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Sahin M, Mert A, Emecen AN, Strunjas NP, Fasanekova L, Batirel A, Darazam IA, Ansari S, Firouzjaei GG, Stebel R, Tigen ET, Sengel BE, Dzupova O, Belitova M, Abid M, Demirbaş ND, Erol S, Kul H, Pekok AU, Ulusoy TÜ, Alay H, Amiri ZM, Cascio A, Karadağ MK, Kolovani E, Mladenov N, Ramosaco E, Sipahi OR, Şanlıdağ G, El-Kholy A, Okay G, Pshenichnaya N, Şahinoğlu MS, Alkan S, Özdemir M, Rahimi BA, Karlidag GE, Balin ŞÖ, Liskova A, Jouhar A, Almajid F, Artur X, Çelik M, Khan A, Lanzafame M, Marıno A, Şenol A, Oncu S, Uğuz M, Zajkowska J, Erdem H. Profiles of primary brain abscesses and their impact on survival: An international ID-IRI study. Int J Infect Dis 2024; 147:107228. [PMID: 39216784 DOI: 10.1016/j.ijid.2024.107228] [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] [Received: 05/13/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES This study of 331 primary brain abscess (PBA) patients aimed to understand infecting agents, predisposing factors, and outcomes, with a focus on factors affecting mortality. METHODS Data were collected from 39 centers across 16 countries between January 2010 and December 2022, and clinical, radiological, and microbiological findings, along with their impact on mortality, were analyzed. RESULTS The patients had a mean ± SD age of 46.8 ± 16.3 years, with a male predominance of 71.6%. Common symptoms included headache (77.9%), fever (54.4%), and focal neurological deficits (53.5%). Gram-positive cocci were the predominant pathogens, with Viridans group streptococci identified as the most frequently isolated organisms. All patients received antimicrobial therapy and 71.6% underwent interventional therapies. The 42-day and 180-day survival rates were 91.9% and 86.1%, respectively. Significant predictors of 42-day mortality included intravenous drug addiction (HR: 6.02, 95% CI: 1.38-26.26), malignancy (HR: 3.61, 95% CI: 1.23-10.58), confusion (HR: 2.65, 95% CI: 1.19-5.88), and unidentified bacteria (HR: 4.68, 95% CI: 1.76-12.43). Significant predictors of 180-day mortality included malignancy (HR: 2.70, 95% CI: 1.07-6.81), confusion (HR: 2.14, 95% CI: 1.11-4.15), temporal lobe involvement (HR: 2.10, 95% CI: 1.08-4.08), and unidentified bacteria (HR: 3.02, 95% CI: 1.49-6.15). CONCLUSION The risk of death in PBA extends beyond the infection phase, with different factors influencing the 42-day and 180-day mortality rates. Intravenous drug addiction was associated with early mortality, while temporal lobe involvement was associated with late mortality.
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Affiliation(s)
- Meyha Sahin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Faculty of Medicine, Istanbul, Türkiye.
| | - Ali Mert
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Faculty of Medicine, Istanbul, Türkiye
| | - Ahmet Naci Emecen
- Dokuz Eylul University, Research and Application Hospital, Izmir, Türkiye
| | | | - Lenka Fasanekova
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Türkiye
| | - Ilad Alavi Darazam
- Department of Infectious Diseases and Tropical Medicine, Logman Hakim, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabboo Ansari
- Department of Infectious Diseases and Tropical Medicine, Logman Hakim, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazaleh Golchoub Firouzjaei
- Department of Infectious Diseases and Tropical Medicine, Logman Hakim, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roman Stebel
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Elif Tukenmez Tigen
- Department of Infectious Diseases and Clinical Microbiology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Buket Erturk Sengel
- Department of Infectious Diseases and Clinical Microbiology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Olga Dzupova
- Department of Infectious Diseases, Third Faculty of Medicine, Charles University, University Hospital Bulovka, Prague, Czech Republic
| | - Maya Belitova
- Department of Anaesthesiology and Intensive Care, Medical University-Sofia, University Hospital 'Queen Giovanna' ISUL, EAD, Sofia, Bulgaria
| | - Maha Abid
- Department of Infectious Diseases, Ibn El Jazzar Medical School, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Nazife Duygu Demirbaş
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Serpil Erol
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Türkiye
| | - Halil Kul
- Department of Neurosurgery, Ankara City Hospital, Ankara, Türkiye
| | - Abdullah Umut Pekok
- Department of Infectious Diseases of Clinical Microbiology, Istanbul Aydın University Faculty of Medicine, VM Medical Park Pendik Hospital, Istanbul, Türkiye
| | - Tülay Ünver Ulusoy
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Türkiye
| | - Handan Alay
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ataturk University, Erzurum, Türkiye
| | - Zahra Mohtasham Amiri
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Palermo, Italy
| | - Mehmet Kürşat Karadağ
- Faculty of Medicine, Department of Neurosurgery, Ataturk University, Erzurum, Türkiye
| | - Entela Kolovani
- Department of Neuroscience, University of Medicine, Service of Neurosurgery, University Hospital Center "Mother Theresa", Tirana, Albania
| | | | - Ergys Ramosaco
- Department of Neuroscience, University of Medicine, Service of Neurosurgery, University Hospital Center "Mother Theresa", Tirana, Albania
| | - Oğuz Reşat Sipahi
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Türkiye
| | - Gamze Şanlıdağ
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Türkiye
| | - Amani El-Kholy
- Faculty of Medicine, Department of Clinical Pathology, Cairo University, Cairo, Egypt
| | - Gulay Okay
- Department of Infectious Diseases and Clinical Microbiology, Bezmi Alem University Faculty of Medicine, Istanbul, Türkiye
| | - Natalia Pshenichnaya
- Department of Infectious Diseases, Central Research Institute of Epidemiology, Moscow, Russia
| | - Mustafa Serhat Şahinoğlu
- Department of Infectious Diseases and Clinical Microbiology, Manisa City Hospital, Manisa, Türkiye
| | - Sevil Alkan
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Canakkale Onsekiz Mart University, Canakkale, Türkiye
| | - Mehmet Özdemir
- Department of Microbiology, Necmettin Erbakan University Meram Medical School Hospital, Konya, Türkiye
| | - Bilal Ahmad Rahimi
- Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
| | - Gulden Eser Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Türkiye
| | - Şafak Özer Balin
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Firat University, Elazig, Türkiye
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Anas Jouhar
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - Fahad Almajid
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Xhumari Artur
- Department of Neuroscience, University of Medicine, Service of Neurosurgery, University Hospital Center "Mother Theresa", Tirana, Albania
| | - Mehmet Çelik
- Department of Infectious Diseases and Clinical Microbiology, Harran University Faculty of Medicine, Sanliurfa, Türkiye
| | | | - Massimiliano Lanzafame
- Unit of Infectious Diseases, Azienda provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Trento, Italy
| | - Andrea Marıno
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Arzu Şenol
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Türkiye
| | - Serkan Oncu
- Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University, Aydin, Türkiye
| | - Mustafa Uğuz
- Department of Infectious Diseases and Clinical Microbiology, Mersin City Hospital, Mersin, Türkiye
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University in Białystok, Białystok, Poland
| | - Hakan Erdem
- Gulhane School of Medicine, Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ankara, Türkiye
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Kisiel M, Bass VM, Fong C, Graham AK, Yahya S, Eichorn FC, Lannon M, Kameda-Smith M, Reddy KKV, Lu JQ. Clinicopathologic characteristics of Nocardia brain abscesses: Necrotic and non-necrotic foci of various stages. J Neurol Sci 2024; 456:122850. [PMID: 38142539 DOI: 10.1016/j.jns.2023.122850] [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] [Received: 10/25/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Nocardia brain abscesses are rare bacterial infections associated with a high mortality rate, and their preoperative diagnosis can be difficult for various reasons including a nonspecific clinical presentation. While late-stage nocardial brain abscesses may be radiologically characteristic, early-stage lesions are nonspecific and indistinguishable from another inflammatory/infectious process and other mimics. Despite the paucity of previous histopathological descriptions, histopathological examination is critical for the identification of the pathogen, lesion stage(s), and possible coexisting pathology. In this study, we examined the clinical, radiological and histopathological features of 10 patients with brain nocardiosis. Microscopic findings were analysed in correlation with clinical and radiological features in 9 patients, which revealed that brain nocardiosis was characterized by numerous necrotic and non-necrotic foci of various stages (I-IV) along with Nocardia identification, as well as the leptomeningeal involvement in most cases, and co-infection of brain nocardiosis with toxoplasmosis in 2 patients. The imaging features were characteristic with a multilobulated/bilobed ring-enhancing appearance in 8 patients including 2 patients with multiple lobulated and non-lobulated lesions and 1 patient showing the progression from a non-lobulated to lobulated lesion. These findings suggest that nocardial brain abscesses particularly at late-stages share common characteristics. Nevertheless, given the complex pathologic features, including possible co-infection by other pathogens, nocardial brain abscesses remain a therapeutic challenge.
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Affiliation(s)
- Marta Kisiel
- Department of Pathology and Molecular Medicine, Canada
| | | | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Sultan Yahya
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Canada.
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Kim S, Suh CH, Kim TO, Kim KW, Heo H, Shim WH, Kim SJ, Lee SA. Detection rate of brain MR and MR angiography for neuroimaging abnormality in patients with newly diagnosed left-sided infective endocarditis. Sci Rep 2023; 13:17070. [PMID: 37816822 PMCID: PMC10564872 DOI: 10.1038/s41598-023-44253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023] Open
Abstract
We aimed to investigate the detection rate of brain MR and MR angiography for neuroimaging abnormality in newly diagnosed left-sided infective endocarditis patients with/without neurological symptoms. This retrospective study included consecutive patients with definite or possible left-sided infective endocarditis according to the modified Duke criteria who underwent brain MRI and MR angiography between March 2015 and October 2020. The detection rate for neuroimaging abnormality on MRI was defined as the number of patients with positive brain MRI findings divided by the number of patients with left-sided infective endocarditis. Positive imaging findings included acute ischemic lesions, cerebral microbleeds, hemorrhagic lesions, and infectious aneurysms. In addition, aneurysm rupture rate and median period to aneurysm rupture were evaluated on follow-up studies. A total 115 patients (mean age: 55 years ± 19; 65 men) were included. The detection rate for neuroimaging abnormality was 77% (89/115). The detection rate in patients without neurological symptoms was 70% (56/80). Acute ischemic lesions, cerebral microbleeds, and hemorrhagic lesions including superficial siderosis and intracranial hemorrhage were detected on MRI in 56% (64/115), 57% (66/115), and 20% (23/115) of patients, respectively. In particular, infectious aneurysms were detected on MR angiography in 3% of patients (4/115), but MR angiography in 5 patients (4.3%) was insignificant for infectious aneurysm, which were detected using CT angiography (n = 3) and digital subtraction angiography (n = 2) during follow-up. Among the 9 infectious aneurysm patients, aneurysm rupture occurred in 4 (44%), with a median period of aneurysm rupture of 5 days. The detection rate of brain MRI for neuroimaging abnormality in newly diagnosed left-sided infective endocarditis patients was high (77%), even without neurological symptoms (70%).
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Affiliation(s)
- Seongken Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Tae Oh Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwon Heo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ah Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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