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Wu L, Mo C, Xiong Y, Chen Y, Jin M, Han K, Fu X. Klebsiella pneumoniae invasive syndrome with pneumocephalus and extensive cerebral infarction: Case report. Heliyon 2024; 10:e25745. [PMID: 38380024 PMCID: PMC10877252 DOI: 10.1016/j.heliyon.2024.e25745] [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: 08/19/2023] [Revised: 01/12/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
A 54-year-old female with diabetes was admitted with fever and altered consciousness. Laboratory tests revealed venous blood glucose level of 43.79 mmol/L. Computed tomography (CT) scans of the head, chest, and abdomen showed a right-sided pneumothorax, consolidation, and atelectasis in the right lung; a large heterogeneous density lesion with fluid and gas-fluid levels in the liver; and scattered gas shadows in both kidneys, respectively. Blood and puncture fluid cultures indicated infection with Klebsiella pneumoniae. Based on the susceptibility profiles of the isolates, imipenem was administered intravenously to treat the infection. On the third day of hospitalization, the patient's condition worsened, with head CT showing an extensive cerebral infarction and multiple gas accumulations in the right cerebral hemisphere, as well as a large-area cerebral infarction in the left parietal and occipital lobes. Ultimately, the patient died of multiple organ dysfunction on the fourth day after initial presentation. Although the Klebsiella pneumoniae isolates from the patient showed sensitivity to imipenem, this antibiotic shows poor entry into the central nervous system. The death of the patient indicates that the selection of antibiotics that can cross the blood-brain barrier may be crucial in the outcome of this type of case. Therefore, antibiotics that can penetrate the blood-brain barrier should be selected as soon as possible, and empirical treatment must be initiated immediately after clinical suspicion of invasive Klebsiella pneumoniae, even if the diagnosis has not been determined.
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Affiliation(s)
- Liangzhe Wu
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Changhong Mo
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Yihan Xiong
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Yanhui Chen
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Meng Jin
- Department of Intensive Care Unit, Shenzhen People's Hospital, 518020, Shenzhen, China
| | - Kunning Han
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Xuejun Fu
- Department of Neurology, Shenzhen People's Hospital, 518020, Shenzhen, China
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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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Rasouli M, Honeybul S. Hydrocephalus as a delayed presentation of Klebsiella pneumoniae ventriculitis: a case report. FUTURE NEUROLOGY 2022. [DOI: 10.2217/fnl-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A new hypervirulent variant of Klebsiella pneumoniae has emerged. In contrast to classic Klebsiella pneumoniae, it can cause serious and life-threatening infection. It has the ability of spreading from the gastrointestinal and genitourinary systems in non immunocompromised patients to the liver, lung, brain and the eye. High morbidity and mortality have been reported especially if there is a CNS involvement. A prompt search for a distant infective metastasis and its early treatment can improve the outcome. This is a report of a patient presenting with delayed obstructive hydrocephalus secondary to an obstructive urosepsis.
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Affiliation(s)
- Mohammad Rasouli
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, 6009, Australia
| | - Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, 6009, Australia & Royal Perth Hospital, Wellington Street, Perth, Western Australia, 6000, Australia
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Zhao J, Huo T, Luo X, Lu F, Hui S, Yang B. Klebsiella pneumoniae-related brain abscess and meningitis in adults: Case report. Medicine (Baltimore) 2022; 101:e28415. [PMID: 35029179 PMCID: PMC8757935 DOI: 10.1097/md.0000000000028415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Klebsiella pneumoniae is once thought to be a less common cause of brain abscess in adults and is mainly hospital-acquired. Community-acquired CNS infection (brain abscess and meningitis) caused by K pneumoniae without other metastatic septic abscesses is exceedingly rare. Therefore, we present a rare adult patient with invasive cerebral abscess and meningitis without other invasive abscesses related to K pneumoniae. PATIENT CONCERNS A 64-year-old woman experienced a sudden onset of severe continuous headache accompanied by intermittent nausea, vomiting, and fever. Meanwhile, she experienced tinnitus and had a feeling of swelling in the right ear. DIAGNOSIS Cranial magnetic resonance imaging revealed abnormal hyperintensity signals in the left head of the caudate nucleus. The next generation sequencing of cerebral spinal fluid showed infection with K pneumoniae. The patient was diagnosed with K pneumoniae-related brain abscesses and meningitis. INTERVENTIONS Antibacterial treatment was carried out for 2 months. OUTCOMES The patient recovered well. CONCLUSION Despite the progress of modern neurosurgical techniques, new antibiotics, and modern imaging techniques, brain abscesses are still a potentially fatal infection. Streptococci are common organisms that result in brain abscesses. Nevertheless, Klebsiella species, once thought to be a less common cause of brain abscess in adults, has become an increasingly important cause of brain abscess, especially in Asia.
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Affiliation(s)
- Jingru Zhao
- Department of Neurology, Hebei General Hospital, 348th Heping West Road, Shijiazhuang, P.R. China
| | - Tiantian Huo
- Department of Neurology, Hebei General Hospital, 348th Heping West Road, Shijiazhuang, P.R. China
| | - Xintong Luo
- Department of Neurology, Hebei General Hospital, 348th Heping West Road, Shijiazhuang, P.R. China
| | - Fan Lu
- Department of Neurology, Hebei General Hospital, 348th Heping West Road, Shijiazhuang, P.R. China
| | - Shuo Hui
- Department of Neurology, Hebei General Hospital, 348th Heping West Road, Shijiazhuang, P.R. China
| | - Baoming Yang
- Department of Hepatobiliary Surgery, the Fourth Hospital of Hebei Medical University, 12th Jiankang Road, Shijiazhuang, P.R. China
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Klebsiella oxytoca Complex: Update on Taxonomy, Antimicrobial Resistance, and Virulence. Clin Microbiol Rev 2021; 35:e0000621. [PMID: 34851134 DOI: 10.1128/cmr.00006-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Klebsiella oxytoca is actually a complex of nine species-Klebsiella grimontii, Klebsiella huaxiensis, Klebsiella michiganensis, K. oxytoca, Klebsiella pasteurii, Klebsiella spallanzanii, and three unnamed novel species. Phenotypic tests can assign isolates to the complex, but precise species identification requires genome-based analysis. The K. oxytoca complex is a human commensal but also an opportunistic pathogen causing various infections, such as antibiotic-associated hemorrhagic colitis (AAHC), urinary tract infection, and bacteremia, and has caused outbreaks. Production of the cytotoxins tilivalline and tilimycin lead to AAHC, while many virulence factors seen in Klebsiella pneumoniae, such as capsular polysaccharides and fimbriae, have been found in the complex; however, their association with pathogenicity remains unclear. Among the 5,724 K. oxytoca clinical isolates in the SENTRY surveillance system, the rates of nonsusceptibility to carbapenems, ceftriaxone, ciprofloxacin, colistin, and tigecycline were 1.8%, 12.5%, 7.1%, 0.8%, and 0.1%, respectively. Resistance to carbapenems is increasing alarmingly. In addition to the intrinsic blaOXY, many genes encoding β-lactamases with varying spectra of hydrolysis, including extended-spectrum β-lactamases, such as a few CTX-M variants and several TEM and SHV variants, have been found. blaKPC-2 is the most common carbapenemase gene found in the complex and is mainly seen on IncN or IncF plasmids. Due to the ability to acquire antimicrobial resistance and the carriage of multiple virulence genes, the K. oxytoca complex has the potential to become a major threat to human health.
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Wu C, Han S, Baydur A, Lindgren B. Klebsiella brain abscess in an immunocompetent patient: a case report. J Med Case Rep 2021; 15:44. [PMID: 33536050 PMCID: PMC7857860 DOI: 10.1186/s13256-020-02633-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/14/2020] [Indexed: 11/14/2022] Open
Abstract
Background Klebsiella pneumoniae brain abscesses are a rare entity and typically present in immunocompromised patients. We present a case of an overall healthy patient who developed a Klebsiella pneumoniae brain abscess in the absence of liver pathology. Case presentation A 46-year-old Vietnamese man with past medical history significant for hypertension presented to the hospital with acute on chronic worsening of altered mental status, personality changes, and gait dysfunction. Initial vitals revealed temperature of 37.1 °C, heart rate 87 beats/minute, blood pressure 150/87 mmHg, respiratory rate 18/minute, and oxygen saturation 99% on room air. Physical exam was notable for altered mental status, Glasgow Coma Scale (GCS) score of 14, and right lower facial droop. Cardiopulmonary exam was within normal limits. Head computed tomography (CT) showed a left frontotemporal mass, with subsequent brain magnetic resonance imaging (MRI) revealing a ring-enhancing lesion concerning for a brain abscess. The abscess was urgently drained; however, there was intraoperative spillage into the ventricles. Intraoperative cultures grew Klebsiella pneumoniae, and the patient was maintained on appropriate antibiotics. He developed worsening mental status, septic shock, and cerebral edema requiring decompressive left hemicraniectomy. Computed tomography of the abdomen and pelvis revealed no hepatic lesions. The patient did not improve, and the family elected for comfort measures. Conclusion High mortality is associated with Klebsiella pneumoniae (as opposed to Klebsiella oxytoca) brain abscesses, especially in the setting of intraventricular spread. This case illustrates the need for early detection, and an aggressive medical and surgical treatment approach is required for a potential favorable outcome.
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Affiliation(s)
- Clay Wu
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, 2020 Zonal Ave, IRD 723, Los Angeles, CA, 90033, USA.
| | - Semi Han
- Department of Internal Medicine, University of Southern California, Los Angeles, California, USA
| | - Ahmet Baydur
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, 2020 Zonal Ave, IRD 723, Los Angeles, CA, 90033, USA
| | - Brett Lindgren
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, 2020 Zonal Ave, IRD 723, Los Angeles, CA, 90033, USA
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Su TM, Lan CM, Lee TH, Hsu SW. Gas-containing brain abscess: etiology, clinical characteristics, and outcome. Kaohsiung J Med Sci 2014; 30:619-24. [PMID: 25476100 DOI: 10.1016/j.kjms.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/21/2014] [Accepted: 10/08/2014] [Indexed: 11/26/2022] Open
Abstract
Gas-containing brain abscess remains a life-threatening disease that requires immediate diagnostic and therapeutic intervention. The aim of this study is to report on a series of gas-containing brain abscess and discuss its pathological mechanism and therapeutic consideration. This study included 11 patients with gas-containing brain abscess at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan during a 27-year period. The predisposing factors to infection included hematogenous spread in five patients, contiguous infection in one patient, and abnormal fistulous communication due to head injury in four patients. In one patient, the predisposing factor might be contiguous infection from frontal sinusitis or abnormal fistulous communication due to previous sinus surgery. Klebsiella pneumoniae was the most common causative pathogen that was isolated from the gas-containing abscess not related to skull base defect. Among these 11 patients, six underwent excision and five accepted aspiration for the surgical treatment of abscess. In the five patients who underwent aspiration, two required repeated craniotomy to excise the recurrent abscess and repair the abnormal fistulous communication through the skull base. When encountered with a gas-containing abscess in patients with an impaired host defense mechanism, K. pneumoniae infection should be suspected, and further attention should be paid to discovering if other metastatic septic abscesses exist. For patients with a history of basilar skull fracture or surgery involving the skull base, craniotomy is indicated to excise the abscess and repair the potential fistulous communication through the cranium. Aspiration may be a reasonable alternative to treat deep-seated lesions, lesions in an eloquent area, patients with severe concomitant medical disease, or patients without a history of basilar skull fracture or surgery involving the skull base. Prompt diagnosis, appropriate antibiotic use, and meticulous surgical treatment are the only way to obtain a favorable outcome.
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Affiliation(s)
- Tsung-Ming Su
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chu-Mei Lan
- Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Tsung-Han Lee
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Wei Hsu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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8
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Muccio CF, Caranci F, D'Arco F, Cerase A, De Lipsis L, Esposito G, Tedeschi E, Andreula C. Magnetic resonance features of pyogenic brain abscesses and differential diagnosis using morphological and functional imaging studies: a pictorial essay. J Neuroradiol 2014; 41:153-67. [PMID: 24957685 DOI: 10.1016/j.neurad.2014.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
The aim of this paper is to illustrate the potential of magnetic resonance imaging (MRI) in diagnosis, differential diagnosis, treatment planning and evaluation of therapy effectiveness of pyogenic brain abscesses, through the use of morphological (or conventional) and functional (or advanced) sequences. Conventional MRI study is useful for the identification of lesions, to determine the location and morphology and allows a correct hypothesis of nature in the most typical cases. However, the differential diagnosis from other brain lesions, such as non-pyogenic abscesses or necrotic tumors (high-grade gliomas and metastases) is often only possible through the use of functional sequences, as the measurement of diffusion with apparent diffusion coefficient (DWI-ADC), proton magnetic resonance spectroscopy ((1)H-MRS) and perfusion weighted imaging (PWI), which complement the morphological sequences and provide essential information on structural, metabolic and hemodynamic characteristics allowing greater neuroradiological confidence. Modern diagnostic MRI of pyogenic brain abscesses cannot be separated from knowledge, integration and proper use of the morphological and functional sequences.
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Affiliation(s)
- Carmine Franco Muccio
- Unit of Neuroradiology, Department of Neuroscience, Hospital "Gaetano Rummo", Benevento, Italy
| | - Ferdinando Caranci
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Felice D'Arco
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Alfonso Cerase
- Unit of Neuroradiology, Department of Neuroscience, University "Santa Maria alle Scotte", Siena, Italy
| | - Luca De Lipsis
- Department of Critical Care Medicine, Hospital "Fatebenefratelli", Benevento, Italy
| | - Gennaro Esposito
- Unit of Neuroradiology, Department of Neuroscience, Hospital "Gaetano Rummo", Benevento, Italy
| | - Enrico Tedeschi
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Cosma Andreula
- Unit of Radiology and Neuroradiology, Anthea Hospital, Bari, Italy
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Hyun JI, Kim YJ, Jeon YH, Kim SI, Park YJ, Kang MW, Kim W, Jang JH. A Case of Ventriculitis Associated with Renal Abscess Caused by Serotype K1 Klebsiella pneumoniae. Infect Chemother 2014; 46:120-4. [PMID: 25024876 PMCID: PMC4091369 DOI: 10.3947/ic.2014.46.2.120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022] Open
Abstract
Recently, serotype K1 Klebsiella pneumoniae has been a major agent of an invasive syndrome characterized by liver abscess and its metastatic infection. Extrahepatic infection and its characteristics in patients with renal abscess caused by K. pneumoniae are poorly understood, and few cases of central nervous system infection have been reported. This is a report of 80-year-old woman with uncontrolled type 2 diabetes mellitus with renal abscess caused by serotype K1 K. pneumoniae, complicated with ventriculitis despite of appropriate use of antibiotics. Physicians need to be aware of possibility of metastatic infection in patients with serotype K1 K. pneumoniae infection, if they develop neurologic symptom and focus of infection is still present.
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Affiliation(s)
- Ji In Hyun
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Youn Jeong Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yoon Hee Jeon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yeon Joon Park
- Department of Laboratory Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Moon Won Kang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Woohyeon Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hye Jang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Hsiao SY, Chang WN, Lin WC, Tsai NW, Huang CR, Wang HC, Su CM, Chuang MJ, Lu CH. The experiences of non-operative treatment in patients with bacterial brain abscess. Clin Microbiol Infect 2011; 17:615-20. [PMID: 20491832 DOI: 10.1111/j.1469-0691.2010.03264.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although treatment of brain abscess requires a combination of antimicrobials and surgical intervention for the infected foci, nonsurgical, empirical treatment is possible and efficient in selected groups of patients. A total of 31 patients were enrolled in this 22-year retrospective study. We describe our therapeutic experiences and attempt to analyze the risk factors that were predictive of therapeutic outcomes. Multiple logistic regression was used to evaluate the relationships between baseline clinical factors and therapeutic outcome during the study period. Of these 31 patients, 25 had community-acquired infections, whereas the other six had nosocomially-acquired infections. Thirteen cases (42%) had a single brain abscess and the other 18 cases (58%) had multiple brain abscesses. Furthermore, the association of bacterial meningitis and brain abscess was found in 81% (25/31) of cases. The overall case fatality rate was 48% (15/31). Significant risk factors for poor outcomes included Glasgow coma scale (GCS) at presentation, presence of septic shock and neck stiffness. In addition, each reduction of one point on the GCS increased the poor outcome rate by 28%. The findings of the study demonstrate that both a higher mortality rate (48%) and worse outcomes were found in this select group of patients. Among the significant prognostic factors, a lower mean GCS at presentation was a major determinant of poor outcome.
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Affiliation(s)
- S-Y Hsiao
- Departments of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Baudrand H, Mbatchou Ngahane B, Marcu M, Freymond N, Pacheco Y, Devouassoux G. Pneumopathie communautaire abcédée à Klebsiella pneumoniae. Rev Mal Respir 2009; 26:773-8. [DOI: 10.1016/s0761-8425(09)72429-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Klebsiella meningoencephalitis presenting like embolic ischemic stroke. J Neurol 2009; 255:1983-4. [PMID: 19153636 DOI: 10.1007/s00415-009-0046-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/10/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
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13
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Cho KT, Park BJ. Gas-forming brain abscess caused by Klebsiella pneumoniae. J Korean Neurosurg Soc 2008; 44:382-4. [PMID: 19137083 DOI: 10.3340/jkns.2008.44.6.382] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 11/24/2008] [Indexed: 11/27/2022] Open
Abstract
Gas forming brain abscess is a rare disease caused by Klebsiella pneumoniae occurring in patients with impaired host defense mechanism such as diabetes mellitus or liver cirrhosis. A 59-year-old man with 2-year history of diabetes mellitus and 20-year history of liver cirrhosis presented to the hospital with headache. On the day after admission, severe headache was developed and he deteriorated rapidly. Brain CT showed a non-enhanced mass including multiple air density as well as surrounding edema seen in the right occipital lobe, and isodensity air-fluid level seen in the right lateral ventricle. Despite emergent ventricular drainage and intraventricular and intravenous administration of antibiotics, his condition progressively worsened to sepsis and to death after 5 days. Bacterial culture of blood and ventricular fluids disclosed a Gram (-) rod, Klebsiella pneumoniae. In this report we review the pathogenic mechanism and its management.
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Affiliation(s)
- Keun Tae Cho
- Department of Neurosurgery, Dongguk University Ilsan Hospital Seoul, Korea
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14
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Community-Acquired Klebsiella pneumoniae Complicated Skin and Soft-Tissue Infections of Extremities: Emphasis on Cirrhotic Patients and Gas Formation. Infection 2008; 36:328-34. [DOI: 10.1007/s15010-008-7272-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 11/23/2007] [Indexed: 12/20/2022]
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15
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Kocaeli H, Hakyemez B, Bekar A, Yilmazlar S, Abas F, Yilmaz E, Korfali E. Unusual complications and presentations of intracranial abscess: experience of a single institution. ACTA ACUST UNITED AC 2008; 69:383-91; discussion 391. [PMID: 17707481 DOI: 10.1016/j.surneu.2007.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Accepted: 03/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Complicating events and unusual presentations associated with intracranial abscess are rare but potentially fatal conditions. This study was undertaken to shed light on the unusual complications and presentations of intracranial abscess treated at a single institution. METHODS We retrospectively reviewed 116 cases of intracranial abscesses that were treated at our institution over the last 10 years and identified 11 (9.4%) cases with unusual complications. RESULTS These complications consisted of (1) rupture within the abscess, (2) hemorrhage into the abscess, (3) hemispheric infarction due to ICA thrombosis, (4) acute visual loss due to pituitary abscess, (5) acute neurologic deterioration due to rapid gas formation within the abscess, (6) acute hydrocephalus, (7) trigeminal neuralgia, (8) fungal abscess developing secondary to intracranial extension of a temporal bone tumor, (9) Cryptococcus abscess with different morphology, (10) pontine infarction, and (11) sigmoid sinus thrombosis. Sinusitis accompanied 8 (72.7%) of the cases, and there were 5 (45.4%) mortalities. Culture results were unyielding in 4 patients, whereas Streptococcus species were identified in 4 and fungi in the rest. CONCLUSION Intracranial abscesses and their complications still continue to be challenging entities in the neurosurgical practice. Our experience may provide an informational source for those who are taking care of patients with intracranial abscess.
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Affiliation(s)
- Hasan Kocaeli
- Department of Neurosurgery, Uludağ University School of Medicine, Gorukle Campus, Bursa 16059, Turkey.
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Lee TH, Chang WN, Su TM, Chang HW, Lui CC, Ho JT, Wang HC, Lu CH. Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses. J Neurol Neurosurg Psychiatry 2007; 78:303-9. [PMID: 17012340 PMCID: PMC2117635 DOI: 10.1136/jnnp.2006.097808] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intraventricular rupture of brain abscesses (IVRBA) remains a catastrophic and fatal complication of bacterial brain abscess (BBA). However, no information has been reported about the risk factors that are predictive of intraventricular rupture. METHODS This study was undertaken to determine the potential risk factors that are predictive of intraventricular ruptures in patients with BBA but without intraventricular rupture when arriving at the hospital. A comparison is also made between patients who already have IVRBA at the time of admission (initial IVRBA) and those who have the episode during hospitalisation (subsequent IVRBA). RESULTS 62 patients, including 45 who had initial IVRBA and 17 who had subsequent IVRBA, were examined. Stepwise logistic regression analysis showed that the adjusted risk of intraventricular rupture during hospitalisation for patients with multiloculated brain abscesses had an odds ratio (OR) of 4.2 (95% confidence interval (CI) 1.24 to 14.3; p = 0.02) compared with those without multiloculated brain abscesses (referent); a reduction of 1 mm in the distance between the ventricle and brain abscesses would increase the rupture rate by 10% (p = 0.006, OR 0.9, 95% CI 0.83 to 0.97). CONCLUSION This study shows that if the abscess is deep seated, multiloculated and close to the ventricle wall, a reduction of 1 mm in the distance between the ventricle and brain abscesses will increase the rupture rate by 10%. Despite aggressive medical and surgical management shown in this series, many patients continue to progress poorly.
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Affiliation(s)
- Tsung-Han Lee
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 83301, Taiwan
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Wang JL, Chen KY, Fang CT, Hsueh PR, Yang PC, Chang SC. Reply to Yu and Chang. Clin Infect Dis 2006. [DOI: 10.1086/498755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Rau CS, Chang WN, Lin YC, Lu CH, Liliang PC, Su TM, Tsai YD, Chang CJ, Lee PY, Lin MW, Cheng BC. Brain abscess caused by aerobic Gram-negative bacilli: clinical features and therapeutic outcomes. Clin Neurol Neurosurg 2002; 105:60-5. [PMID: 12445926 DOI: 10.1016/s0303-8467(02)00103-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Thirty-three patients (24 males and nine females) with brain abscesses resulting from infection by aerobic Gram-negative bacilli were identified at Kaohsiung Chang Gung Memorial Hospital over a period of 14 years. Of these, 23 cases developed spontaneously, with the remaining ten postneurosurgery. The organisms most frequently involved were Klebsiella (K.) pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus species and included some rare pathogens, such as Salmonella and Enterobacter species, K. oxytoca, Vibrio and Morganella morganii. Apart from one exception, the locations of the abscess were supratentorial. Twenty-four patients presented with a single abscess, while nine revealed multiple abscesses, with 26 treated surgically and seven with antibiotics exclusively. In total, seven patients died, representing an overall mortality rate of 21%. This study demonstrates that brain abscesses associated with neurosurgical procedures are not rare, accounting for 30% of cases in this study, with K. pneumoniae, Proteus and Enterobacter species the most prevalent of the revealed pathogens. Further, Proteus species were the most prevalent pathogens demonstrated for cases of both otogenic and polymicrobial infections. If brain abscesses are diagnosed for diabetic patients or have a gas-forming appearance, a diagnosis of K. pneumoniae infection should be considered, with particular attention paid to detection of other metastatic septic abscesses. In light of the high mortality rate, early treatment is essential to maximize the chances of survival.
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Affiliation(s)
- Cheng-Shyuan Rau
- Department of Neurosurgery, Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan, ROC
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Su TM, Lin YC, Lu CH, Chang WN, Liliang PC, Lee TC. Multiple Pyogenic Brain Abscesses: Analysis of Clinical Features in Twelve Patients. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2002. [DOI: 10.1097/00019048-200201000-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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