and antimicrobial therapy was initiated and she was transferred to an intensive care unit. Three additional surgical procedures were needed before sufficient drainage was achieved. There was growth of different oral commensals from four separate pus aspirates, while Eggerthia catenaformis was cultured in all samples. Due to the extent of the infection, the patient stayed in the intensive care unit for 16 days, but recovered completely due to adequate surgery and antimicrobial therapy for 4 weeks. Here we present the third reported case of a severe deep neck space infection with multiple abscesses due to E. catenaformis.
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Affiliation(s)
- Jens Fabricius Krarup
- Otorhinolaryngology - Head and Neck Surgery, Aalborg Universitetshospital, Aalborg, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg Universitetshospital, Aalborg, Denmark .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Sander Danstrup
- Otorhinolaryngology - Head and Neck Surgery, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ribeiro BNDF, Marchiori E. Porphyromonas gingivalis as an uncommon cause of intracranial abscesses. Rev Soc Bras Med Trop 2021; 54:S0037-86822021000100810. [PMID: 33681914 PMCID: PMC8008890 DOI: 10.1590/0037-8682-0370-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Bruno Niemeyer de Freitas Ribeiro
- Instituto Estadual do Cérebro Paulo Niemeyer, Departamento de Radiologia, Rio de Janeiro, RJ, Brasil.,Labs A+/Grupo Fleury, Rio de Janeiro, RJ, Brasil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro, Departamento de Radiologia, Rio de Janeiro, RJ, Brasil
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33
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Chen KP, Lee YP, Hwang MJ, Chiang CP. Fusobacterium nucleatum-caused brain abscess - Case report. J Dent Sci 2021; 16:776-777. [PMID: 33854732 PMCID: PMC8025227 DOI: 10.1016/j.jds.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Kuan-Pin Chen
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yi-Pang Lee
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ming-Jay Hwang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Pin Chiang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
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Bactericidal activity of a substituted thiazole against multidrug-resistant Eggerthia catenaformis isolated from patients with dental abscess. Anaerobe 2021; 69:102328. [PMID: 33524547 DOI: 10.1016/j.anaerobe.2021.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 11/20/2022]
Abstract
Human infections caused by the anaerobic bacterium Eggerthia catenaformis are rare. However, a growing number of case reports have presented the bacterium as the causative agent in many serious complications. This study provides data on the isolation and antibiotic susceptibility profiles of E. catenaformis from dental abscess. Identification of isolates was performed using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). We also investigated the antibacterial activity of 5-acetyl-4-methyl-2-(3-pyridyl) thiazole (AMPT) on E. catenaformis isolates. Minimum inhibitory concentrations (MICs) were determined by an agar dilution method and bactericidal activity was evaluated by a time-kill assay. Moreover, the mechanism of action of AMPT was also explored by cell membrane disruption assay and scanning electron microscopy (SEM). MALDI-TOF MS results revealed unambiguous identification of all isolates with score values between 2.120 and 2.501. Isolates NY4 and NY9 (20% of isolates) were found resistant to multiple antibiotics judged by MIC values. As multidrug-resistant strains of E. catenaformis were not reported to date, we then confirmed the identity of NY4 and NY9 based on 16S rRNA gene sequence. Favorably, all isolates were susceptible to AMPT with an MIC range of 0.25-1 mg/L. Time-kill kinetics of AMPT indicated that it exhibited potent bactericidal activity against the multidrug-resistant isolates NY4 and NY9. Furthermore, this study also hypothesizes that AMPT exerts its antibacterial effect through damaging the cell membrane and thereby induce the release of intracellular components. AMPT could therefore be considered as a therapeutic option for infections caused by multidrug-resistant bacteria.
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Karampatakis T, Papavasiliou A, Dimitris Tatsis, Paraskevopoulos K, Katsifa H. A rare case of polymicrobial chronic maxillary sinusitis due to concurrent isolation of Parvimonas micra and Fusobacterium nucleatum. Anaerobe 2020; 66:102284. [DOI: 10.1016/j.anaerobe.2020.102284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022]
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36
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Franceschi D, Giuliani V, Giuntini V, Pini Prato G. Brain abscess and periodontal pathogens ( Fusobacterium Nucleatum). Report of a case. Clin Case Rep 2020; 8:2488-2493. [PMID: 33363764 PMCID: PMC7752455 DOI: 10.1002/ccr3.3173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/30/2020] [Accepted: 07/05/2020] [Indexed: 11/05/2022] Open
Abstract
Patients who develop brain abscesses must be evaluated through a complete set of diagnostic tests including a microbiological and clinical periodontal assessment. A genetic comparison of the pathogens from intracranial/extracranial sites is necessary.
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Affiliation(s)
- Debora Franceschi
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Valentina Giuliani
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Veronica Giuntini
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
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The use of host defense peptides in root canal therapy in rats. Clin Oral Investig 2020; 25:3623-3632. [PMID: 33200281 DOI: 10.1007/s00784-020-03684-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES In order to evaluate host defense peptides (HDPs) HHC-10 and synoeca-MP activity in in vitro osteoclastogenesis process and in vivo induced apical periodontitis, testing the effect of molecules in the inflammatory response and in apical periodontitis size/volume after root canal treatment. MATERIALS AND METHODS In vitro osteoclastogenesis was assessed on bone marrow cell cultures extracted from mice, while in vivo endodontic treatment involved rats treated with Ca(OH)2 or HDPs. In vitro osteoclasts were subjected to TRAP staining, and in vivo samples were evaluated by radiographic and tomographic exams, as well as histologic analysis. RESULTS None of the substances downregulated the in vitro osteoclastogenesis. Nevertheless, all treatments affected the average of apical periodontitis size in rats, although only teeth treated with HDPs demonstrated lower levels of the inflammatory process. These results demonstrated the in vivo potential of HDPs. Radiographic analysis suggested that HHC-10 and synoeca-MP-treated animals presented a similar lesion size than Ca(OH)2-treated animals after 7-day of endodontic treatment. However, tomography analysis demonstrated smaller lesion volume in synoeca-MP-treated animals than HHC-10 and Ca(OH)2-treated animals, after 7 days. CONCLUSIONS These molecules demonstrated an auxiliary effect in endodontic treatment that might be related to its immunomodulatory ability, broad-spectrum antimicrobial activity, and possible induction of tissue repair at low concentrations. These results can encourage further investigations on the specific mechanisms of action in animal models to clarify the commercial applicability of these biomolecules for endodontic treatment. CLINICAL SIGNIFICANCE HDPs have the potential to be adjuvant substances in endodontic therapy due to its potential to reduce inflammation in apical periodontitis.
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Skull Base Sphenoid Bone: A Potential Route of Brain Abscesses Induced by Odontogenic Infection. J Craniofac Surg 2020; 32:e32-e34. [PMID: 32868724 DOI: 10.1097/scs.0000000000006861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Odontogenic foci are rarely linked with brain abscesses. The lack of an effective approach to match the causative origin with the infection can lead to late medical response of patients. Here we present a case of a 53-year-old man with brain abscesses that was probably caused by odontogenic foci. The imaging examinations clearly showed the periodontitis of mandibular left second molar and the destruction of greater sphenoid wing. Therefore, possible routes of extension through masticator space abscesses were indicated. For early infection of the maxillofacial space caused by potential odontogenic lesions, oral surgeons should eliminate the potentially odontogenic foci and use computerized tomography imaging to determine the existence of bone destruction around the oral cavity such as the skull to prevent further bone defect complications such as brain abscesses.
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Prieto R, Callejas-Díaz A, Hassan R, de Vargas AP, López-Pájaro LF. Parvimonas micra: A potential causative pathogen to consider when diagnosing odontogenic brain abscesses. Surg Neurol Int 2020; 11:140. [PMID: 32547827 PMCID: PMC7294173 DOI: 10.25259/sni_20_2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Brain abscess is a life-threatening entity which requires prompt and long-term antibiotic therapy, generally associated with surgical drainage, and eradicating the primary source of infection. Parvimonas micra (Pm) has only been reported once before as the lone infecting organism of an orally originated, solitary brain abscess. Diagnosing brain abscesses caused by this Gram-positive anaerobic coccus, constituent of the oral cavity flora, is challenging, and an optimal treatment regimen has not been well established. We report the diagnosis and successful treatment of a Pm caused odontogenic brain abscess. Case Description: A 62-year-old immunocompetent male with a right-parietal brain abscess presented with headache and seizures. He was started on empirical antibiotic therapy and subsequently underwent surgical drainage. The only source of infection found was severe periodontitis with infected mandibular cysts. Thus, tooth extraction and cyst curettage were performed 1 week after brain surgery. Cultures of brain abscess fluid were negative, but amplification of bacterial 16S ribosomal RNA (rRNA) with polymerase chain reaction demonstrated Pm. After 3 weeks of intravenous ceftriaxone and metronidazole, the patient was switched to oral metronidazole and moxifloxacin for 6 weeks. Conclusions: This case highlights the potential risk of untreated dental infections causing brain abscesses. Pm should be considered as a possible pathogen of odontogenic brain abscesses despite its presence usually not being detected by standard bacterial cultures. Therefore, 16S rRNA gene sequencing analysis is strongly recommended for bacterial identification before defining brain abscesses as cryptogenic.
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Affiliation(s)
- Ruth Prieto
- Departments of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Rasha Hassan
- Departments of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
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Hsu G, Zhang J, Selvi F, Shady N, August M. Do brain abscesses have a higher incidence of odontogenic origin than previously thought? Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:10-17. [PMID: 32362575 DOI: 10.1016/j.oooo.2020.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/15/2019] [Accepted: 01/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to answer the following clinical question: "In patients admitted to a tertiary care hospital with a diagnosis of brain abscess, how common is odontogenic etiology?" STUDY DESIGN We designed a retrospective study of patients with brain abscesses diagnosed at the Massachusetts General Hospital between 1980 and 2017. Inclusion criteria were complete medical records outlining clinical course, relevant dental history, and radiographic and microbiologic data. RESULTS Of 167 intracranial abscesses, 88 (52.7%) originated from a head/neck source, and 12 (13.6%) were of odontogenic etiology. Dental radiographs in 7 cases showed active dental infection. The remaining 5 patients reported recent dental procedures. Frontal lobe localization was the most common (7 of 12 [58.3%]). Presenting signs included headache (66.7%), mental status changes (41.6%), visual deficits (41.6%), and speech difficulties (33.3%). Computed tomography (CT) or magnetic resonance imaging (MRI) confirmed all diagnoses. Drainage via open craniotomy was performed in 6 (50%) of 12 patients, and stereotactic CT-guided drainage in 4 (33.3%). The most common pathogens were Streptococcus milleri (45.5%), Staphylococcus species (27.3%), and Fusobacterium (27.3%). All cases had favorable outcomes. Five had residual neurologic deficits, 4 had persistent visual complaints, and a recurrent abscess developed in 1 case. CONCLUSIONS These findings showed a higher subset (13.6%) of brain abscesses that could be attributed to odontogenic etiology than previously reported in the literature and highlight the need to rule out dental sources in cryptogenic cases.
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Affiliation(s)
- Grace Hsu
- Harvard School of Dental Medicine, Boston, MA, USA.
| | | | - Firat Selvi
- Oral and Maxillofacial Surgery Istanbul University, Istanbul, Turkey
| | - Neil Shady
- Department of Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Meredith August
- Department of Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
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Abstract
RATIONALE In patients receiving biological therapies, serious infections are a major concern. Infections associated with anti-tumor necrosis factor antibody therapy include tuberculosis, viral, fungal, and bacterial infections. Likewise, severe infections of the upper and lower respiratory tract, lung, skin and soft tissue, urinary tract, gastrointestinal tract, joint, and bone have also been reported previously. However, infections involving the central nervous system are rare, especially an intracranial infection caused by odontogenic infection. To date, only few cases have been reported of this infection. This is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. PATIENT CONCERNS A 39-year-old male with psoriatic arthritis receiving adalimumab treatment came to the emergency department with initial presentation of sudden onset convulsions. He had been receiving adalimumab treatment for 1 month. Two days after the third injection, the patient had an episode of sudden-onset general convulsion for nearly 5 min with the upgazing and general tonic presentation. Magnetic resonance imaging (MRI) showed left frontal lobe brain abscess. Pus culture from the brain abscess detected Streptococcus sanguinis (S. sanguinis), Fusobacterium nucleatum (F. nucleatum), and Parvimonas micra (P. micra). DIAGNOSIS Brain abscess with odontogenic infection. INTERVENTIONS The patient received left frontal craniotomy, abscess drainage and systemic empiric antibiotics treatment with vancomycin, cefepime, and metronidazole. Due to drug rash with eosinophilia and systemic symptoms during the treatment, vancomycin and metronidazole were discontinued, and systemic antibiotics were switched to teicoplanin and ceftriaxone. OUTCOMES A brain MRI follow-up performed after 1 month of initial treatment revealed the reduced size of the abscess lesion and minimal oedema. The patient was discharged with stable condition. LESSONS To the best of our knowledge, this is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Such a rare diagnosis must be kept in mind when patients treated with adalimumab present with sudden-onset convulsions. Careful dental examination should be performed before administration of adalimumab.
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Affiliation(s)
- Yu-Pei Lo
- Department of Dermatology, China Medical University Hospital
- Department of Dermatology, China Medical University, Taiwan, ROC
| | - Snehal Desale
- Department of Dermatology, China Medical University Hospital
| | - Po-Yuan Wu
- Department of Dermatology, China Medical University Hospital
- Department of Dermatology, China Medical University, Taiwan, ROC
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Multiple brain abscesses treated by extraction of the maxillary molars with chronic apical lesion to remove the source of infection. Maxillofac Plast Reconstr Surg 2019; 41:25. [PMID: 31321221 PMCID: PMC6606678 DOI: 10.1186/s40902-019-0208-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background Brain abscess is a life-threatening condition that occurs due to complications during a neurosurgical procedure, direct cranial trauma, or the presence of local or distal infection. Infection in the oral cavity can also be considered a source of brain abscess. Case presentation A 45-year-old male patient was transported with brain abscess in the subcortical white matter. Navigation-guided abscess aspiration and drainage was performed in the right mid-frontal lobe, but the symptoms continued to worsen after the procedure. A panoramic radiograph showed alveolar bone resorption around the maxillary molars. The compromised maxillary molars were extracted under local anesthesia, and antibiotics were applied based on findings from bacterial culture. A brain MRI confirmed that the three brain abscesses in the frontal lobe were reduced in size, and the patient’s symptoms began to improve after the extractions. Conclusion This is a rare case report about multiple uncontrolled brain abscesses treated by removal of infection through the extraction of maxillary molars with odontogenic infection. Untreated odontogenic infection can also be considered a cause of brain abscess. Therefore, it is necessary to recognize the possibility that untreated odontogenic infection can lead to serious systemic inflammatory diseases such as brain abscess. Through a multidisciplinary approach to diagnosis and treatment, physicians should be encouraged to consider odontogenic infections as a potential cause of brain abscesses.
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43
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Eggerthia catenaformis bacteremia in a patient with an odontogenic abscess. Anaerobe 2019; 57:115-116. [PMID: 31002871 DOI: 10.1016/j.anaerobe.2019.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/22/2019] [Accepted: 04/16/2019] [Indexed: 01/07/2023]
Abstract
Eggerthia catenaformis is a Gram-positive anaerobic rod, which has been rarely reported in human diseases. We report the second case of bacteremia due to this microorganism in an elderly patient. A 73-year-old man, without underlying diseases presented with fever, odynophagia and swelling of the cervical lymph node for several days. Culture of drained cervical fluid resulted in the isolation of Raoultella ornithinolytica and Streptococcus anginosus. Anaerobic blood cultures yielded a rare anaerobic microorganism, identified as Eggerthia catenaformis. No resistance to tested antimicrobials was documented. Treatment with drainage and several antibiotic regimens was established, and the general condition of the patient improved, at two months of follow-up.
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44
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First case of pleural empyema and pulmonary abscess caused by Eggerthia catenaformis. Anaerobe 2018; 50:9-11. [DOI: 10.1016/j.anaerobe.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 11/21/2022]
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45
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Hibi A, Amakusa Y. Intracranial subdural abscess with polymicrobial infections due to frontal sinusitis in an adolescent: life-threatening complication of a common disease. Clin Case Rep 2018; 6:516-521. [PMID: 29531731 PMCID: PMC5838286 DOI: 10.1002/ccr3.1355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/17/2017] [Accepted: 12/10/2017] [Indexed: 01/28/2023] Open
Abstract
Intracranial abscess is one of the most serious complications of frontal sinusitis, particularly among adolescents, even in the absence of odontogenic infection. Polymicrobial infections due to anaerobes are common. Because antibiotic therapy alone is usually ineffective, early endoscopic sinus surgery is the key for infection control and good clinical outcomes.
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Affiliation(s)
- Arata Hibi
- Division of Nephrology and RheumatologyDepartment of Internal MedicineKariya Toyota General Hospital5‐15, Sumiyoshi‐choKariyaAichi448‐8505Japan
| | - Yoshinobu Amakusa
- Department of NeurologyKariya Toyota General Hospital5‐15, Sumiyoshi‐choKariyaAichi448‐8505Japan
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Gonzales Zamora JA, Espinoza LA. Pyogenic Brain Abscess Caused by Peptostreptococcus in a Patient with HIV-1 Infection. Diseases 2017; 5:diseases5040026. [PMID: 29149022 PMCID: PMC5750537 DOI: 10.3390/diseases5040026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022] Open
Abstract
In the setting of HIV, cerebral lesions are usually secondary to lymphoma and opportunistic infections; however, in patients with CD4 counts above 200 cells/uL, other pathologies such as pyogenic brain abscess could gain importance. The microbiology of pyogenic brain abscess has Staphylococcus and Streptococcus as the leading etiologic pathogens in immunocompetent individuals. Peptostreptococcus is also recognized as a common cause of brain abscess in this patient population. In HIV-infected individuals, there have been sporadic reports of Peptostreptococcus infections but none of brain abscess. We describe the case of a 43-years-old HIV-infected patient with a CD4 count of 350 cells/uL that developed a Peptostreptococcus brain abscess presumably from hematogenous spread of an odontogenic source. Treatment with stereotactic needle aspiration in two opportunities and four weeks of intravenous antibiotics led to a complete resolution of this infection. This case highlights the importance of a multidisciplinary approach for an effective treatment of pyogenic brain abscess in HIV-1 patients.
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Affiliation(s)
- Jose Armando Gonzales Zamora
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
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Abstract
Dentoalveolar surgeries are among the more common procedures performed by oral maxillofacial surgeons. It is only natural that there are several controversies associated with many aspects of this type of surgery. Although good scientific evidence is the basis of most oral maxillofacial procedures, some of what is accepted as common wisdom may not meet strict guidelines of evidence-based practice. This article explores some controversies that are relevant to the current practice of dentoalveolar surgery.
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Affiliation(s)
- Deepak G Krishnan
- Division of Oral Maxillofacial Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA.
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48
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Kodukula K, Faller DV, Harpp DN, Kanara I, Pernokas J, Pernokas M, Powers WR, Soukos NS, Steliou K, Moos WH. Gut Microbiota and Salivary Diagnostics: The Mouth Is Salivating to Tell Us Something. Biores Open Access 2017; 6:123-132. [PMID: 29098118 PMCID: PMC5665491 DOI: 10.1089/biores.2017.0020] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The microbiome of the human body represents a symbiosis of microbial networks spanning multiple organ systems. Bacteria predominantly represent the diversity of human microbiota, but not to be forgotten are fungi, viruses, and protists. Mounting evidence points to the fact that the "microbial signature" is host-specific and relatively stable over time. As our understanding of the human microbiome and its relationship to the health of the host increases, it is becoming clear that many and perhaps most chronic conditions have a microbial involvement. The oral and gastrointestinal tract microbiome constitutes the bulk of the overall human microbial load, and thus presents unique opportunities for advancing human health prognosis, diagnosis, and therapy development. This review is an attempt to catalog a broad diversity of recent evidence and focus it toward opportunities for prevention and treatment of debilitating illnesses.
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Affiliation(s)
- Krishna Kodukula
- Bridgewater College, Bridgewater, Virginia
- ShangPharma Innovation, Inc., South San Francisco, California
- PhenoMatriX, Inc., Natick, Massachusetts
| | - Douglas V. Faller
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Cancer Research Center, Boston University School of Medicine, Boston, Massachusetts
| | - David N. Harpp
- Department of Chemistry, McGill University, Montreal, Canada
| | | | - Julie Pernokas
- Advanced Dental Associates of New England, Woburn, Massachusetts
| | - Mark Pernokas
- Advanced Dental Associates of New England, Woburn, Massachusetts
| | - Whitney R. Powers
- Department of Health Sciences, Boston University, Boston, Massachusetts
- Department of Anatomy, Boston University School of Medicine, Boston, Massachusetts
| | - Nikolaos S. Soukos
- Dana Research Center, Department of Physics, Northeastern University, Boston, Massachusetts
| | - Kosta Steliou
- PhenoMatriX, Inc., Natick, Massachusetts
- Cancer Research Center, Boston University School of Medicine, Boston, Massachusetts
| | - Walter H. Moos
- ShangPharma Innovation, Inc., South San Francisco, California
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of California San Francisco, San Francisco, California
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Van der Cruyssen F, Grisar K, Maes H, Politis C. Case of a cerebral abscess caused by Porphyromonas gingivalis in a subject with periodontitis. BMJ Case Rep 2017; 2017:bcr-2016-218845. [PMID: 28228396 PMCID: PMC5337642 DOI: 10.1136/bcr-2016-218845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We report the case of a 65-year-old man presenting with generalised seizures after developing a right frontal brain abscess. Stereotactic aspiration and subsequent matrix assisted laser desorption/ionisation time-of-flight analyzer (MALDI-TOF) spectrometry revealed Porphyromonas gingivalis as the only causative anaerobe microorganism. Secondary incision and drainage was required due to neurological deterioration with increased dimensions of the abscess, intracranial pressure and formation of a subdural occipitoparietal empyema. Oral imaging was positive for apical periodontitis of multiple elements; therefore, the remaining dentition was removed. Targeted antibiotic treatment included intravenous ceftriaxone and ornidazole. The patient was discharged to our revalidation unit 59 days after admission to make a full recovery. To the best of our knowledge, this is the sixth reported case of P. gingivalis causing an intracranial abscess and the third case of a true intracerebral parenchymal abscess caused by this bacterium.
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Affiliation(s)
- Frederic Van der Cruyssen
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - Koenraad Grisar
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - Honorine Maes
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
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